Weekly Iron-Folic Acid Supplements to Prevent Anemia among Cambodian Women in Three Settings: Process and Outcomes of Social Marketing and Community Mobilization

Objective: We examined factors affecting compliance to antenatal micronutrient supplementation and women's perceptions of supplement use. Design: Randomized controlled supplementation trial of four alternative combinations of micronutrients given during pregnancy through to 3 months postpartum. Women were visited twice weekly to monitor compliance and to replenish tablets by female study workers. At 6 weeks postpartum women with live births (n 4096) were interviewed regarding their perceptions of the supplement. Median compliance calculated as percentage of total eligible doses received by women was high (84 %). Setting: Rural southern Nepal. Subjects: Pregnant women. Results: Women with high compliance (above the median of 84 %) were likely to be older, less educated, poorer, undernourished, belong to lower caste and of Pahadi (hill) ethnicity compared with women with low compliance (at or below the median of 84 %). Smoking and drinking alcohol in the past week during pregnancy were strongly associated with low compliance. The major reason for irregular intake was forgetting to take supplements. A higher proportion of the high compliers liked taking the supplements but only half of them were willing to purchase them in the future. A large proportion of women (91 %) perceived a benefit from taking the supplement such as improved strength and health, whereas only about 10 % perceived any side-effects which were not a major barrier to compliance. Conclusions: The present analysis highlights that poor, undernourished, uneducated women can have high compliance to antenatal supplementation if they are supplied with the tablets and reminded to take them regularly, and counselled about side-effects.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Determinants of compliance to antenatal micronutrient supplementation and women’s perceptions of supplement use in rural Nepal

Kulkarni

Christian

LeClerq

et al. 2009

“…Community-based distribution of iron-folic acid supplementation is a valuable platform to increase awareness and knowledge of anaemia and iron-folic acid supplementation Seven studies reported on increased knowledge and coverage of IFA supplementation through provision of messages and counselling on anaemia and IFA supplementation through community-based channels (17)(18)(19)(20)(21)(22)(23) . A study from Iran found that CHW provided counselling on the importance of taking IFA supplements for reducing anaemia.…”

Section: Strengths Of Community-based Distribution Of Ironfolic Acid mentioning

confidence: 99%

“…• Increased awareness of iron-deficiency anaemia, its causes and effects, and the importance of weekly IFA supplementation Kanal et al (18) 2005 Cambodia Pilot programme of social marketing and community mobilization in secondary-school girls, women working in urban garment factories and women in rural villages. Supplements were distributed or sold by volunteer school-based peer educators, garment factory team leaders and rural peer educators, respectively…”

Section: Strengths Of Community-based Distribution Of Ironfolic Acid mentioning

confidence: 99%

Community-based distribution of iron–folic acid supplementation in low- and middle-income countries: a review of evidence and programme implications

Kavle

Landry

2017

Objective: The present literature review aimed to review the evidence for community-based distribution (CBD) of iron-folic acid (IFA) supplementation as a feasible approach to improve anaemia rates in low-and middle-income countries. Design: The literature review included peer-reviewed studies and grey literature from PubMed, Cochrane Library, LILAC and Scopus databases. Setting: Low-and middle-income countries. Subjects: Non-pregnant women, pregnant women, and girls. Results: CBD programmes had moderate success with midwives and community health workers (CHW) who counselled on health benefits and compliance with IFA supplementation. CHW were more likely to identify and reach a greater number of women earlier in pregnancy, as women tended to present late to antenatal care. CBD channels had greater consistency in terms of adequate supplies of IFA in comparison to clinics and vendors, who faced stock outages. Targeting women of reproductive age through school and community settings showed high compliance and demonstrated reductions in anaemia. Conclusions: CBD of IFA supplementation can be a valuable platform for improving knowledge about anaemia, addressing compliance and temporary side-effects of IFA supplements, and increasing access and coverage of IFA supplementation. Programmatic efforts focusing on community-based platforms should complement services and information provided at the health facility level. Provision of training and supportive supervision for CHW on how to counsel women on benefits, side-effects, and when, why, and how to take IFA supplements, as part of behaviour change communication, can be strengthened, alongside logistics and supply systems to ensure consistent supplies of IFA tablets at both the facility and community levels. Globally, anaemia affects 29 % of pregnant women and 38 % of non-pregnant women (1) and is associated with one-fifth of maternal deaths (2) . Anaemia puts women at greater risk of mortality, morbidity, postpartum haemorrhage and poor birth outcomes, including preterm births and low birth weight (3,4) . The WHO recommends daily iron-folic acid (IFA) supplementation (30-60 mg iron, 0·4 g folic acid) initiated as early as possible and continued throughout pregnancy for all adolescent and adult women as a key intervention to reduce the risk of maternal anaemia, iron deficiency and infants born with low birth weight (5) . According to findings from a recent meta-analysis, IFA supplementation would increase the mean blood Hb concentration by 10·2 (95% CI 6·1, 14·2) g/l in pregnant women and by 8·6 (95% CI 3·9, 13·4) g/l in non-pregnant women (aged 19-21 years) (6) . Applying these shifts to estimated blood Hb concentrations indicates that about 50 % of anaemia in women could be eliminated by IFA supplementation (6) .

“…For these reasons Honduras would benefit more from the implementation of a cost-effective preconceptional folic acid supplementation programme that would reach the poor urban and rural high-risk populations. Recently, the regional office of the WHO in South Asia (Philippines, Cambodia and Vietnam) published results on community trials assessing the effectiveness of micronutrient supplementation to the population with a pill containing both Fe and folic acid (37)(38)(39)(40)(41)(42) . The strategy tailored the supplementation intervention and market strategy to each country's culture and values.…”

Section: Discussionmentioning

confidence: 99%

Effect of different dosage and administration schedules of folic acid on blood folate levels in a population of Honduran women of reproductive age

Rosenthal

Milla²,

Flores

et al. 2008

Background: Observational studies and clinical trials have shown conclusive evidence that periconceptional folic acid supplementation prevents up to 70 % of neural tube defects (NTD). The Honduran government wanted to implement a supplementation programme of folic acid but needed to assess the relative effects of two dosages of folic acid. Objective: To determine the effect of two dosages of folic acid on blood folate levels in Honduran female factory workers aged 18 to 49 years. Design: This was a randomized, double-blind control supplementation trial conducted in Choloma, Honduras. A total of 140 eligible women were randomly assigned to two dosage groups and followed up for 12 weeks. One group received a daily dosage of 1 mg folic acid and the other a once weekly dosage of 5 mg. Serum folate and red blood cell folate levels were determined by radioassay at baseline, 6 weeks and 12 weeks. Results: Serum folate levels increased from 6?3 (SE 0?2) to 14?9 (SE 0?6) ng/ml (P , 0?0001) in women assigned to the 1 mg/d group and from 6?9 (SE 0?3) to 10?1 (SE 0?4) ng/ml (P , 0?0001) in those assigned to the 5 mg/week group. Red blood cell folate concentrations also increased significantly in both groups, albeit more slowly. Educational level, age and BMI were not associated with the changes in serum and red blood cell folate levels during the supplementation period. However, a differential effect on serum folate levels by dosage group and time was observed. Conclusions: Although both folate supplementation regimens increased serum and red blood cell folate levels significantly among the women studied, blood folate levels that are considered to be protective of NTD were reached faster with the daily dosage of 1 mg folic acid.