Iron And Folic Acid Research Articles

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...

Health assessment of rural primary school children in Raipur, Chhattisgarh: Findings from a cross-sectional study

Abstract Background: Optimal health status during childhood and adolescence is the foundation for future health and well-being. Habits formed in this period could prevent the early development of chronic diseases. The aim of this study was to determine the health status of primary school children in terms of morbidity, growth, dietary behavior, and hygiene. Materials and Methods: An analytical cross-sectional study was conducted from an opportunistic screening of rural primary school in Raipur district, Chhattisgarh. All primary class children were included resulting in a sample of 215. Data were collected using Google forms and analyzed with Stata v16. Results: Of 215 children, only 45.6% were appropriately vaccinated till date, 70.2% had not taken vitamin A regularly; prophylactic iron and folic acid (IFA) and albendazole were taken regularly by 23.7% and 69.8% of children. Children with active complaints were 25% and 43.7% had dental caries. The percentage of children with grade 3, grade 2, grade 1 thinness, normal, and overweight were 15.4%, 22.3%, 36.7%, 24.7%, and 0.9%, respectively; and did not differ significantly between boys and girls. The mean weight and height were significantly lower at all ages for both boys and girls in comparison with Indian council of medical research standards with a maximum difference at 11 years (MD, −10.31 kg; 95% confidence interval, −12.55 to −8.08). The dietary behavior and hygiene practice was suboptimal in the study population. Conclusion: Thinness/underweight and stunting remain a significant problem among school-going children and adolescents. Change in dietary pattern with increased consumption of junk food and carbonated drinks could be a concern among school-age children.

Antenatal multiple micronutrient supplements versus iron-folic acid supplements and birth outcomes: Analysis by gestational age assessment method.

Meta-analyses consistently have found that antenatal multiple micronutrient supplementation (MMS) compared with iron and folic acid (IFA) alone reduce adverse birth outcomes. In 2020, the World Health Organization (WHO) placed a conditional recommendation for MMS and requested additional trials using ultrasounds to establish gestational age, because the evidence on low birthweight (LBW), preterm birth and small for gestational age(SGA) was considered inconsistent. We conducted meta-analyses to determine if the effects of MMS on LBW, preterm birthand SGA differed by gestational age assessment method. Using data from the 16 trials in the WHO analyses, we calculated the effect estimates of MMS versus IFA on birth outcomes (generic inverse variance method and random effects model) stratified by method of gestational age assessment: ultrasound, prospective collection of the date of last menstrual period (LMP) and confirmation of pregnancy by urine testand recall of LMP. The effects of MMS versus IFA on birthweight, preterm birthand SGA appeared consistent across subgroups with no evidence of subgroup differences (p > 0.05). When limited to the seven trials that used ultrasound, the beneficial effects of MMS were demonstrated: risk ratiosof 0.87 (95% confidence interval [CI] 0.78-0.97) for LBW, 0.90 (95% CI, 0.79-1.03) for preterm birth and 0.9 (95% CI, 0.83-0.99) for SGA. Sensitivity analyses indicated consistency in the results. These results, together with recent analyses demonstrating comparable effects of MMS (vs. IFA) on maternal anaemia outcomes, strengthen the evidence to support a transition from IFA to MMS programmes in low- and middle-income countries.

Child Stunting Reduction in Aceh Province: Challenges and a Way Ahead.

Indonesia ranks the fifth highest in child stunting among Asian countries. Aceh, a westernmost province in Indonesia recorded the highest prevalence of stunting in children under two years old in the nation. Our study investigated the current government efforts on child stunting reduction activities since the introduction of Governor Regulation No. 14/2019. The study investigated the current efforts of Aceh governments and relevant actors on child stunting reduction using in-depth interviews, document reviews and focus group discussions. Thirty-five (35) respondents including policy makers were interviewed, four focus group discussions (15 each group) were conducted, and various official documents were reviewed. Various challenges for reducing child stunting in Aceh were identified: inadequate knowledge and skills of Posyandu cadres on child stunting; reluctance to consume iron and folic acid (IFA), and supplementary foods (PMT Bumil) by many pregnant women due to perceived annoying effects and unappetizing taste; work engagement, insufficient breast milk production and inadequate support from husbands failing to achieve exclusive breastfeeding among nursing women; inadequate provision of complementary fortified foods for children 6-23 months; lack of clean water, waste management and WASH practices. The intervention on both nutrition-specific and nutrition-sensitive factors was found to be insufficient in Aceh. Although WASH (water, sanitation and hygiene) practices are the most important contributors to child stunting, only the health agency plays a singular role in reduction efforts by focussing on specific factors. Coordination between relevant agencies to address both factors is required to achieve the effectiveness of child stunting reduction and prevention in Aceh.

