Iron And Folic Acid Supplementation Research Articles

Determinants of compliance to iron folate supplementation among pregnant women attending antenatal care in public health facilities of South West Ethiopia: A case-control study.

The prevalence of anemia among pregnant women remains high globally, particularly in low-income settings. Iron and folic acid supplementation (IFAS) during pregnancy is the most widely employed strategy to alleviate adverse pregnancy outcomes. This study aimed to explore the determinants of compliance with iron supplementation in the study area. To identify determinants of IFAS compliance among pregnant women attending antenatal care (ANC) in Mettu town, South West Ethiopia, in 2021. A facility-based, unmatched case-control study was conducted from May to July 2021 with a total sample size of 344 (115 cases and 229 controls). Cases and controls were selected using systematic random sampling. Data was collected using a structured, pretested interviewer-administered questionnaire, entered into Epi-data software version 3.1, and exported to SPSS version 23 for analysis. Variables with p < 0.25 during bivariate analyses were entered into a multivariable logistic regression model. Then, variables with a p < 0.05 at 95% confidence interval (CI) were declared to be statistically significant determinants of IFAS. The odds ratio was used to indicate the strength of the association. Having Previous history of anaemia (adjusted odds ratio [AOR] = 5.8, 95% CI [2.5-13.6], p < 0.01), having good knowledge about IFAS (AOR = 3.3, 95% CI [1.7-6.7], p < 0.001), being a government employee (AOR = 5.2 [2.4-11.5], p < 0.01], and receiving counseling service during ANC (2.495% CI [1.3-4.7] p < 0.01) were among determinants of adherence to IFAS. Maternal knowledge about IFAS, counseling about IFAS, occupation, and history of anaemia were found to be significantly associated factors with compliance with iron folate supplementation during pregnancy. This implies that adherence to IFAS can be improved through improving maternal knowledge about importance of IFAS, quality counseling services and strengthening an overall ANC follow-up services.

Adherence to Iron and Folic Acid Supplementation Among Pregnant Women From Northern Ghana

Iron and folic Acid (IFA) supplementation is an effective intervention for reducing the incidence of anaemia during pregnancy. The WHO recommends at least 6 months intake of IFA to pregnant women. However, in Ghana some women experience challenges with adhering to IFA supplementation. The main objective of the study was to assess the level of adherence to iron and folic acid supplementation and its associated factors among pregnant women in a peri-urban municipality in Northern Ghana. A cross-sectional study was conducted from March to December 2021 among 400 pregnant women who attended ANC in Sagnarigu municipality in Ghana and were selected through a 3-stage random sampling technique. A structured questionnaire was used to collect data. The data were analysed using descriptive statistics, univariate and binary logistic regression statistical tools. Self-reported level of adherence to iron and folic acid supplementation was 84.5%. Knowledge of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) was associated with adherence. Three other factors: time of first antenatal visit (AOR = 0.32: 0.153, 0.649) having history of anaemia [AOR = 2.67: 1.373, 5.201] having side effects of IFA [AOR = 3.70, CI: (1.756, 7.793)], and having knowledge of management of side effects of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) were found to be significantly associated with adherence. Adherence to iron and folic supplementation among the pregnant women was generally frequent. Strategies to increase iron and folic acid supplementation adherence among pregnant women could focus on encouraging pregnant women to have early ANC visits and educating them on how to manage side effects.

Influence of intermittent iron and folic acid supplementation on cognitive abilities among adolescent girls in northwestern Tanzania.

