Evaluating Malaysian Government Primary Healthcare Workers Knowledge, Attitude and Practice in Managing Iron Deficiency Anaemia during Pregnancy

Introduction: Management of iron deficiency anaemia (IDA) in pregnancy remains suboptimal. This study aimed to develop a tool and determine the knowledge, attitude, and practice (KAP) of primary healthcare providers and its associated factors using a newly developed validated questionnaire.

Methodology: A validation study was conducted among 159 Perak government primary healthcare doctors and nurses. Cronbach’s alpha, factor analysis, face validation and test-retest were performed. Subsequently, a cross-sectional study was conducted among 435 doctors and nurses in Selangor, Johor, and Terengganu from October to December 2023. Association between socio-demographics, clinical experience, organizational support, and attitude with the knowledge and practices were analyzed using logistic regression.

Results: The final Health Care Providers Knowledge, Attitude and Practice- Iron Deficiency Anaemia (HCPKAP-IDA) questionnaires had 28 items. A good internal consistency was observed; Cronbach’s alpha (0.781-0.859), factor loading; attitude (0.490-0.811), and practice (0.444-0.841). Using HCPKAP-IDA, poor knowledge (38.9%), attitude (46.9%), and practice (43%) scores were shown. The significant factors associated with the poor practice were female (OR=0.39, 95% CI 0.15- 0.99, p=0.049), had IDA (OR=0.74, 95% CI 1.34- 1.58, p=0.043), experienced Anaemic symptoms (OR=0.71, 95% CI 1.36- 1.40, p=0.032), took iron supplement (OR=0.62, 95% CI 1.70- 2.87, p=0.033), received training (OR=0.29, 95% CI 0.11- 0.74, p=0.010), availability of parenteral iron (OR=0.74, 95% CI 1.03- 1.28, p=0.027) and good attitude (OR=0.40, 95% CI 2.62- 6.01, p=0.001). The significant factors associated with poor knowledge were community nurses (OR=15.49, 95% CI 6.46- 37.11, p<0.001), staff nurses (OR=7.74, 95% CI 3.45- 17.39, p<0.001), and availability of guidelines (OR=0.18, 95% CI 0.05- 0.69, p=0.012).

Conclusion: Improving the knowledge of primary healthcare providers through training and the availability of parenteral iron in all primary care clinics nationwide should be advocated. A national guideline that incorporates quick algorithms and checklists should be considered.