Study protocol for a randomised controlled trial of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal: VALID

IntroductionDespite evidence that iron and folic acid (IFA) supplements can improve anaemia in pregnant women, uptake in Nepal is suboptimal. We hypothesised that providing virtual counselling twice in mid-pregnancy, would...

Scaling-up high-impact micronutrient supplementation interventions to improve adolescents’ nutrition and health in Burkina Faso and Tanzania: protocol for a cluster-randomised controlled trial

IntroductionAdolescence is a critical time for growth and development, but this age group is often neglected in research and development of nutrition interventions. Despite recommendations from the WHO to provide...

Risk Factors Affecting Stunting of Toddlers in Murtajih Village, Pamekasan District

The incidence of stunting in toddlers is still high which is caused by inadequate nutritional intake in the long term. The purposed of this study is to analyze the risk factors for stunting in children under five. This research was conducted from November 24 - December 7, 2021, in Murtajih Village, Pamekasan Regency. This research design uses the case control method. Respondents as the case group in this study were mothers with toddlers aged 12 – 59 months with nutritional status in the stunting category, and respondents as control groups were mothers with toddlers of the same age with normal nutritional status. Data analysis used the Chi-square test and logistic regression. The results of the analysis showed that the risk factors for stunting in children under five were the respondents consuming the amount of blood-added tablets during pregnancy that did not meet the standard (OR= 11; 95% CI= 1.998–60.572), birth length (OR= 4; 95% CI= 0.983–16.271), breastfeeding status (OR = 7.364; 95% CI= 1.337 – 40.548), basic immunization status (OR= 6; 95% CI= 1.082–33.274), history of diarrheal disease (OR= 0.074; 95% CI = 0.013 – 0.411), and a history of ARI (OR= 0.095; 95% CI= 0.021 – 0.440). It can be concluded that the consumption of Iron and Folic Acid (IFA) tablet does not match the standard and is the most dominant risk factor for stunting in children under five. Meanwhile, toddlers who do not have a history of diarrhea and ARI can prevent the risk of stunting in toddlers.

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.

Effectiveness of daily educational message on pregnancy anemia prevention behavior and knowledge: A pilot randomized controlled trial.

Distance education and mobile health (mHealth) usage are yet to be researched widely, particularly in terms of anemia prevention in Indonesian pregnant women. This study aimed to analyze the daily educational messages' effectiveness on anemia prevention behavior and knowledge, in pregnant women in Surakarta City, Indonesia. This pilot randomized controlled trial was conducted in two Primary Healthcare Centers in Surakarta in April-September 2022. The target population was pregnant women who conducted Antenatal Care at Primary healthcare Center. The sample was put into two randomized groups consisting of pregnant women in the first and second trimesters: intervention and control. This study included a total of 44 participants. The intervention was a daily educational message sent through WhatsApp for seven weeks. Measurement of anemia prevention knowledge, anemia prevention diet, and Iron and Folic Acid (IFA) tablet consumption was collected at the baseline and follow-up. The intervention resulted in a significant difference (P value .003) in mean IFA tablet consumption (last 42 days), which was higher in the intervention group (39.54 ± 3.94) than in the control group (34.86 ± 8.13). It has a significant effect on knowledge (P value .007) as well. However, no significant difference in the anemia prevention diet between groups at the end of the intervention. The daily educational message improves pregnant women's knowledge and IFA tablet consumption. Conducting a full-scale randomized controlled trial is feasible to confirm the effectiveness of daily educational messages as a pregnant anemia prevention program, considering the needed improvements.