Iron and folic acid (IFA) supplementation to reduce anemia is key for improving substantial lost disability adjusted life years (DALYs) for adolescent girls. This study assessed the impact of weekly IFA supplementation (WIFAS) on cognitive ability among adolescent girls in the Simiyu Region in northernwestern Tanzania. This cross-sectional comparative evaluation study of 770 adolescent girls (396 -WIFAS supplemented; 374 -not supplemented) evaluated the association between WIFAS and cognitive ability through a face-to-face survey and cognitive ability assessment using standardized tests (Span-forward Test, Span-backward Test and Maze Test). Using a modified Poisson regression, we controlled for the geographic setting (urban vs rural), availability of potable water and feeding programs in schools, age and school level of adolescent girls, parental status, main parental economic activities, and the number of teachers. Participants were between the ages of 11 and 19 years, with more than half (57%) between 12-15 years of age. Those with WIFAS had higher cognitive ability (Span-forward scores, χ2 = 46.34% p <0.001; Span-forward, χ2 = 46.34% p <0.001; and Global Composite Cognitive Performance (GCCP), χ2 = 32.52% p<0.001). Among the IFA supplemented adolescent girls, secondary school level had a significantly higher score with respect to Span-backward (aPR = 1.43, 95% CI = 1.06-1.62); Span-forward ability (aPR = 1.26, 95% CI = 1.04-1.53) and Maze Test ability (aPR = 1.12, 95% CI = 1.01-1.25) as compared to their counterpart in primary school level. Individual adolescent girls with WIFAS and living with both parents performed much better on the Span-backward Test (aPR = 1.22, 95% CI = 1.07-1.68) as compared to those living with relatives and/or orphans. The presence of potable water program among the WIFAS schools resulted in a higher Span-backward ability (aPR = 1.34, 95% CI = 1.03-1.89); and GCCP (aPR = 1.27, 95% CI = 1.03-1.75). Adolescent girls from WIFAS schools with feeding program had higher Span-forward (aPR = 1.38, 95% CI = 1.03-1.63) ability as well as a higher Maze Test (aPR = 1.15, 95% CI = 1.07-1.26) score. The present study provides compelling evidence that WIFAS is positively associated with higher cognitive ability among adolescent girls. Nevertheless, IFA interventions are still rare in communities across Tanzania.

Compliance to iron folic acid supplementation and its associated factors among pregnant women attending Antenatal clinic in Wondo district: a cross-sectional study

Pregnant women are at high risk for iron deficiency anemia due to increased nutrient requirements during pregnancy. Despite high coverage of iron and folic acid supplementation (IFAS), low compliance is reported. The study aimed to assess compliance with IFAS and its associated factors among antenatal care (ANC) attendees in Wondo District, Southern Ethiopia. A facility-based cross-sectional study was conducted among 400 pregnant women. Pregnant women were selected through systematic random sampling. Pre-tested structured questionnaire was used to collect data through face to face interview. Data were entered into Epi-info and exported to Statistical Package for Social Sciences for analysis. The variables with p-value < 0.25 in the bivariable analysis were entered into the multivariable logistic regression model. P values less than 0.05 were considered significant. Results were reported as crude and adjusted odds ratios with 95% confidence intervals. The prevalence of compliance to IFAS was (177, 44.3%). Factors significantly associated with compliance to IFAS were maternal age ≥ 25 years [AOR 2.27, 95% CI (1.21, 4.28)], maternal education [AOR 2.62, 95% CI (1.43, 4. 79)], husband's education [AOR 3.60, 95% CI (2.07, 6.25)], knowledge of anemia [AOR 4.40, 95% CI (2.65, 7.30)], and knowledge of IFA [AOR 2.21, 95% CI (1.40, 3.50)]. This study showed that compliance to IFAS was low. Maternal age, maternal education, husband's education, knowledge about anemia and iron folic acid was found to be significantly associated with adherence to IFAS. Emphasis should be placed on young, uneducated mothers and their husbands.

Knowledge, Attitude, and Practice Regarding Supplemental Iron and Folic Acid Amongst Women Delivering in Edaga-Hamus Community Hospital: A Cross-Sectional Study in Asmara, Eritrea.

