Coverage of antenatal iron-folic acid and calcium distribution during pregnancy and their contextual determinants in the northeastern region of India

Abstract

Iron-folic acid (IFA) and calcium supplementation are nutritional interventions recommended prophylactically (against maternal anemia and preeclampsia, respectively) to all antenatal mothers in India under basic antenatal care (ANC) services. Using Health Management Information System data (reporting period: 2018–19 to 2020–21), we mapped the coverage of antenatal IFA and calcium distribution across the remote northeastern region of India relative to the number of pregnant women (PW) who registered for ANC, disaggregated by states and districts. Variations in coverage were also investigated by subgroups based on contextual attributes, viz., physiography (hilly/ plateau/ plain), socioeconomic development (“aspirational”/ “non-aspirational”) and proportion of early ANC visits (low/ medium/ high). Full course of antenatal IFA and calcium supplements were received by 79.36 (95% CI: 79.31–79.40) and 61.26 (95% CI: 61.21–61.32) PW per 100 ANC registered women, respectively. There was widespread heterogeneity in outreach, with calcium coverage generally trailing behind IFA coverage. Among states, coverage of the two interventions (per 100 ANC registered women) was highest in Assam (97.06 and 78.11 PW, respectively) and lowest in Nagaland (24.87 and 16.77 PW, respectively). At the district-level, the two interventions failed to reach even 50 PW per 100 ANC registered women in 32 (out of 115) districts. The coverage tended to be inferior in districts that were hilly, “non-aspirational” and had low proportion of early ANC visits. The granular information provided by our findings will facilitate monitoring, root cause analyses, microplanning, informed resource allocation and tailoring of locally appropriate solutions to achieve targeted coverage improvements.

Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia: a mixed-methods systematic review

“…Five studies aimed to evaluate the implementation of calcium supplements in pregnancy 27 30 31 39 40. Seven studies evaluated the incorporation of calcium supplement recommendation to other recommended supplements taken during pregnancy, including aspirin,18 and iron and folic acid supplements 19 28 33 37 38 41 42.…”

“…In sub-Saharan Africa, three studies were conducted in Kenya,28 33 38 39 one study in Ethiopia19 and one study in Kenya in Ethiopia 40 41. In Asia, four studies were conducted in India,27 29 32 42 three studies in Bangladesh,30 34 35 two studies in Nepal31 37 and one study in China 36. There is one study conducted in Europe, specifically the Netherlands 18…”

“…One mixed-method study included pregnant women40 41 and one included healthcare providers and facility staff 42. Among the 10 quantitative studies, 8 included pregnant women or women who had recently given birth,27–30 32–34 36 37 1 included healthcare providers31 and 1 included both women and their husbands 35…”

“…Five studies aimed to evaluate the implementation of calcium supplements in pregnancy. 27 30 31 39 40 Seven studies evaluated the incorporation of calcium supplement recommendation to other recommended supplements taken during pregnancy, including aspirin, 18 and iron and folic acid supplements. 19 28 33 37 38 41 42 Four studies focused on general nutritional practices during pregnancy 29 32 34 35 and one study on all types of micronutrient supplements used before and during pregnancy.…”

“…The included papers were published in English between 2014 and 2022. Out of 16 studies, 10 were quantitative and came from 11 papers, [27][28][29][30][31][32][33][34][35][36][37] 4 were qualitative 18 19 38 39 and 2 were mixed-methods and came from 3 papers. [40][41][42] Detailed study characteristics can be found in table 1.…”