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

Scaling up prenatal nutrition could reduce the global burden of noncommunicable diseases in the next generation: a modeling analysis

Nutritional conditions during pregnancy may influence the epigenetic development of an individual and consequently their later-life risk of noncommunicable disease (NCD). Improving nutrition for pregnant females may therefore serve the dual purpose of directly improving pregnancy outcomes and preventing NCDs in the next generation. We estimated the impact of prenatal supplementation with iron and folic acid (IFA), multiple micronutrients (MMS), or calcium at 50%, 75%, or 90% coverage on future NCDs by age and sex in 2015. We used secondary data sources from 132 countries to quantify the cases of diabetes and hypertension and the deaths from selected NCDs that could be averted or delayed by scaling up prenatal micronutrient supplementation. Globally, >51,000 NCD deaths, 6 million cases of hypertension, and 3 million cases of diabetes could be prevented per offspring birth cohort if mothers were prenatally supplemented with MMS at 90% coverage. For IFA these numbers would be roughly half. Calcium supplementation at 90% could delay 51,000 deaths per birth cohort. Our model suggests that substantial numbers of NCD deaths and cases of hypertension and diabetes could be prevented in future generations by scaling up micronutrient supplementation for mothers during pregnancy. Highlighting the additional benefits of proven nutrition interventions is critical in ensuring adequate and sustained investments, and programmatic integration. As the double burden of disease continues to grow, population-wide efforts to scale up micronutrient supplementation to pregnant females could help prevent both undernutrition and chronic disease.

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.

Use of antenatal and delivery care services and their association with maternal and infant mortality in rural India

Optimum use of antenatal care (ANC) and delivery care services could reduce morbidity and mortality among prospective mothers and their children. However, the role of ANC and delivery services in prevention of both maternal and child mortality is poorly understood, primarily because of dearth of prospective cohort data. Using a ten-years population-based prospective cohort data, this study examined the use of ANC and delivery services and their association with maternal and infant mortality in rural India. Descriptive statistics were estimated, and multivariable logistic regression modelling was used to attain the study objective. Findings revealed that consumption of ≥ 100 iron-and-folic acid (IFA) tablet/equivalent syrup during pregnancy had a protective association with maternal and infant mortality. Lack of maternal blood group checks during pregnancy was associated with increased odds of the death of infants. Caesarean/forceps delivery and delivery conducted by untrained personnel were associated with increased odds of maternal mortality. Findings from this study reemphasizes on increasing coverage and consumption of IFA tablets/equivalent syrup. Improved ANC and delivery services and increased uptake of all types of ANC and delivery care services are equally important for improvement in maternal and child survival in rural India.

Knowledge, Attitudes and Practices towards the Use of Iron and Folic Acid Supplements among Pregnant and Lactating Women in Dar es Salaam

The current study investigated knowledge, attitudes and practices (KAP) regarding the use of iron and folic acid (IFA) supplements among pregnant and lactating women living with Human Immunodeficiency Virus (HIV) in Dar es Salaam. A cross-sectional survey involved 294 pregnant and lactating women attending Prevention of Mother-To Child Transmission (PMTCT) clinics. A semi-structured questionnaire was used to collect data from the subjects. The data were analysed using SPSS. Multivariate regression analysis was carried out to determine factors associated with IFA supplement use among the study subjects. The findings indicated that knowledge of IFA supplement use among the subjects was good (92.2%). Most of the respondents (89.8%) had appropriate perceptions of IFA supplements. The subjects also showed positive attitudes towards the use of IFA supplements during pregnancy and lactation. However, practices towards the use of supplements were not satisfactory. It was further revealed that only 15.2% of the women received supplements during pregnancy and a few weeks after delivery as recommended. Women claimed the main barriers towards using the supplements were bad taste (46.7%) and nausea (45.2%). The multivariate logistic regression model showed that factors like being a businesswoman, comfortable use of the supplements and experiencing any barriers were significantly associated with practices on the use of the supplements. Thus, healthcare workers should clear up the misconceptions about using the supplements and instruct women on how to manage their potential side effects as they have been doing with other conditions or illnesses. 
 Keywords: Iron, folic acid, anaemia, supplements, knowledge, attitude, practice, pregnant, lactating women

Ideal Dose of Iron in Multiple Micronutrient Supplement: A Narrative Review of Evidence.

