scholarly journals Is Distribution a Problem in Iron-Folic Acid Consumption in India? An Exploration of District Level Household Survey

2020 ◽  
Vol 12 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Shiva S. Halli ◽  
Rajeshwari A. Biradar
Keyword(s):  
Folic Acid ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Household Survey ◽  
District Level ◽  
Indian States ◽  
The Government ◽  
Iron Folic Acid ◽  
Almost All ◽  
Women In India

Aims: Anemia accounts for 40% of maternal deaths in India. In order to address this problem, the Government of India implemented the largest programme with the greatest potential to reduce maternal mortality by free distribution of Iron-Folic Acid (IFA) supplementations especially during Antenatal Care (ANC) visits. But the major concern among the policymakers and researchers has been poor adherence to the supplement among pregnant women. However, we tend to think that given the severity of the problem, there is no investigation on the adherence issue. Hence, the aim of the paper is to understand whether IFA consumption by pregnant women in India is largely a distribution problem of IFA supplements through ANC. Background: The distribution of Iron-Folic Acid (IFA) supplementation is not working especially through Antenatal Care (ANC) attendance. The program implementers believe that it is because of lack of adherence to IFA supplements by pregnant women. It is important to investigate the problem before any policy changes are made without proper evidence. Objectives: The purpose of this study is to examine whether the problem of IFA consumption by pregnant women is due to the problem of public distribution of IFA supplements through ANC attendance. Methods: This study had used the fourth round of District Level Household Survey data, which collects information on IFA supplements, their distribution and consumption. Bivariate and tri-variate analyses were used to understand the relationship between IFA distribution to pregnant women and their consumption patterns in 19 Indian states and two Union Territories (UTs) of pregnant women (88,487) and between the age of 15-49 years. Results: In almost all the states except Chhattisgarh, more than 75% of the pregnant women consumed 100 or more IFA supplements when they received 100 or more IFA supplements from providers. Similar is the case even among those women who received 100 or more IFA supplements through 1 or 2 ANC attendance except Arunachal Pradesh (60%), Meghalaya (67%), Pondicherry (57%) and Andaman and Nicobar (0%). The consumption of IFA supplements among pregnant women gets better than 75% if they receive 100 or more supplements only after attending three or more ANCs. Conclusion: It seems that distribution is a problem in the consumption of IFA supplements by pregnant women in India. Full antenatal attendance by the women could be part of the problem but not supplying at least 100 IFA supplementations to even those who attend ANC due to stock-outs and ineffective management is a serious concern. Hence, Governments should distribute at least the recommended 100 IFA supplements to the women in their 1st ANC attendance to address anaemia.

scholarly journals The effect of early antenatal booking on adherence to Iron/folic acid supplementation among antenatal care attendees in Libo kemkem district, Ethiopia

2019 ◽  
Author(s):  
Tewachew Muche liyeh ◽  
Yitayal Ayalew Goshu ◽  
Amare Simegn Ayele ◽  
Yibeltal Abebe
Keyword(s):  
Folic Acid ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Folic Acid Supplementation ◽  
Medical Advice ◽  
Adherence Rate ◽  
Acid Supplementation ◽  
Iron And Folic Acid ◽  
Iron Folic Acid Supplementation ◽  
Iron Folic Acid

