Coverage, compliance, acceptability and feasibility of a program to prevent pre-eclampsia and eclampsia through calcium supplementation for pregnant women: an operations research study in one district of Nepal

Abstract

BackgroundCalcium supplementation during pregnancy has been shown to reduce the incidence of pre-eclampsia/eclampsia among women with low calcium intake. Universal free calcium supplementation through government antenatal care (ANC) services was piloted in the Dailekh district of Nepal. Coverage, compliance, acceptability and feasibility of the intervention were evaluated.MethodsAntenatal care providers were trained to distribute and counsel pregnant women about calcium use, and female community health volunteers (FCHVs) were trained to reinforce calcium-related messages. A post-intervention cluster household survey was conducted among women who had given birth in the last six months. Secondary data analysis was performed using monitoring data from health facilities and FCHVs.ResultsOne Thousand Two hundred-forty postpartum women were interviewed. Most (94.6 %) had attended at least one ANC visit; the median gestational age at first ANC visit was 4 months. All who attended ANC were counseled about calcium and received calcium tablets to take daily until delivery.79.5 % of the women reported consuming the entire quantity of calcium they received. The full course of calcium (300 tablets for 150 days) was provided to 82.3 % of the women. Consumption of the full course of calcium was reported by 67.3 % of all calcium recipients. Significant predictors of completing a full course were gestational age at first ANC visit and number of ANC visits during their most recent pregnancy (p < 0.01). Nearly all (99.2 %) reported taking the calcium as instructed with respect to dose, timing and frequency. Among women who received both calcium and iron (n = 1,157), 98.0 % reported taking them at different times of the day, as instructed. Over 97 % reported willingness to recommend calcium to others, and said they would like to use it during a subsequent pregnancy. There were no stock-outs of calcium.ConclusionsCalcium distribution through ANC was feasible and effective, achieving 94.6 % calcium coverage of pregnant women in the district. Most women (over 80 %) attended ANC early enough in pregnancy to receive the full course of calcium supplements and benefit from the intervention. High coverage, compliance, acceptability among pregnant women and feasibility were reported, suggesting that this intervention can be scaled up in other areas of Nepal.

A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal

“…Of note, 6 studies were RCTs, 21 , 22 , 23 , 24 , 25 , 26 and 6 more were nonrandomized controlled, that is, cluster-controlled 27 , 28 , 29 , 30 or were before and after studies. 31 , 32 In addition, 9 were cohort studies, 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 2 were cross-sectional, 42 , 43 1 was a pure qualitative study 44 , and another had cluster-controlled and qualitative elements. 45 Notably, 15 of the studies involved community-based interventions, 22 , 23 , 26 , 27 , 28 , 29 , 31 , 34 , 36 , 37 , 38 , 39 , 40 , 44 , 45 9 were hospital-based, 21 , 24 , 25 , 30 , 32 , 33 , 35 , 42 , 43 , and 1 contained elements of both.…”

“… 45 Notably, 15 of the studies involved community-based interventions, 22 , 23 , 26 , 27 , 28 , 29 , 31 , 34 , 36 , 37 , 38 , 39 , 40 , 44 , 45 9 were hospital-based, 21 , 24 , 25 , 30 , 32 , 33 , 35 , 42 , 43 , and 1 contained elements of both. 41 The detailed summaries of the included studies can be found in Table 4 . The types of interventions reported in the included studies are shown in Figure 2, and the study locations are shown in Figure 3 .…”

Maternal nutrition practices in Uttar Pradesh, India: Role of key influential demand and supply factors

“…Similar to IFA, a key limiting factor will be availability and accessibility of calcium supplements. Experience from Nepal reiterates the need for strengthening supply‐side factors including provision of complete ANC services and uninterrupted provision of supplements, which were associated with consumption of full‐course of calcium among PW who received them (Thapa et al, ). Consistent with literature, our study shows that maternal knowledge, receiving counselling on calcium supplementation, beliefs and self‐efficacy, ANC visits, and positive social norms were associated with increased consumption of calcium.…”

Trial of feasibility and acceptability of routine low-dose aspirin versusEarlyScreeningTest indicated aspirin for pre-eclampsia prevention (TESTstudy): a multicentre randomised controlled trial

“…In the developing world, pregnant women are willing to take calcium, oral iron and micronutrients. 19–21 If instructed about potential side-effects and reminded frequently, women had higher levels of adherence with the greatest barrier being forgetfulness. Average medication adherence in pregnancy for chronic illness is higher than for non-routine medications at 90%–95%, 22 hence it its promising that we have noted a rate as high as this in our own study.…”