Anemia is a significant public health problem in low- and middle-income countries (LMICs). The co-existence of other micronutrient deficiencies and iron deficiency among pregnant women may be the reason for the inability to control anemia through iron and folic acid (IFA) supplementation. Multiple micronutrient supplementation (MMS) in pregnancy may help to overcome this problem. However, the recent World Health Organization (WHO) guidelines on MMS supplementation in pregnancy raised concerns regarding the adequacy of a 30mg iron dose in the MMS supplements in LMICs. The review summarized the literature to answer this question. Though most studies showed a comparable effect of MMS with 30mg iron and IFA with 60mg iron on maternal anemia outcomes, anemia persisted in the third trimester in both groups. There is a need to consider the use of a higher iron dose in MMS, especially in LMICs, to combat the problem of anemia, alongside correcting other micronutrient deficiencies.

Iron and Folic Acid Supplementation in Pregnancy: Findings from the Baseline Assessment of a Maternal Nutrition Service Programme in Bangladesh.

Effective coverage of antenatal iron and folic acid (IFA) supplementation is important to prevent adverse maternal and newborn health outcomes. We interviewed 2572 women from two rural districts in Bangladesh who had a live birth in the preceding six months. We analysed the number of IFA tablets received and consumed during pregnancy and examined the factors influencing IFA consumption by multiple linear regression and user adherence-adjusted effective coverage of IFA (consuming ≥180 IFA tablets) by Poisson regression. Overall, about 80% of women consumed IFA supplements in any quantity. About 76% of women received antenatal care at least once, only 8% received ≥180 IFA tablets, and 6% had user adherence-adjusted coverage of antenatal IFA supplementation. Multivariable analysis showed a linear relationship between the number of antenatal care (ANC) visits and the number of IFA supplements consumed, which was modified by the timing of the first ANC visit. Women’s education, free IFA, and advice on IFA were also associated with higher IFA consumption. Interventions targeting at least eight ANC contacts, starting early in pregnancy, providing advice on the importance of IFA, and providing IFA supplements in higher quantity at ANC contacts are likely to increase effective coverage of antenatal IFA supplementation.

Plasma Lecithin-Cholesterol Acyltransferase Activity in Pregnant Women Enrolled in the iLiNS-DYAD Trial in Ghana

ObjectivesThe International Lipid-Based Nutrient Supplement (iLiNS) Project developed small-quantity lipid-based nutrient supplements (SQ-LNS) for mothers and their children with the goal of reducing malnutrition. The aim of this secondary outcome analysis is to investigate the effects of SQ-LNS on the activity of plasma lecithin-cholesterol acyltransferase (LCAT), a key enzyme involved in the remodeling of high-density lipoprotein (HDL) particles, which increases their cholesterol carrying capacity.MethodsPlasma samples from a subset of 197 out of 1320 women at 36-wk gestation enrolled in the iLiNS-DYAD trial in Ghana were analyzed. In the main cohort, women were enrolled during the second trimester (≤ 20 wk gestation) and randomly assigned to receive SQ-LNS, iron and folic acid (IFA), or a multiple micronutrient supplement. Women in this subset received either SQ-LNS or IFA. Plasma LCAT activity was measured using a commercial fluorometric kit and the non-transformed data was compared by Wilcoxon test (mean ± SD). LCAT activity is expressed as a ratio (390 nm/470 nm), where greater ratio indicates higher enzyme activity. We also explored whether LCAT activity differed by enrollment season (Dry, November–April; Wet, May-October) or was associated with biomarkers of inflammation.ResultsThere was no significant difference in LCAT activity between the SQ-LNS and IFA groups (1.44 ± 0.17 vs. 1.41 ± 0.14, P = 0.24). Women enrolled during the wet season had higher LCAT activity than women enrolled during the dry season (1.47 ± 0.15 vs. 1.37 ± 0.14, P < 0.001), with no differences between intervention groups stratified by season (P > 0.05). LCAT activity was negatively correlated with inflammatory biomarkers α1-acid glycoprotein (R = −0.19, P = 0.007) and C-reactive protein (R = −0.28, P < 0.001) measured at 36-wk gestation.ConclusionsPlasma LCAT activity, as a measure of HDL maturation and cholesterol carrying capacity, is more sensitive to factors mediated by seasonal variation (e.g., infection, inflammation) than by nutrient supplementation in this cohort of women in Ghana. These findings confirm a previously established link between HDL and inflammation.Funding SourcesThis project was supported by Bill & Melinda Gates Foundation grant (OPP124589) to the University of California, Davis.

