Strengthen iron folate supplementation of pregnant women in Ntchisi District, Malawi

Abstract

While an estimated 45% of pregnant women in Malawi are anaemic, only 33% take iron tablets for a minimum of 90 days during pregnancy. The study explored the capacity of health facilities and communities to strengthen antenatal iron folate supplementation in Ntchisi, to support the achievement of Malawi’s nutrition target on halving anaemia in women of reproductive age by 2025.
 This qualitative study employed systematic random and purposeful sampling. Eight Focus Group Discussions with mothers of children 0-23 months, eight with Care Group volunteers and eight in-depth interviews with Village Health Workers (Health Surveillance Assistants) were conducted in each village falling within the catchment area of each of 8 health facilities. Health facilities had been sampled each from the 7 Traditional Authorities with the district hospital and direct observations had been conducted at each for antenatal care service delivery. 10 key informants from the health facilities and the District Health Office were interviewed. Thus a total of 16 FGDs, 8 HSA interviews, and 10 key informant interviews provided the data analysed in this paper. Data were analysed manually using thematic framework analysis.
 Poor access to and follow up of antenatal care at the health facility has limited access to iron folate supplements, as the health facility is the main source of Iron folates. Recurrent depletion of stock of iron folate were reported by mothers at most health facilities. Consumer demand for the tablets was low due to side effects, poor acceptability, associated myths, forgetfulness and frustration from having to take a daily medication. There was limited training and education materials at the health facility and community with inadequate support given to women. The absence of clear policies and guidelines on iron folate supplementation resulted in inconsistencies in messaging. Uptake and adherence were not routinely monitored.
 There is a need to improve the main building blocks of the iron folate programme, including the: delivery system, tablet supply, patient education, consumer demand, monitoring and evaluation and policy.

The Role of Health Facilities in Supporting Adherence to Iron-folic Acid in Haiti and Malawi: A Study Linking Health Facility Survey and Population Survey Data

“…Our analysis found that 32% of rural women in Malawi lived in an area without a health facility or only one facility offering IFA supplements within 10 km, which would make it di cult for many women to access IFA supplements. Museka-Saidi and colleagues (22) also found that long distance to health facilities is one of the key barriers to IFA supplement access for women in remote rural areas in Malawi. In Haiti's mountainous rural areas, physical access to services is a strong determinant of use of health care (30,31).…”

“…In our study, IFA supplements were commonly available in formal-sector ANC facilities in both countries, and especially Malawi, where over 90% of facilities reported availability of IFA supplementation. This may re ect the government of Malawi's efforts in increasing supply and providing free IFA supplementation to pregnant women (22,29).…”

“…Although most health facilities in Haiti and Malawi had IFA supplements in stock on the day of the survey, SPA surveys do not provide information about stocking levels or the duration and frequency of stock-outs. Studies have reported supply outages in health facilities due to various reasons and that women who came for ANC services were not able to receive IFA supplementation as a result (22,32).…”

“…Similarly, in Malawi, the prevalence of anemia is high, affecting 45% of pregnant women and only 51% of pregnant women had at least 4 ANC visits (20). Facility and community ANC services are common throughout Malawi but facilitybased ANC is the primary delivery platform for IFA supplementation and the government provides free ANC and IFA supplements for pregnant women (21,22).…”

“…Several studies have assessed factors related to health providers that affect IFA supplementation, such as IFA supplement availability in health facilities, provider knowledge and training, and follow-up of ANC services (22,23). However, few have directly linked the supply side-services offered at health facilitiesto IFA supplement adherence measured in pregnant women.…”