In Eritrea, every pregnant woman is provided with a supplemental iron and folic acid (IFA) tablet starting from the first antenatal visit throughout the end of pregnancy. In Zoba Maekel, two-third of first antenatal visits have been at either the second or third trimesters. This practice could limit pregnant women's timely access to the nutritional supplement and its benefits. Therefore, this study aims to identify the knowledge, attitude, and practice of women delivering in Edaga-Hamus Community Hospital towards the supplemental IFA tablet. A health facility-based cross-sectional study was carried out on 360 women delivering in Edaga-Hamus Community Hospital. Data were collected using a structured questionnaire through systematic sampling. Associated factors were identified using bivariate and multivariable logistic regression. Associations with a p-value <0.05 were considered significant. Mothers with higher level of IFA knowledge and attitude held 52.8% and 65.4%, respectively. Health care workers were predominantly (92.3%) the main source for IFA information. Possible IFA side-effects were known by 64.8% of the mothers, even though only 28.2% knew reduction of side effects if taken with food. Almost all (96.1% and 97.0% respectively) believed IFA is beneficial and can prevent anemia. Only 27.9% had appropriately practiced taking the IFA supplement. Mothers who visited for antenatal care more than 8 times (AOR: 4.02, 95% CI: 1.45, 11.09) and 5 to 8 times (AOR: 2.87, 95% CI: 1.52, 5.41) had increased odds of appropriate IFA practice compared to those who visited for 1 to 4 times. Women who had planned pregnancies (AOR: 2.03, 95% CI: 1.01, 4.10) were more likely to have appropriate practice than their counterparts who had unplanned pregnancies. The study indicated that further strategies need to be implemented to increase the current level of knowledge, attitude, and practice of IFA.

Telephonic intervention to combat non-adherence to oral iron-folic acid supplementation in pregnancy: A randomized controlled trial

IntroductionIron deficiency anemia is a public health problem globally attributing to high incidences of maternal and infant mortality and morbidity. Iron and folic acid supplementation (IFAS) is essential and provided free of cost by the public health sectors, however, a systematic review shows that the national-level adherence to oral Iron-Folic Acid Supplementation (IFAS) is less than half in pregnant women, and the significant obstacles to non-adherence are fear of side effects and forgetfulness. This trial was designed to mitigate the side effects and tackle forgetfulness with telephonic intervention. The objectives were to investigate the effectiveness of the telephonic intervention on oral IFAS adherence and hemoglobin and the reasons for non-adherence to oral IFAS, to find out the proportion of anemia in the study population, and to assess the effectiveness of the intervention on maternal and neonatal outcomes. MethodsHospital-based open-label multi-centric parallel-group randomized controlled trial, used block randomization and allocated treatment in a 1:1 ratio recruited 286 anemic pregnant women between 14 and 24 weeks of gestation with hemoglobin level < 11 g/dl having smartphones at a secondary hospital and a tertiary hospital in Eastern India. The experimental group received telephonic intervention for one month via structured text reminders, WhatsApp audio messages, and phone calls. The standard course of treatment was given to the control group. Results286 women (n1 =143, n2 =143) were randomized, 36 had attrition leaving 250 for analysis (n1 =123, n2 =127), the experimental group experienced a 44.9 % and the control group 13.8 % increase in adherence (P < 0.001). The leading reasons for non-adherence were forgetfulness (24 %), nausea and vomiting (23.2 %), and constipation (18.8 %). Hemoglobin level increased by 0.8 g/dl (P < 0.001) in the experimental group and 0.2 g/dl (P < 0.807) in the control group. ConclusionIn addition to improving adherence to oral IFAS, telephonic intervention mitigates side effects and enhances hemoglobin in anemic pregnant women. The increase in adherence was threefold in the experimental group compared to a marginal rise in the control group. This study recommends the implementation of a telephonic intervention to promote adherence to oral IFAS among anemic pregnant women.

Adherence to Iron-Folic Acid Among Pregnant Women Attending Antenatal Care in Southern Ethiopia, 2022.

