Factors Influencing the Use of Biomedical Health Care by Rural Bolivian Anemic Women: Structural Barriers, Reproductive Status, Gender Roles, and Concepts of Anemia

The persistently high prevalence of anemia in rural highland Bolivia argues for targeted iron supplementation. We evaluated the cultural, structural and behavioral factors that may facilitate or impede an anemic woman's decision to secure this biomedical treatment from a rural Bolivian health center. Methods Non-pregnant women from a rural town and its surrounding region were tested for anemia. During phase 1 ( n = 181), anemic women received a written recommendation for low-cost purchase of iron pills at the nearest health center. They were subsequently interviewed on their actions and experiences. Results Estimated anemia prevalence among these non-pregnant women was 50% higher than the national average. Despite holding conceptualizations of anemia generally aligned with biomedical concepts, only 40% of anemic women attempted to obtain iron supplements from the health center. Town residents were about twice as likely to attempt to purchase pills as outside-town residents. Town women who were concurrently breastfeeding and menstruating, considered anemia most serious for women, and considered family health the shared responsibility of spouses were most likely to decide to purchase iron pills. Age, education, or native language did not negatively influence this health care behavior. Conclusions Securing iron supplements involves individual trade-offs in the allocation of time, cost and effort. Nonetheless, suitably tailored programs can potentially harness local perceptions in the service of reducing anemia. Because of their comparatively high motivation to obtain iron supplements, targeting concurrently breastfeeding and menstruating women could have a positive cascade effect such that these women continue attending to their iron needs once they stop breastfeeding and if they become pregnant again. Because a sense of shared responsibility for family health appears to encourage women to attend to their own health, programs for women could involve their spouses. Complementing centralized availability, biomedical and traditional healers could distribute iron supplements on rotating visits to outlying areas and/or at highly attended weekly markets.U.S. National Science Foundation [SBR 9506107]; Office of the Vice Provost for Research, Indiana University, BloomingtonOpen Access Journal.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Dopaminergic metabolism in carotid bodies and high-altitude acclimatization in female rats

We tested the hypothesis that ovarian steroids stimulate breathing through a dopaminergic mechanism in the carotid bodies. In ovariectomized female rats raised at sea level, domperidone, a peripheral D 2-receptor antagonist, increased ventilation in normoxia (minute ventilation = +55%) and acute hypoxia (+32%). This effect disappeared after 10 daily injections of ovarian steroids (progesterone + estradiol). At high altitude (3,600 m, Bolivian Institute for High-Altitude Biology-IBBA, La Paz, Bolivia), neutered females had higher carotid body tyrosine hydroxylase activity (the rate-limiting enzyme for catecholamine synthesis: +129%) and dopamine utilization (+150%), lower minute ventilation (-30%) and hypoxic ventilatory response (-57%), and higher hematocrit (+18%) and Hb concentration (+21%) than intact female rats. Consistent signs of arterial pulmonary hypertension (right ventricular hypertrophy) also appeared in ovariectomized females. None of these parameters was affected by gonadectomy in males. Our results show that ovarian steroids stimulate breathing by lowering a peripheral dopaminergic inhibitory drive. This process may partially explain the deacclimatization of post-menopausal women at high altitude.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Reported Perceptions of Anemia Organized by Locale of Participant.

<p>Reported Perceptions of Anemia Organized by Locale of Participant.</p

Hb Distribution in the Study Samples (Non-pregnant Women).

<p>Black solid vertical line = sample mean; green dashed vertical line = threshold for anemia (15.5 g/dL).</p

Probability of Attempting to Secure Iron Pills.

<p>Women living in or close to Patacamaya ("town") <i>vs</i>. those living in outlying communities ("rural").</p

Hemoglobin (Hb) Mean ± Standard Deviation (SD).

<p>Hemoglobin (Hb) Mean ± Standard Deviation (SD).</p

Multivariate Models of Factors Motivating or Impeding a Woman's Decision to Secure Iron Pills to Treat Anemia.

<p>Probability of town residents going to health center for iron supplements by (a) reproductive status AND opinion regarding which spouse (husband or wife) is responsible for family health [Model 6 in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170475#pone.0170475.t004" target="_blank">Table 4</a>], (b) reproductive status AND opinion regarding for whom is anemia most serious [Model 7 in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170475#pone.0170475.t004" target="_blank">Table 4</a>].</p

Reported Experiences at Health Center Organized by Locale of Participant.

<p>Reported Experiences at Health Center Organized by Locale of Participant.</p

Factors Affecting Decision to Obtain Iron Pills (Logistic Regression Models).

<p>Factors Affecting Decision to Obtain Iron Pills (Logistic Regression Models).</p