Abstract Background Iron and folic acid supplementation is the feasible and cost effective strategy to control and prevent anemia in pregnancy. Pregnant women are vulnerable for iron deficiency anemia due to increased nutrient requirement during pregnancy. In Ethiopia, the national data suggests that from all pregnant women supplemented with these tablets, only 5.1% consumed more than 90 tablets during their pregnancy time. The factors for this low adherence are not clearly known. Objective: To assess factors associated with adherence to iron-folic acid supplementation among pregnant women attending antenatal care service in Libo Kemkem district, Ethiopia 2017. Method: Hospital based cross sectional study was conducted using quantitative methods on 406 pregnant women attending antenatal care at Libo Kemkem district public health institutions. Systematic random sampling method was used. An interview with pre tested semi structured questionnaire was carried out. The collected data was entered in Epi data 4.1 and analyzed with SPSS version 20. Bivariate and multivariable logistic regression model were used. Odds ratio with 95% interval was computed and P- value <0.05% considered as level of significance. Result: About 406 respondents were included in the study. The adherence rate of iron-folic acid supplementation was 49.3% (95% CI= 44.3%-54.2%). Factors significantly associated with adherence to iron-folic acid utilization were urban residence (AOR =4.8, 95% CI=1.82-12.79), women aged 21-30 (AOR = 4.3, 95% CI=1.60-11.42) ,women aged 31-40 (AOR =4.2, 95% CI=1.33-13.41),early ANC booking (AOR =4.1, 95% CI=1.80-9.30) and getting medical advice (AOR = 2.5, 95% CI = 1.04 – 6.16). Fear of side effects, forgetfulness and too many pills were the major reasons for missing the doses of tablets. Conclusion: adherence rate of iron and folic acid supplementation was low. Residence, maternal age, early ANC booking and getting medical advice were significantly associated with adherence to iron and folic acid. Key Words: Iron-folic acid, pregnant women and adherence

scholarly journals Utilization of iron folic acid tablets among pregnant women in rural Punjab: an interventional study

2020 ◽  
Vol 7 (4) ◽  
pp. 1307
Author(s):  
Geetika Singh ◽  
Mohan Lal ◽  
Saurav Singh
Keyword(s):  
Folic Acid ◽  
Health Education ◽  
Pregnant Women ◽  
Health Workers ◽  
Economic Status ◽  
Public Health Problem ◽  
Before And After ◽  
The Government ◽  
Iron Folic Acid ◽  
Prevalence Of Anemia

Background: Anemia in pregnancy remains a public health problem and is an important indirect cause of maternal mortality accounting for 20% of total maternal deaths in India. However, it is largely preventable and easily treatable. Since, decades, the Government of India has recommended iron folic acid (IFA) supplementation as prophylaxis but adherence to IFA tablets is invariably poor. Health education of antenatal women can be an effective tool for improvement in IFA consumption and compliance. Thus, this study was conducted to assess the problem of anemia and its epidemiological determinants among pregnant women in rural field practice area of Punjab as well as to evaluate the compliance and utilization of IFA tablets before and after the health education intervention.Methods: Author filled in the predesigned and pretested proforma and imparted health education to all the pregnant women who were then followed. Hb was estimated on two different occasions, before and after the intervention.Results: After intervention, 82.88% of pregnant women took IFA tablets out of which 42.31% consumed more than 90 tablets. Factors like education, socio-economic status, type of family and gravidity were found to be significantly associated with anemia. Although the overall prevalence of anemia reduced slightly from 96.4% to 92.67% after intervention, the mean Hb levels got decreased.Conclusions: Despite interventions, the desired outcomes were not obtained. Constant motivation of antenatal women by health workers and IEC activities in the community are thus recommended to improve the IFA compliance rates and combat anemia.

scholarly journals Prevalence of iron and folic acid supplements consumption and associated factors among pregnant women in Eswatini: a multicenter cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gugulethu N. Mabuza ◽  
Alexander Waits ◽  
Owen Nkoka ◽  
Li-Yin Chien
Keyword(s):  
Folic Acid ◽  
Side Effects ◽  
Antenatal Care ◽  
Pregnant Women ◽  
World Health ◽  
Transport Costs ◽  
Cross Sectional ◽  
Iron And Folic Acid ◽  
Almost All ◽  
Low Consumption