Among the micronutrient deficiencies, iron and folic acid are the most common and frequently occur in pregnant women. So, the objective of this study was to assess the adherence to iron and folic acid among pregnant women booking antenatal services in the study area. A facility-based cross-sectional study design was used from January to April 2022. A structured questionnaire was used to collect data using systematic sampling techniques to approach 339 pregnant women. Data were entered and analyzed using SPSS software version 20. A descriptive analysis was performed. Adjusted odds ratios and corresponding 95% confidence intervals (CIs) were used, and statistical significance was reported at p-values <0.05 with 95% confidence. In this study, 339 (99%) pregnant women participated. The mean age of the respondents was 28.04 years old, with a standard deviation of 5.3 years. The rate of adherence to iron and folic acid supplementation (IFAS) in pregnant women was 62.8%. Mothers under 19 years old (adjusted odds ratio [AOR] = 0.025; 95% CI [0.003-0.218]), daily (AOR = 0.127; 95% CI [0.028-0.568]), and those with a history of miscarriage (AOR = 0.276; 95% CI [0.086-0.891]) were less likely to be using IFAS. However, greater knowledge of IFAS was positively correlated with use of the supplements (AOR = 5.56; 95% CI [1.23-8.34]). In this study, the adherence rate with IFAS of pregnant women in the study area was 62.8%. This indicates that one in four women is not in compliance with IFAS. Appropriate counseling and health education should be provided to pregnant women to improve compliance.

Multiple micronutrient supplementation cost-benefit tool for informing maternal nutrition policy and investment decisions.

Antenatal multiple micronutrient supplementation (MMS) is an intervention that can help reach three of the six global nutrition targets, either directly or indirectly: a reduction in low birth weight, stunting, and anaemia in women of reproductive age. To support global guideline development and national decision-making on investments into maternal nutrition, Nutrition International developed a modelling tool called the MMS cost-benefit tool to help users understand whether antenatal MMS is better value for money than iron and folic acid supplementation (IFAS) during pregnancy. The MMS cost-benefit tool can generate estimates on the potential health impact, budget impact, economic value, cost-effectiveness and benefit-cost ratio of investing in MMS compared to IFAS in LMICs. In the 33 countries with data included in the tool, the MMS cost-benefit tool shows that transitioning is expected to generate substantial health benefits in terms of morbidity and mortality averted and can be very cost-effective in multiple scenarios for these countries. The cost per DALY averted averages at US$ 23.61 and benefit-cost ratio ranges from US$ 41-US$ 1304: $1.0, which suggest MMS is good value for money compared with IFAS. With its user-friendly design, open access availability, and online data-driven analytics, the MMS cost-benefit tool can be a powerful resource for governments and nutrition partners seeking timely and evidence-based analyses to inform policy-decision and investments towards the scale-up of MMS for pregnant women globally.

Strengthening Nutrition Interventions during Antenatal Care Improved Maternal Dietary Diversity and Child Feeding Practices in Urban Bangladesh: Results of a Quasi-Experimental Evaluation Study

BackgroundBangladesh is urbanizing rapidly, facing challenges of malnutrition, low coverage and poor quality of urban nutrition services. ObjectivesWe assessed the effect of integrating maternal, infant, and young child nutrition interventions, delivered at urban Maternal Neonatal and Child Health facilities, on maternal dietary diversity, iron and folic acid (IFA) and calcium consumption, and child feeding practices. MethodsWe used a quasi-experimental design with a nonrandom assignment of 20 health care facilities in Dhaka to intensive and standard service arms. We conducted facility-based observations and community-based surveys at baseline (2020) and endline (2022) (n = 2455 observations and surveys with 1678 pregnant women [PW] or recently delivered women [RDW] at endline). We derived difference-in-difference (DID) estimates, adjusted for characteristics that differed at baseline or endline, and accounted for clustering. ResultsExposure to antenatal care (ANC) was similar in both arms: two-thirds of RDW received ANC during the first trimester and three-fourths received ≥4 ANC checkups. Compared to the standard arm, a higher proportion of PW in the intensive arm received counseling on dietary diversity (DID: 45 percentage points [pp]), and a higher proportion of RDW received IFA (25 pp) and calcium supplementation (19 pp), showed adequate weight gain (44 pp), and recorded appropriate child feeding (27 pp). Improvements were greater in the intensive than the standard arm for the number of food groups consumed (DID: 1.1 food groups) and minimum dietary diversity (23 pp); no effect was observed for IFA and calcium consumption during pregnancy. However, effects were observed for early initiation of (20 pp) and exclusive breastfeeding (45 pp), introduction of solid or semisolid foods (28 pp), and egg and/or flesh food consumption (33 pp) among children. Minimum dietary diversity and acceptable diet remained low in both arms. ConclusionsIntensifying nutrition in government-aligned health care services delivered by experienced nongovernmental organization-run facilities is a feasible model to address the urban health gap, nutrition services coverage, and improve practices.The trial was registered at clinicaltrials.gov as NCT03882268.

