Predictors of adherence to micronutrient supplementation before and during pregnancy in Vietnam

Ines Gonzalez-Casanova,Kimberly B Harding,Son Nguyen,Hoa Pham,Truong V Truong,Melissa Fox Young,Hieu Nguyen,Phuong Hong Nguyen,Reynaldo Martorell,Lynnette M Neufeld,Meredith Nechitillo,Greg Reinhart,Usha Ramakrishnan

doi:10.1186/s12889-017-4379-4

Abstract

BackgroundPoor adherence to micronutrient supplementation often limits the effectiveness of public health programs. While predictors of adherence to micronutrient supplementation during pregnancy are well documented, information on adherence to preconception supplements is scarce. The objective of this study was to describe the predictors of adherence to preconception and prenatal micronutrient supplementation among women participating in a randomized control trial in Vietnam.MethodsAdherence data were collected prospectively from a double blind randomized controlled trial in rural Vietnam. Five thousand eleven women of reproductive age were randomized to receive preconception supplements for weekly consumption containing either: Folic Acid, Iron and Folic Acid (IFA), or Multiple Micronutrients. Women who became pregnant received prenatal IFA supplements for daily consumption through delivery. Village health workers visited participants’ homes every two weeks to deliver supplements and record consumption and side effects. Multivariate logistic regression was used to assess individual, household, and programmatic predictors of supplement adherence.ResultsAdherence was high with 78 and 82% of the women consuming more than 80% of the preconception and prenatal supplements, respectively. Women of minority ethnicity (OR = 0.78 95% CI = 0.67, 0.91) and farmers (OR = 0.71 95% CI = 0.58, 0.88) were less likely to consume >80% of the preconception supplements while socioeconomic status (SES) (OR = 2.71 highest vs. lowest quintile; 95% CI = 2.10, 3.52) was positively associated with >80% adherence in the entire preconception sample with available information (n = 4417). Women in their first pregnancy had lower prenatal adherence compared to multiparous women. At the programmatic level, each village health worker visit was associated with higher odds of >80% adherence by 3–5% before pregnancy and 18% during pregnancy.ConclusionsKey determinants of adherence included SES, ethnicity, occupation (farmer) and parity which may be helpful for targeting women for counseling on supplement adherence. Increased contact with village health workers was positively associated with adherence to micronutrient supplementation both before conception and during pregnancy indicating the need for resources to support community outreach to women of reproductive age.Trial registrationNCT01665378. Registered on August 12, 2012.

Highlights

Poor adherence to micronutrient supplementation often limits the effectiveness of public health programs
We have previously reported the findings from a qualitative study of beliefs and attitudes related to adherence to preconception and prenatal micronutrient supplementation that was conducted in a sub-sample of pre-pregnant, pregnant, and postpartum participants in the PRECONCEPT study [15], and found that women reported that they were more likely to adhere to supplements during pregnancy, as they considered them necessary for their and their offspring’s well-being
The Folic Acid (FA) supplement contained 2800 mcg of folic acid, the Iron and Folic Acid (IFA) supplement contained the same amount of folic acid plus 60 mg of ferrous iron, and the Multiple Micronutrients (MM) supplement included the same amount of iron and folic acid plus 13 other micronutrients based on current international recommendations (Table 1)

Summary

Introduction

Poor adherence to micronutrient supplementation often limits the effectiveness of public health programs. The WHO has issued recommendations to provide weekly iron folic acid (IFA) supplements to women of reproductive age in populations with a high prevalence of anemia as a measure to promote adequate nutritional status. Though this intervention is not recommended to improve pregnancy outcomes (due to lack of evidence), it is widely accepted that improving women’s health prior to pregnancy will help ensure positive outcomes for mother and child [4]. Adherence to prenatal micronutrient supplements, especially daily IFA supplements, has been found to vary across populations, and studies have identified socio-demographic and programmatic factors as important predictors [6]. Data on adherence to micronutrient supplementation within the context of a supplementation intervention prior to pregnancy (even among women of reproductive age) are limited

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