IJCM_16A: Calcium supplementation in pregnancy: adherence, determinants and barriers

Abstract

Background: Calcium intake of 1gram/day in pregnancy reduces the risk of pre-ecclampsia and preterm birth. Universal free calcium supplementation program was started throughout India at considerable cost to the government. Although coverage is high, this program is only effective if there is good adherence among mothers, and this is unknown. Objectives: 1. To estimate the prevalence of adherence to calcium tablets among mothers attending antenatal clinic at Kundrathur PHC. 2. To identify the determinants and barriers to Calcium tablet adherence. Methodology: A cross sectional mixed methods study was conducted among mothers attending antenatal clinic at Kundrathur PHC during November 2023. Mothers with >20 weeks gestation were recruited consecutively. They were interviewed using the Morisky Medication Adherence Scale (MMAS-8). Barriers to adherence was elicited by freelisting and analysed with Visual Anthropac. Results: 89 mothers completed the study. The participants had a mean age of 25.29+4.275 years. Majority of mothers were literate, and primi gravida (57.3%). Mean MMAS score was 4.98+1.79(95% CI 4.61, 5.36) out of maximum possible 8. Adherence was low among 69.7%, medium in 23.6% and high in only 6.7%. Only 3.4% mothers were aware of the role of calcium in hypertension. There was a significant association between adherence and level of education (X2 37.422, df 8, p<0.001) and having a support person (OR 11.5 95%CI 2.568, 51.502). Major barriers identified were forgetfulness (S 0.462), big tablets (S 0.205), difficulty in swallowing (S 0.130), timing (S.077), and vomiting (S 0.077). Conclusion: Adherence to Calcium supplementation is low among mothers. Educating mothers regarding importance and role of calcium may ensure better results of the program. Forgetfulness is the major barrier, and having a designated support partner in pregnancy, who helps in reminding and giving supplements, can help improve the adherence.