International Lipid-Based Nutrient Supplements (iLiNS) DYAD-Ghana Follow-Up Study: Effects on Social-Emotional Problems at Age 9–10 Years

ObjectivesWe aimed to investigate the effect of pre- and post-natal small-quantity lipid-based nutrient supplements (SQ-LNS) on child social-emotional problems at age 9–10 years in the context of children’s home environments. As previously found in the 5-year follow-up study of the same trial, we expected that SQ-LNS would reduce social-emotional problems and that greater effects of SQ-LNS would be found among children from more disadvantaged home environments. MethodsThe International Lipid-Based Nutrient Supplements (iLiNS) DYAD-Ghana trial was a randomized controlled trial conducted in 2009–2014. 1320 pregnant women ≤ 20 weeks gestation were randomly assigned to receive daily (1) iron and folic acid (IFA) during pregnancy and placebo during 6 mo postpartum, (2) multiple (18) micronutrients (MMN) during pregnancy and 6 mo postpartum, or (3) SQ-LNS (20 g/d) for pregnant women during pregnancy and 6 mo postpartum and SQ-LNS for children from 6 to 18 mo of age. In 2021, we assessed child social-emotional problems at age 9–10 years by caregiver, child, and/or teacher report using the Strengths and Difficulties Questionnaire (SDQ), Brief Problem Monitor, Early Adolescent Temperament Questionnaire, Mood and Feelings Questionnaire, Screen for Child Anxiety Related Emotional Disorders, and Children’s Emotion Management Scales. ResultsWe re-enrolled and assessed outcomes in 966 children, 79.4% of the 1217 children eligible for re-enrollment (excluding those known not survived). At age 9–10 years, a very small percentage (<2%) of children had social-emotional difficulties scores in the abnormal range on the caregiver-reported SDQ, in contrast to the high prevalence previously found at age 5 years in the same cohort (25%). No significant differences were found between SQ-LNS and control groups. Early childhood home environment score did not modify the effect of SQ-LNS on any score. ConclusionsEffects of pre- and post-natal SQ-LNS on social-emotional development previously found at age 5 y were not sustained to age 9–10 y in this cohort. This may have been due to the low prevalence of social-emotional problems at 10 y of age, such that there was little potential to benefit from early nutritional intervention at this age in this outcome domain. Funding SourcesNational Institutes of Health, Bill & Melinda Gates Foundation.

Pregnant Women’s Experience With Multiple Micronutrient Supplements (MMS): Qualitative Research From Three Districts in Indonesia

Abstract Objectives The provision of multiple micronutrient supplements (MMS) to pregnant women is efficacious in improving pregnancy outcomes, safe, cost-effective, and recommended in the context of rigorous research by the World Health Organization. This study examines experiences related to MMS adherence in Indonesia. Methods Qualitative methods were used and included focus group discussions (FGD) with 52 pregnant women who received MMS. Pregnant women were selected through purposive sampling in six health centers across 3 districts within two provinces. Midwives coordinators from each health center were also interviewed as key informants using semi-structured in-depth interviews (IDIs). High MMS adherence was defined as the number of MMS consumed compared to the number of MMS received. Data was analyzed using descriptive and thematic analysis. Results MMS was distributed in health centers by midwives as a replacement for iron and folic acid (IFA). When interviewed, the average gestational age of women was six months. Most women (78%) reported high adherence to MMS, but adherence varied by district (range: 62% to 91% adherence). The provision of counseling by midwives, perceived benefit after taking MMS, family support, and acceptability of smell, size and shape of MMS were reason women reported for taking MMS on a regular basis. While most (73%) women reported that they experienced no side effects while taking MMS, the most common reason (61%) reported for not consuming MMS was forgetfulness. Conclusions MMS was well accepted by pregnant women as indicated by adequate counseling, high adherence, and perceived health benefit. Funding Sources The Vitamin Angels Alliance, Inc.