How can formative research inform the design of an iron-folic acid supplementation intervention starting in first trimester of pregnancy in Bangladesh?

Ashraful Alam,Shams E Arifeen,Michael J Dibley,Tamanna Sharmin,Tanvir M Huda,Sabrina Rasheed,Nazib Uz Khan

doi:10.1186/s12889-015-1697-2

Abstract

BackgroundThe study objective was to understand community preparedness for iron and folic acid (IFA) supplementation early in pregnancy and to inform the design of a large-scale trial of early introduction of IFA supplementation in rural Bangladesh.Methods66 in-depth interviews (pregnant women, husbands, and older women in the household), 20 key-informant interviews, 3 focus-group discussions (community health workers and adolescent female students), and observation of two community-based clinics were conducted.ResultsMost of the women who used IFA tablets during pregnancy reported better health and physical strength after taking them. Women perceived that IFA increased blood volume, leading to foetal nourishment and compensated for blood loss during delivery. However, a culturally informed perceived barrier was the belief that IFA supplementation will increase foetus size, leading to birth complications, hospitalisation, caesarean section and financial burden for the family. Community health workers (CHWs) of BRAC (a non-government organisation) were the main sources of IFA information and supplements, although knowledge of IFA tablets among women’s social networks also helped to make it acceptable. Pregnant women felt that they could start taking IFA during the first trimester of pregnancy if advised by the CHWs. Programme managers and healthcare providers expressed concern about starting IFA supplementation early.ConclusionOur study suggests that introduction of IFA supplementation early in pregnancy is feasible with support from CHWs. Promotion of IFA could benefit from efforts to include culturally sensitive reasons for usage; improvement of the CHW training modules; targeted home visits and counselling; and outreach to standardize messages.

Highlights

The study objective was to understand community preparedness for iron and folic acid (IFA) supplementation early in pregnancy and to inform the design of a large-scale trial of early introduction of iron-folic acid (IFA) supplementation in rural Bangladesh
In national maternal health programmes, a standard formulation of IFA tablets with 60 mg of iron is available for distribution through different public health facilities free of charge for daily supplementation as soon as women come to the facilities
Perceptions related to pregnancy and childbirth Birth weight and size In the community, people did not aspire for a certain weight for their babies and, showed no concern about birth weight

Summary

Introduction

The study objective was to understand community preparedness for iron and folic acid (IFA) supplementation early in pregnancy and to inform the design of a large-scale trial of early introduction of IFA supplementation in rural Bangladesh. Iron-deficiency is the most widespread nutritional deficiency globally and the most common cause of anaemia during pregnancy [1,2,3,4]. It is highly prevalent and most severe in pregnant women, infants, and children, as iron requirement rises during these stages of life [5,6]. Researchers have identified lower risks of neonatal mortality in infants for mothers who reported taking antenatal iron-folic acid (IFA) supplements during pregnancy compared to those who did not [17]. Folic acid and iron in combination was shown to be more effective than iron or folic acid supplementation alone for the treatment both of anaemia during pregnancy [19] and of neonatal mortality [20]

Methods

Results

Conclusion