Predictors of adherence to micronutrient supplementation before and during pregnancy in Vietnam

Abstract

BackgroundPoor adherence to micronutrient supplementation often limits the effectiveness of public health programs. While predictors of adherence to micronutrient supplementation during pregnancy are well documented, information on adherence to preconception supplements is scarce. The objective of this study was to describe the predictors of adherence to preconception and prenatal micronutrient supplementation among women participating in a randomized control trial in Vietnam.MethodsAdherence data were collected prospectively from a double blind randomized controlled trial in rural Vietnam. Five thousand eleven women of reproductive age were randomized to receive preconception supplements for weekly consumption containing either: Folic Acid, Iron and Folic Acid (IFA), or Multiple Micronutrients. Women who became pregnant received prenatal IFA supplements for daily consumption through delivery. Village health workers visited participants’ homes every two weeks to deliver supplements and record consumption and side effects. Multivariate logistic regression was used to assess individual, household, and programmatic predictors of supplement adherence.ResultsAdherence was high with 78 and 82% of the women consuming more than 80% of the preconception and prenatal supplements, respectively. Women of minority ethnicity (OR = 0.78 95% CI = 0.67, 0.91) and farmers (OR = 0.71 95% CI = 0.58, 0.88) were less likely to consume >80% of the preconception supplements while socioeconomic status (SES) (OR = 2.71 highest vs. lowest quintile; 95% CI = 2.10, 3.52) was positively associated with >80% adherence in the entire preconception sample with available information (n = 4417). Women in their first pregnancy had lower prenatal adherence compared to multiparous women. At the programmatic level, each village health worker visit was associated with higher odds of >80% adherence by 3–5% before pregnancy and 18% during pregnancy.ConclusionsKey determinants of adherence included SES, ethnicity, occupation (farmer) and parity which may be helpful for targeting women for counseling on supplement adherence. Increased contact with village health workers was positively associated with adherence to micronutrient supplementation both before conception and during pregnancy indicating the need for resources to support community outreach to women of reproductive age.Trial registration NCT01665378. Registered on August 12, 2012.

Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis

“…Also, the improvement made on maternal health-seeking behaviour and ANC visit might be the reason to increase the level of adherence in this setting. This estimate was also lower compared with the reports in Vietnam, 82% [9] and Niger,68% [61]. The observed variation might be due to the differences in socio-demographic characteristics and knowledge of IFA supplementation [62].…”

Neither Preconceptional Weekly Multiple Micronutrient nor Iron–Folic Acid Supplements Affect Birth Size and Gestational Age Compared with a Folic Acid Supplement Alone in Rural Vietnamese Women: A Randomized Controlled Trial

“…Compliance with the intervention both before and during pregnancy was also very high (>90%) and did not differ by treatment group (32). Second, the use of standardized protocols, an efficient monitoring and supervision system, and well-trained field staff also contributed to the internal validity of our results.…”

Low Prevalence of Folic Acid Supplementation during Pregnancy: A Multicenter Study in Vietnam

“…Both a lack of antenatal care attendance and lack of full awareness in health professionals contribute to the low prevalence of correct FA supplementation during the periconceptional period. A randomized controlled trial on prenatal micronutrient supplements indicated a positive relationship between the number of community health worker visits and adherence to prenatal supplementation in Vietnam [26]. These findings suggest that the support of community health services may improve the prevalence of correct FA supplementation recommended by the WHO.…”

“…The prevalence of NTDs declined slightly from 62.1 per 100,000 live births to 61.7 per 100,000 live births during the past 10 years (from 2007 to 2017), but was still higher than the corresponding rates in Singapore (12.4 per 100,000 live births) and Cambodia (45.3 per 100,000 live births) in 2017 [23]. The awareness of the importance of FA prior to conception and during early pregnancy is low, and little information is available on the coverage of supplementation with FA during this period [24,25,26,27]. Studies that reported the coverage of FA supplementation were not able to assess the frequency and duration of supplementation.…”

“…For examples, the authors noted that maternal age, parity, and a planned pregnancy are associated with FA supplementation [30,32]. A randomized controlled trial in Vietnam reported several factors associated with the use of prenatal micronutrient supplements by pregnant women [26]. However, the study was conducted in only one rural province.…”