Intensified Nutrition Interventions in Antenatal Care Services Increased Consumption of Iron and Folic Acid Supplements and Early Breastfeeding Practices in Burkina Faso: Results of a Cluster-Randomized Program Evaluation

BackgroundAlive & Thrive supported the Government of Burkina Faso to strengthen the provision of iron and folic acid (IFA) supplementation and interpersonal counseling on maternal nutrition and breastfeeding through antenatal care (ANC) services and community-based contacts in 2 regions. ObjectivesWe assessed the impacts of intensified nutrition interventions during ANC compared with standard ANC services on intervention coverage and maternal nutrition practices. MethodsA cluster-randomized evaluation compared 40 health center catchment areas in intervention areas with 40 in control areas. Repeated cross-sectional surveys in 2019 and 2021 (960 pregnant women and 1920 women with children 0–5 mo of age per survey round) provided data on impact indicators, intervention exposure, and other factors. We derived difference-in-difference (DID) effect estimates, adjusted for geographic clustering, for maternal dietary diversity, IFA consumption, and early breastfeeding practices. ResultsMore women in intervention areas had 4+ ANC visits (DID: 8.3 percentage points [pps]) and started ANC during the first trimester (DID: 10.5 pp), compared with control areas. Improvements were achieved in exposure to nutrition counseling on dietary diversity (DID: 44.4 pp), food quantity (DID: 42.9 pp), adequate weight gain (DID: 35.1 pp), and breastfeeding (DID: 25.9 pp). Women in intervention areas consumed more IFA supplements during pregnancy (DID: 21 tablets). Early initiation of and exclusive breastfeeding also improved (DID: 17.0 and 8.3 pp, respectively). However, dietary diversity (4 out of 10 food groups) and mean probability of adequacy of micronutrient intake (14%) among pregnant women remained low in both areas. ConclusionsStrengthening maternal nutrition interventions delivered through government ANC services was feasible and effective in improving maternal nutrition practices. Continued efforts to strengthen the delivery and use of maternal nutrition services may be required for greater behavior changes, and to address family support, social norms, and other factors to improve women’s diets during pregnancy.

Comprehensive Approach for Improving Adherence to Prenatal Iron and Folic Acid Supplements Based on Intervention Studies in Bangladesh, Burkina Faso, Ethiopia, and India.

The World Health Organization recommends daily iron and folic acid (IFA) supplementation during pregnancy, but consumption remains low, and high prevalence of anemia among pregnant women (PW) persists. This study aims to (1) examine factors at the health system, community, and individual levels, which influence adherence to IFA supplements; and (2) describe a comprehensive approach for designing interventions to improve adherence based on lessons learned from 4 country experiences. We conducted literature search, formative research, and baseline surveys in Bangladesh, Burkina Faso, Ethiopia, and India and applied health systems strengthening and social and behavior change principles to design interventions. The interventions addressed underlying barriers at the individual, community, and health system levels. Interventions were further adapted for integration into existing large-scale antenatal care programs through continuous monitoring. Key factors related to low adherence were lack of operational protocols to implement policies, supply chain bottlenecks, low capacity to counsel women, negative social norms, and individual cognitive barriers. We reinforced antenatal care services and linked them with community workers and families to address knowledge, beliefs, self-efficacy, and perceived social norms. Evaluations showed that adherence improved in all countries. Based on implementation lessons, we developed a program pathway and details of interventions for mobilizing health systems and community platforms for improving adherence. A proven process for designing interventions to address IFA supplement adherence will contribute to achieving global nutrition targets for anemia reduction in PW. This evidence-based comprehensive approach may be applied in other countries with high anemia prevalence and low IFA adherence.