Abstract Background During pregnancy, nutritional requirements increase and if not met, pregnancy-related complications may manifest. To prevent these undesirable outcomes, the World Health Organization recommends daily oral iron and folic acid (IFA) supplementation as part of antenatal care. Despite this recommendation, the use of IFA supplements is still very low in several developing countries. Additionally, no prior information exists regarding the level of consumption of IFA in Eswatini. Thus, this study aimed to determine the prevalence of consumption of IFA supplements and to identify factors associated with the consumption of IFA supplements among pregnant women in Eswatini. Methods A cross-sectional questionnaire survey was conducted among 330 pregnant women aged ≥ 18 years in their third trimester in Eswatini. Participants were recruited from eight purposively selected healthcare facilities from July 2019 to October 2019. Good consumption was defined as consuming all or almost all IFA supplements throughout pregnancy. Results During the first trimester, 10.3 % of the participants consumed all or almost all IFA supplements. In the second and third trimesters, those who consumed all or almost all supplements were 37 and 39.7 %, respectively, for iron and 37.6 and 40.9 %, respectively, for folic acid. Barriers, including side effects, forgetfulness, safe previous pregnancies without IFA, others’ advice against consumption, IFA stock-outs, inability to meet transport costs, and inadequate supply of IFA tablets, contribute to low consumption of IFA. Multivariate logistic regression models showed that the barriers were inversely associated with good consumption of IFA supplements. Better knowledge and attitude toward IFA and older maternal age were positively associated with good consumption of IFA supplements. Conclusions Low consumption of IFA supplements in overall pregnancy is mainly owing to the late antenatal care attendance. Strategies such as establishing a preconception care unit and school-based provision of IFA may be helpful. It is evident that most women still lack knowledge, and some have negative attitudes about IFA supplements. Health education to raise awareness and emphasize the importance of starting antenatal care early as well as consuming supplements on time should be revisited and intensified. Multiple strategies such as including community health care workers for distributing IFA supplements, discussing with clients about the measures to reduce forgetfulness, advising ways to prevent and manage the side effects, providing subsidies to cover transport costs, and ensuring adequate supply of IFA supplements in facilities may need to be employed to reduce the identified barriers.

scholarly journals Direct and Indirect Effects of Janani Suraksha Yojana on Antenatal Care and Institutional Delivery

2019 ◽  
Vol 2 (1) ◽  
pp. 01-07
Author(s):  
Mohammad Mahbubur Rahman ◽  
Saseendran Pallikadavath
Keyword(s):  
Antenatal Care ◽  
Institutional Delivery ◽  
Household Survey ◽  
Janani Suraksha Yojana ◽  
Regression Methods ◽  
Care Services ◽  
Health Institutions ◽  
Iron Folic Acid ◽  
Women In India ◽  
Fourth Round

Janani Suraksha Yojana (JSY) provides conditional cash incentives to eligible pregnant women in India so that they can take at least three antenatal care services including tetanus injection and iron-folic acid, to deliver their babies in health institutions, and to take at least one postnatal service for them and their neonatal babies. We examine its effects on antenatal care and the institutional delivery. We also decompose effects into direct and indirect categories, deriving parameters from the theoretical model, then estimating them using several regression methods including the propensity score matching. We use the fourth round of the District Level Household Survey (DLHS), which has an advantage over the previous waves of DLHS.

scholarly journals Re-evaluating the need for universal iron supplementation in pregnant Indian women in the light of gestational age specific low hemoglobin prevalence

2021 ◽  
Vol 33 (3) ◽  
pp. 435-439
Author(s):  
Aswathi Saji ◽  
Jeswin Baby ◽  
Anura V Kurpad ◽  
Tinku Thomas
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Gestational Age ◽  
Iron Supplementation ◽  
Folic Acid Supplementation ◽  
Indian Women ◽  
Iron Folic Acid Supplementation ◽  
Iron Folic Acid ◽  
Women In India ◽  
Prevalence Of Anemia

