Demand and supply factors of iron-folic acid supplementation and its association with anaemia in North Indian pregnant women.

Jithin Sam Varghese,Anura V Kurpad,Sumathi Swaminathan,Tinku Thomas,Jacobus P Van Wouwe

doi:10.1371/journal.pone.0210634

Jithin Sam Varghese, Anura V Kurpad + Show 3 more

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https://doi.org/10.1371/journal.pone.0210634

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Abstract

Anaemia prevalence in pregnant women of India declined from 57.9% to 50.3% from National Family Health Survey (NFHS)-3 to NFHS-4. However, over the course of that decade, the uptake of iron and folic acid (IFA) supplementation for 100 days of pregnancy improved by only 15%. To understand demand side risk factors of anaemia specifically related to IFA intake, an in-depth survey was conducted on pregnant women (n = 436) in 50 villages and wards of Sirohi district of Rajasthan, India. At the demand side, consistent IFA consumption in the previous trimester was inversely and strongly associated with anaemia (OR: 0.26, 95% CI: 0.12, 0.55). Reasons for inconsistent consumption included not registering to antenatal clinic, not receiving IFA tablets from the health worker and perceived lack of need. At the supply side, an analysis of IFA stock data at various levels of the health care (n = 168) providers from primary to tertiary levels showed that 14 out of 52 villages surveyed did not have access to IFA tablets. The closest availability of an IFA tablet for 16 villages, was more than 5 km away. To improve the uptake of IFA supplementation and thereby reduce iron deficiency anaemia in pregnant women, a constant supply of IFA at the village or sub-centre level, where frontline workers can promote uptake, should be ensured.

Highlights

Anaemia is characterised by low haemoglobin concentrations and could lead to adverse health outcomes such as maternal and peri-natal mortality and low birth weight [1,2]
This paper studies the risk factors associated with anaemia and the coverage of the flagship iron and folic acid (IFA) supplementation program (NIPI), among pregnant women in Sirohi district, Rajasthan, and maps the distance to the nearest iron supplements for women in the villages surveyed
The present study shows that health worker visits are more likely for those women who are registered for antenatal care

Summary

Introduction

Anaemia is characterised by low haemoglobin concentrations and could lead to adverse health outcomes such as maternal and peri-natal mortality and low birth weight [1,2]. In India, among pregnant women, anaemia is a major public health problem, with the recently concluded nationally representative NFHS-4 [3] reporting a prevalence of 50.3%, with not much variation between rural (54.3%) and urban (50.9%) populations. Iron deficiency is probably the most common cause of anaemia in India [4]. For this reason, under the National Iron Plus Initiative (NIPI, [5]), the government of India provides daily doses of IFA to pregnant women for a period of 100 days during their pregnancy. Despite revisions to the NIPI programme with an increase in provision of elemental iron from 60 mg to 100 mg, the prevalence of anaemia in pregnant women has not come down.

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