Anemia – a scourge to maternal and child development in Bihar, India

Introduction and aim. Anemia remains a leading contributor to years lived with disability (YLDs), being responsible for 50.3 million (5.82%) YLDs worldwide and 19.3 million (12.03%) YLDs in India, respectively. Results of the National Family Health Survey 2019-2021 (NFHS-5) suggest a high burden of anemia in India among women of reproductive age and children aged 6-59 months at the national level (57%, 67.1%), and in the state of Bihar, India (63.5%, 69.4%). Iron deficiency is the leading cause, accounting for more than half the cases. Anemia bodes harmful implications for both the mother and child, with long-lasting consequences for the latter. Anemia control programs have yielded little benefit despite efforts stretching over five decades. This narrative review aims to highlight the burden of anemia and the probable factors behind it among under-5 children and women of reproductive age in the Indian state of Bihar. Material and methods. The paper is a narrative review. The following databases were used to search and select literature: PubMed, Web of Science, Scopus, and Google Scholar. In addition, the websites of relevant government departments and national health programs were searched for pertinent material. Analysis of the literature. A multitude of reasons seem to be behind the unabated high prevalence in Bihar: low socioeconomic status, gender disparities, traditional customs and practices, food insecurity, lack of diverse diets, poor consumption, and no adherence to iron and folic acid (IFA) supplements, groundwater contamination with arsenic and fluoride, and supply chain mismanagement, all playing roles of varying degree. Conclusion. An all-encompassing approach and not merely the provision of IFA supplements are necessary to unravel the intricate web of factors that lead to anemia.

Adherence and barriers of prophylactic iron and folic acid supplementation in children: a community-based mixed method study

Background: Anemia is a public health challenge in India among children, adolescents and reproductive age women. Still, 58% of under-five children in India and 43% in Puducherry are anaemic. To determine the proportion of mothers of one-to-nine-year children, aware about iron and folic acid (IFA) supplementation, the proportion of children adherent to the dosage of IFA and the barriers for the adherence to IFA. Methods: A community-based explanatory sequential mixed methods study consisting survey using a semi-structured questionnaire and followed by focus group discussions (FGD) using an interview guide. The data was collected using EpiCollect5 analysed using SPSS. The results were expressed as proportions with 95% confidence interval (CI) and the qualitative results were expressed as a conceptual framework. Results: Awareness about IFA supplementation given to children from the public health system was 57% (95% CI: 51.8-62.0) among mothers of one-to-nine-year children. Adherence to IFA supplementation was 34% (28.9.0-38.6). The main reason of the non-adherence reported by the mothers was non-availability of the supplements, nausea and vomiting among children and forgetfulness of the mother. In the FGD, supply side reasons were non-palatability and wrong dose administration, and demand side reasons were lack of awareness and coverage. Conclusions: Only one out of ten children among under five years were taking IFA syrup and only half of the children ages five-to-nine-years consumed IFA tablets given in their schools. Irregular distribution of IFA tablets, medication side-effects, and non-palatability of the medication were the main reasons quoted by the mother for non-adherence.

Effect of Local Culture-based Nutrition Education on Compliance with Iron and Folic Acid Supplementation in Female Adolescent

The non-compliance of female adolescents with the consumption of iron and folic acid supplementation (IFAS) poses a challenge to reducing the incidence of anemia. Therefore, this study aimed to determine the effect of nutrition education using the local culture-based approach on the level of knowledge and attitudes regarding awareness, interest, evaluation, trial, and adoption dimensions, as well as compliance of female adolescents in consuming IFAS. The intervention was conducted using a quantitative quasi-experimental design approach. The sample comprised 68 and 58 senior high school girls in the control and intervention groups. The intervention group received IFAS and local culture-based nutrition education for 12 weeks and followed up after four weeks; while, the control group was given a leaflet and IFAS. Univariate analysis was conducted to analyze the participants’ characteristics; while, bivariate analysis used an independent T-test. The multivariate analysis was carried out using multiple linear and logistic regression analyses. The study showed a statistically significant increase in knowledge and attitudes scores in the intervention group (p-value&lt;0.01) compared to the control group. In conclusion, the compliance with IFAS in the intervention group was 82.8%.

