Acceptability and Utilization of Three Nutritional Supplements during Pregnancy: Findings from a Longitudinal, Mixed-Methods Study in Niger

Abstract

Nutritional status in pregnancy is a key determinant of birth outcomes. In low-income countries, maternal diets are often limited, and daily nutrient supplements are recommended to fill nutrient gaps. As a result, it is important to understand the factors influencing acceptability and utilization of nutrient supplements in these settings. Qualitative data (individual interviews and focus group discussions with pregnant women, household members, and study staff) and quantitative data (unannounced household spot checks) were collected in 24 villages in the Maradi region of south-central Niger. Each village was randomly assigned to one of three study arms, with pregnant women receiving either iron and folic acid (IFA) supplements, multiple micronutrient (MMN) supplements, or medium-quantity lipid-based nutrient supplements (MQ-LNS) for daily consumption during pregnancy. Data were collected longitudinally to capture changes in perspective as women progressed through their pregnancy. Participants accepted all three supplement types, and perceived a wide range of health benefits attributed to supplement consumption. However, several important barriers to appropriate consumption were reported, and rumors about the supplements leading to childbirth complications also decreased utilization. The household spot checks suggested that IFA had the highest level of correct consumption. Overall, despite a stated high level of acceptance and enthusiasm for the supplements among participants and their household members, certain fears, side effects, and organoleptic factors led to decreased utilization. The effectiveness of future programs to improve maternal nutritional status through supplementation may be improved by understanding perceived barriers and facilitating factors among participants and tailoring communication efforts appropriately.

Compliance with and acceptability of two fortified balanced energy protein supplements among pregnant women in rural Nepal

“…Our medium-term compliance results for both supplements were similar to the median self-reported compliance of small quantity lipid-based nutrient supplements (LNS) for pregnancy of 83.7% and 93.8% in Ghana and Malawi, respectively (Klevor et al, 2016). An increase in self-reported compliance over time was seen in other long-term adherence studies of supplements in pregnant women in Niger (Clermont et al, 2018) and Malawi (Klevor et al, 2016). Similar to our findings, the women reported getting used to the product as one factor for increased compliance (Clermont et al, 2018).…”

“…Support from family members and healthcare professionals could also play a key role in compliance and uptake of supplements. In Niger, health workers played an important role in sensitizing women and their families, thus increasing the acceptance of the supplements (Clermont et al, 2018).…”

Longitudinal Qualitative Methods in Health Behavior and Nursing Research: Assumptions, Design, Analysis and Lessons Learned

“…Common outcomes presented in LQR publications are themes (and how they change across time), intervention development/evaluation, or conceptual pathways. For example, Clermont et al (2018) were able to identify themes that explained decreased utilization of nutrient supplements in pregnant women despite their stated high level of acceptance. Mean-while, Corepal et al (2018) used their qualitative study to better understand how and why an intervention designed to promote physical activity was effective among a group of adolescents.…”

Prenatal supplementation with multiple micronutrient supplements or medium-quantity lipid-based nutrient supplements has limited effects on child growth up to 24 months in rural Niger: a secondary analysis of a cluster randomized trial

“…Our findings that MQ-LNS improved WLZ at 1 mo of age relative to IFA are consistent with this hypothesis of a better nutritional environment in utero. Another potential explanation is that there was a higher propensity to share MQ-LNS with other household members or substituting it for food ( 27 ) and therefore the actual micronutrient intake in the MQ-LNS arm may have been lower than planned. Additional research is needed to understand the mechanisms that may lead to transient differences in anthropometric outcomes in children whose mothers receive prenatal MQ-LNS as compared with MMS or IFA.…”

“…Detailed nutritional composition of the 3 study supplements is shown in Supplemental Table 1 . Formative work conducted prior to the start of the trial showed that the 3 supplements were well accepted by the communities and pregnant women ( 27 ).…”