Rapid assessment of calcium supplements compliance among pregnant women attending antenatal care in Chhattisgarh

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2 Rapid assessment of calcium supplements compliance among pregnant women attending antenatal care in Chhattisgarh INTRODUCTION: Poor maternal and newborn health and nutrition remain significant contributors to the burden of disease and mortality. Calcium supplementation has the potential to reduce adverse gestational outcomes, in particular by decreasing the risk of developing hypertensive disorders during pregnancy, which are associated with a significant number of maternal deaths and considerable risk of preterm birth, the leading cause of early neonatal and infant mortality. WHO (2013) has strongly recommend inclusion of routine prenatal calcium supplementation in high doses (>1 gm/day), especially in areas where dietary calcium intake is low. Suggested scheme for calcium supplementation in pregnant women (WHO. Guideline: Calcium supplementation in pregnant women. Geneva, World Health Organization, 2013) National Protocol for calcium supplementation Oral swallow able calcium tablets to be taken twice a day (total 1g calcium/day) starting from 14 weeks of pregnancy up to 6 months post partum. Calcium tablets should not be taken empty stomach since it causes gastritis. Calcium and iron tablets (IFA) should not be taken together since calcium inhibits iron absorption. 1 P a g e

3 Each calcium tablet should contain 500mg elemental calcium. The rationale for inclusion of Vitamin D (250 IU vitamin D3) is to enhance the Absorption of calcium... (National_Guidelines_for_Calcium_Supplementation_During_Pregnancy_and_Lactation. Maternal Health Division, Ministry of Health & Family Welfare Government of India December 2014) METHOD Study design Cross sectional Study tool Semi structured questionnaire Study duration Feb 2016 May 2016 Sample selection Purposive Study population Beneficiaries o Total pregnant women (health facility) - 20 pregnant women (community) Caregivers o Total 17 - Staff nurses ANM 3 - Medical officer (MO) RMA 3 - Nursing sister 1 Study area District 4 (Rajnandgaon, Bilaspur, Champa and Surguja) Block 10 (Chuikhadaan, Rajnandgaon, Pendra, Bilaspur, Bilha, Balod, Bamhnidih, Lundra, Udaipur and Ambikapur) Facilities 10 - PHC 1 - CHC 6 - DH 3 Ethical consideration Informed consent was taken before interview 2 P a g e

4 FINDINGS Status of caregivers 1. Out of 17 caregivers, approx half (8) of the caregivers replied that they have not got training regarding revised guidelines of calcium supplementation. SN Trained on Caregivers calcium Total supplementation 1 ANM Staff nurse RMA Nursing sister MO 0 2 Total Out of 7 health facilities, only four facilities have availability of calcium tablets. Following reasons were mentioned for non-availability of calcium tablets- - No supply from CGMSC for the last two months. - Huge demand and Low supply of Calcium tablet Health facility Availability of Calcium SN tablets 1 CHC Pendra No 2 DH Bilaspur No 3 CHC Balod No 4 PHC Lakhram, Bilaspur Yes 5 CHC Dhaurpur Yes 6 CHC Udaipur Yes 7 DH Ambikapur Yes 3. According to the protocol for calcium supplementation, calcium tablets should be taken twice a day (total of 1gm calcium per day) onwards 2 nd month of pregnancy but, it was found that majority (13 out of 17) caregivers are not aware of the protocol. 3 P a g e

5 Month to start of calcium supplementation 6th 5th 4th 3rd 1st 2nd Don t know Responded 1 MO 1 Staff nurse 2 Staff nurse, 1 RMA 1 ANM 1 ANM,1 MO 2 Staff nurse, 1 ANM, 1 RMA 1 Staff nurse,1 Nursing sister Majority (11) of caregivers said, they don t participate in the monthly review meeting at which calcium supplementation programme is discussed. There is no monitoring system for calcium supplements. 4. Majority (71%) of caregivers replied that they provide counseling to pregnant women regarding ca supplementation. SN 1 Caregivers provide advices (n=17) To drink one glass of milk everyday 11 2 About taking green leafy vegetables 8 Benefits of taking calcium 5 3 supplementation leads to maternal & fetal well being 4 Method of taking IFA 5 About not taking calcium tablets in 1 5 empty stomach since it causes gastritis About not taking calcium and iron tablets 2 6 together since calcium inhibits iron absorption 7 Other side effects 1 8 To take morning sunlight everyday 0 Status of beneficiaries 4 P a g e a) Socio-demographic profile of the study participants (n=55) Age distributio n Education >30 3 Illiterate 5 >6 class Graduate 2 Post graduate 1 Occupatio House wife 49

6 n Farming 3 Other 3 b) Awareness about calcium supplementation during pregnancy (n=55) c) Intake of calcium supplement among pregnant women Ca tablet / day n=55 One 27 Two 8 did not take 20 Method of Intake of Ca n=35 After food at day 30 After food at night 3 Anytime 2 Following reasons were mentioned for not taking calcium tablets- 5 P a g e Not received from health facilities. Not available at health facility. They were feeling good that s why they did not take. It shows that women have perception that calcium should be taken during illness. One responded replied, she did not take because delivery time was near. Few women responded that they did not take because they felt nauseated.

7 d) Source of getting Calcium tablet as per beneficiaries Source N=55 SHC 1 PHC 3 CHC 8 DH 5 Anganwadi 2 Private store 4 Don t know 12 did not take 20 Recommendations I. Regular supply of Calcium tablets. II. III. IV. Orientation of medical staff regarding calcium supplementation. Monitoring of calcium supplementation Proper counseling of beneficiaries regarding Calcium intake, doses and duration. 6 P a g e