title: The Effectiveness of a New Model in Managing Pregnant Women with Iron Deficiency Anemia in Indonesia: A Nonrandomized Controlled Intervention Study.
abstract: BACKGROUND
  Indonesia has a major problem with iron deficiency anemia among pregnant women. A new model named the Four Pillars Approach was designed to improve antenatal care for these women. This study aimed to measure the effectiveness of the model in managing pregnant women with iron deficiency anemia.
  
  
  METHODS
  We used a nonrandomized controlled intervention study. The study, with the Four Pillars Approach as intervention versus usual care as its control, was conducted in two provinces in Java (Indonesia) during the period from March 2012 until May 2013. Main outcome measures were a difference of Hb level ≥ 0.5 g/dL, the number of women who attended five or more antenatal care visits, and birthing with a skilled birth attendant.
  
  
  RESULTS
  Three hundred fifty-four participants were enrolled in the study. Participants in the intervention group had an adjusted odds ratio of 25.0 (95% CI 12.03-52.03, p = 0.001) for increased hemoglobin of ≥ 0.5 g/dL at 35-37 weeks of gestation, compared with the control group. In the intervention group, 95.0 percent of women had five or more antenatal care visits, compared with 57.2 percent (p = 0.001) in the control group. All births in both groups were assisted by skilled birth attendants.
  
  
  CONCLUSIONS
  The Four Pillars Approach is effective in increasing the hemoglobin level and the frequency of antenatal care visits of participants when compared with the usual care for pregnant women with anemia.
authors.affiliation: School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.|Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
authors.forename: Widyawati
authors.initials: W
authors.lastname: Widyawati
authors.affiliation: Royal Dutch Organisation of Midwives (KNOV), Utrecht, The Netherlands.
authors.forename: Suze
authors.initials: S
authors.lastname: Jans
authors.affiliation: Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
authors.forename: Hans H J
authors.initials: HH
authors.lastname: Bor
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Dillen
authors.affiliation: Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
authors.forename: Antoine L M
authors.initials: AL
authors.lastname: Lagro-Janssen
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019468:Disease Management; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D017146:Models, Organizational; D009819:Office Visits / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data; D015397:Program Evaluation
chemical_list: D006454:Hemoglobins
keywords: anemia; pregnant women; the Four Pillars Approach