Improving coverage of antenatal iron and folic acid supplementation and malaria prophylaxis through targeted information and home deliveries in Côte d’Ivoire: a cluster randomised controlled trial

IntroductionCoverage of antenatal iron and folic acid (IFA) supplementation and malaria chemoprophylaxis remains low in many low-income and middle-income settings. We assessed the effectiveness of personal information (INFO) sessions and...

The role of social support and interpersonal trust to improve compliance of iron supplementation amongst adolescent girls: A qualitative approach.

Adolescence is a crucial phase in preventing and controlling anaemia. One of the efforts made by the Indonesian government to overcome adolescent girl's anaemia is the iron and folic acid (IFA) supplementation programme. This programme is one of the most effective interventions that various countries have used to overcome anaemia. The key to the success of the supplementation of IFA is the compliance of adolescent girls. This study investigates the compliance and its contributing factors of IFA supplementation and the role of social support and interpersonal trust as a source of information and reminder amongst adolescent girls in Sidoarjo, Indonesia. This research was a qualitative study using the in-depth interview to collect data. Thirteen adolescent girls from three high schools in Sidoarjo, Indonesia, were recruited using a snowball sampling technique. Most of the girls did not comply with IFA supplementation. Contributing factors were the influence of peers, influence of teachers, parental influence, risk and benefit of taking IFA tablet and also failure to remember to take IFA tablet. The social environment that provided information and reminder came from teacher, parent, peer and also health worker. Interpersonal trust was needed to have positive perceived social support. Compliance with the consumption of IFA supplements requires the cooperation of various parties (teachers, parents, peers and health workers) and also interpersonal trust between adolescent girls to their social environment so the programme could be run optimally.

Prevention and management of Anaemia in Pregnancy in India: Challenges and Opportunities

Seven decades ago, over 80% of Indian pregnant women were anaemic. About 3/4th of anaemia was due to nutritional deficiencies of: iron (most common), folic acid (second) and vitamin B12 (not as common). Anaemia in pregnancy was associated with higher maternal morbidity and mortality, low birth weight and high perinatal mortality. Detection and appropriate management of anaemia, including parenteral iron therapy and intensive care for severe anaemia were important components of antenatal care in India, but only about 10% of women had access to antenatal care. In 1970s the national programme for anaemia in pregnancy focussed on identifying all pregnant women and providing them iron and folic acid (IFA) supplementation. The coverage and compliance with supplementation were low. In 1990 when the primary health care infrastructure was established, the anaemia control programme embarked on testing and providing appropriate treatment to anaemic women. The tertiary care centres operationalised this “test and treat” strategy. In primary and secondary care settings, accurate test for diagnosis of anaemia was not available. In the absence of accurate Hb estimation at all levels of care, it was not possible to provide appropriate treatment based on Hb levels. So, all pregnant women continued to receive one tablet of IFA throughout pregnancy. Over the next two decades, coverage under antenatal care and IFA supplementation improved but compliance with supplementation was low because about a third of pregnant women had gastrointestinal side effects with IFA. Despite these problems, between 2002 and 2015, there had been a decline in the prevalence of severe and moderate anaemia. To accelerate the decline in anaemia in pregnancy the country is focusing on the ‘test and treat’ strategy in pregnant women using an accurate method for Hb estimation and providing appropriate treatment. Nutrition education to improve iron intake prior to and during pregnancy, is focussing on dietary diversification and use of iron fortified salt or cereals. Progress will be monitored through national surveys and locale specific appropriate mid-course modifications in the programme will be made.