Background: Anemia prevalence among Indian pregnant women in 2015-16 was 50.4% and has not declined from 49.7% in 1998-99 despite the national policies on iron-folic acid supplementation. New gestational age-specific cut-offs (INTERGROWTH cut-off) for risk of low Hemoglobin (Hb) have been identified. Aims and objectives: Compare prevalences of low Hb  based on WHO and INTERGROWTH cut-offs Methods: The prevalence of anemia/low Hb among pregnant women in trimesters 2 and 3 from NFHS-4 data were estimated using the current WHO recommendations and the INTERGROWTH cut-offs. Results: Prevalence of low Hb by the INTERGROWTH cut-off was 28.1%(95% CI:26.9-29.4) and 21.7%(95% CI:20.6-22.9) in trimesters 2 and 3. Anemia prevalence by WHO cut-off was much higher at 41.2%(95% CI:39.8-42.5) and 54.8%(95 CI:53.2-56.3) in trimesters 2 and 3. The prevalence of low-Hb was similar between ANC and no-ANC reported groups in both trimesters (26.1% and 28.9% in trimester-2; 20.1% and 22.4% in trimester-3). Conclusion: The  prevalence of low-Hb with gestational age specific cut-offs is much lower compared to earlier estimates using WHO cut-off. The universal iron supplementation program for pregnant women in India need to be re-examined in this light and a tragetter Hb testing based supplementation may be more beneficial in reducing anemia prevalence.

scholarly journals Iron+folic acid distribution and consumption through antenatal care: identifying barriers across countries

2015 ◽  
Vol 19 (4) ◽  
pp. 732-742 ◽  
Author(s):  
Celeste Sununtnasuk ◽  
Alexis D’Agostino ◽  
John L Fiedler
Keyword(s):  
Folic Acid ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Health Surveys ◽  
Demographic And Health Surveys ◽  
Policy Makers ◽  
The Past ◽  
Iron Folic Acid ◽  
The Ideal

AbstractObjectiveThe prevalence of maternal anaemia remains unacceptably high in developing countries. At the same time, the percentage of women who consume one or more Fe+folic acid (IFA) tablets during pregnancy remains persistently low. The objective of the present study was to identify where, within antenatal care (ANC) programmes, pregnant women falter in obtaining and consuming an ideal minimum of 180 IFA tablets.DesignData from Demographic and Health Surveys were used to develop a schematic which identifies four sequential ‘falter points’ to consuming 180 IFA tablets: ANC attendance, IFA receipt or purchase, IFA consumption and the number of tablets consumed.SettingTwenty-two countries with high burdens of undernutrition.SubjectsA sample of 162 958 women, 15 to 49 years of age, with a live birth in the past 5 years.ResultsAcross all countries, 83 % of all pregnant women had at least one ANC visit, 81 % of whom received IFA tablets. Of those receiving IFA tablets, 95 % consumed at least one. Overall adherence to the ideal supplementation regimen, however, was extremely low: only 8 % consumed 180 or more IFA tablets. There were only two countries in which the percentage of pregnant women consuming 180 or more tablets exceeded 30 %.ConclusionsWhile most women receive and take some IFA tablets, few receive or take enough. The analysis identifies where ANC-based distribution of IFA falters in each country. It enables policy makers to design and prioritize follow-up activities to more precisely identify barriers, an essential next step to improving IFA distribution through ANC.

scholarly journals Adherence to prenatal iron–folic acid supplementation and associated factors among pregnant women attending antenatal care services in Dilla town, South Ethiopia

2021 ◽  
Vol 5 ◽  
pp. 239920262110088
Author(s):  
Tizalegn Tesfaye Mamo ◽  
Eden Ashenafi ◽  
Addisu Alemayehu Gube ◽  
Tesfanew Bekele
Keyword(s):  
Public Health ◽  
Folic Acid ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Associated Factors ◽  
Folic Acid Supplementation ◽  
Care Services ◽  
History Of ◽  
Iron Folic Acid Supplementation ◽  
Iron Folic Acid