Effect of Iron and Folic Acid supplementation among nutritionally anemic women of reproductive age in rural Maharashtra: Acommunity-based intervention study

Background: In the context of the limited effectiveness of daily iron supplementation in national programs, intermittent iron supplementation is currently under debate as a possible alternative. Objective: To study the outcome of twice weekly iron supplementation compared to daily supplementation. Methods: A community-based interventional study was carried out in 283 women of the 15-49 years age group who were not pregnant and not lactating at the initiation of the study. For intervention purpose, women with mild and moderate anemia were taken. In two schedules, an interventional drug (100 mg elemental iron with 0.5 mg folic acid) was given for three months. In the daily schedule, one tablet every day; and in the weekly schedule, two tablets once a week on a fixed day were given. Result: Out of 283 anemic participants, 141 received daily while 142 received weekly iron and folic acid supplementation. Post intervention, the weekly iron supplementation group revealed that, proportion of anemia cases reduced to the tune of 32.4% and the mean increase in hemoglobin level was 1.42 gm/dl (SD ± 0.77). In contrast, in patients who had a daily supplementation regimen, the mean increase in hemoglobin level was 1.78 gm/dl (SD ± 0.83). Conclusion: Result of present study shows that, effect of daily Iron and Folic Acid (IFA) supplementation to raise hemoglobin level was higher as compared to weekly IFA supplementation. But weekly supplementation when considered separately also had significant effect to raise the hemoglobin level. It is observed that, there is no statistically significant difference in the rise of hemoglobin in both the groups, signifying weekly iron therapy as effective role as daily iron therapy in reducing anemia

Improving Iron and Folic Acid Supplementation Among Pregnant Women: An Implementation Science Approach in East-Central Uganda.

To address maternal iron-deficiency anemia and low uptake of iron and folic acid supplementation (IFAS) among antenatal care (ANC) clinic attendees in East-Central Uganda, the Anemia Implementation Science Initiative embedded enhanced quality improvement (QI) activities into an integrated health project utilizing QI methodologies. To address 2 bottlenecks of stock-outs and inadequate health education for pregnant women during ANC, an enhanced QI intervention was implemented from July 2019 to September 2020 in 2 districts. We conducted a mixed-methods effectiveness quasi-experimental study to assess whether the intervention increased the availability of IFAS in the intervention districts. We used longitudinal facility-level data from 2 treatment districts and 1 comparison district for the quantitative results. Difference-in-difference estimation was used to measure the impact of the intervention on IFAS health education and IFA availability at the health facility. We used logistic regression modeling to control for factors associated with IFAS uptake and potential differences in baseline values. Researchers conducted exit interviews with ANC clients and in-depth interviews with providers and district managers for greater insights into the implementation process. The intervention increased the probability, at a statistically significant level, of pregnant women both receiving IFAS and receiving health education on IFAS during ANC. According to inter-viewees, the intervention approach improved stakeholder engagement and buy-in, which brought about change at all levels of the health system. The intervention successfully addressed the 2 main bottlenecks to availability of IFAS for pregnant women attending ANC-inadequate provision of IFAS education and a weak drug quantification process. Even without additional funds to purchase commodities, this approach improved district capacity to advocate for and manage IFAS commodities. It could also be used to strengthen overall ANC quality.

The Association between Iron and Folic Acid Supplementation and Malaria Prophylaxis and Linear Growth among Children and Neonatal Mortality in Sub-Saharan Africa-A Pooled Analysis.

The majority of research on linear growth among children is confined to South Asia and focuses on iron and folic acid (IFA) supplementation during pregnancy, without considering malaria prophylaxis. Similarly, there is limited evidence on the association of antenatal IFA supplementation and malaria prophylaxis with neonatal mortality in sub-Saharan Africa (SSA). This study aims to address these gaps. A pooled analysis of demographic and health survey (DHS) data from 19 countries in SSA was conducted to study the association between IFA supplementation and malaria prophylaxis and linear growth and neonatal mortality. Multivariate logistic and linear regression models were used. Malaria prophylaxis was significantly associated with stunting, height-for-age Z scores (HAZ scores), and neonatal mortality, but IFA supplementation was not associated with these outcomes. When women's height and body mass index (BMI) were introduced in the model, a significant association between combined malaria prophylaxis and IFA supplementation was found with HAZ scores only. For severe stunting, no significant association was found with either in the two models. In conclusion, this study underscores the importance of antenatal malaria prophylaxis as a potential intervention for nutrition outcomes (linear growth) and neonatal mortality, as well as the importance of coordinating efforts between malaria and the health and nutrition sectors to improve these outcomes in the countries of SSA.