Background: During pregnancy, due to the physiological and hormonal change, the requirement of iron–folic acid is enhanced. Therefore, the occurrence of iron/folic acid deficiency is relatively high and it is responsible for 95% of anemia during pregnancy. Objectives: The aim of this study was to assess adherence to prenatal iron–folic acid supplementation (IFAS) and associated factors among pregnant women attending antenatal care services at public health facilities of Dilla town. Methods: Facility-based cross-sectional study design was employed selecting 403 pregnant women attending antenatal care services in three public health institutions of Dilla town. The women were included in the study by simple random sampling. Data were collected by interview and document review. Then it was entered into EPI Data version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariate binary logistic regression techniques were used to identify independent predictors. A p-value <0.05 was taken as indication of statistical significance. Results: From the total of planned 403 pregnant women, 396 participated in the study, with a response rate of 98.2%. Of these, 172 (43.4%) pregnant women were adhered to IFAS. The study also revealed that history of previous anemia (adjusted odds ratio (AOR) = 1.87; 95% confidence interval (CI): (1.01–3.47); p = 0.04), frequency of antenatal care center (ANC) visits (AOR = 2.51; 95% CI: (1.17–5.37); p = 0.01), knowledge of IFA supplement (AOR = 2.28; 95% CI: (1.36–3.82); p = 0.002), and knowledge of anemia (AOR = 2.30; 95% CI: (1.40–3.77); p = 0.001) were independent predictors of adherence to IFAS. Conclusion: The finding of this study showed that less than half of the pregnant women were adhered to IFAS. History of previous anemia, frequency of ANC visits, knowledge of IFA supplement, and knowledge of anemia were the factors associated with adherence to IFA supplement.

Effect of routine iron–folic acid supplementation among rural pregnant women living in low- and high-groundwater-iron areas in Bangladesh

2019 ◽  
Vol 22 (15) ◽  
pp. 2844-2855 ◽  
Author(s):  
Faruk Ahmed ◽  
Moududur Rahman Khan ◽  
Ireen Akhtar Chowdhury ◽  
Rubhana Raqib ◽  
Anjan Kumar Roy ◽  
...  
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Significant Proportion ◽  
Significant Risk ◽  
Folic Acid Supplementation ◽  
Fe Deficiency ◽  
Prospective Longitudinal Study ◽  
Iron Folic Acid ◽  
Hb Concentration ◽  
Prospective Longitudinal

AbstractObjective:The present study investigated the risks and benefits of routine Fe–folic acid (IFA) supplementation in pregnant women living in low- and high-groundwater-Fe areas in Bangladesh.Design:A case-controlled prospective longitudinal study design was used to compare the effect of daily Fe (60 mg) and folic acid (400 μg) supplementation for 3·5 months.Setting:A rural community in Bangladesh.Participants:Pregnant women living in low-groundwater-Fe areas (n 260) and high-groundwater-Fe areas (n 262).Results:Mean Hb and serum ferritin concentrations at baseline were significantly higher in pregnant women in the high-groundwater-Fe areas. After supplementation, the mean change in Hb concentration in the women in the low-groundwater-Fe areas (0·10 mg/dl) was higher than that in the pregnant women in the high-groundwater-Fe areas (–0·08 mg/dl; P = 0·052). No significant changes in the prevalence of anaemia or Fe deficiency (ID) in either group were observed after IFA supplementation; however, the prevalence of Fe-deficiency anaemia (IDA) decreased significantly in the women in the low-groundwater-Fe areas. The risk of anaemia, ID and IDA after supplementation did not differ significantly between the groups. None of the participants had Fe overload. However, a significant proportion of the women in the high- and low-groundwater-Fe areas remained anaemic and Fe-deficient after supplementation.Conclusion:IFA supplementation significantly increased the Hb concentration in pregnant women living in the low-groundwater-Fe areas. Routine supplementation with 60 mg Fe and 400 μg folic acid does not pose any significant risk of haemoconcentration or Fe overload. Further research to identify other nutritional and non-nutritional contributors to anaemia is warranted to prevent and treat anaemia.

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