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. 2019 Jan 30;14(1):e0210634.
doi: 10.1371/journal.pone.0210634. eCollection 2019.

Demand and supply factors of iron-folic acid supplementation and its association with anaemia in North Indian pregnant women

Jithin Sam Varghese  1 , Sumathi Swaminathan  1 , Anura V Kurpad  1   2 , Tinku Thomas  3
Affiliations

Demand and supply factors of iron-folic acid supplementation and its association with anaemia in North Indian pregnant women

Jithin Sam Varghese et al. PLoS One. .

Abstract

Anaemia prevalence in pregnant women of India declined from 57.9% to 50.3% from National Family Health Survey (NFHS)-3 to NFHS-4. However, over the course of that decade, the uptake of iron and folic acid (IFA) supplementation for 100 days of pregnancy improved by only 15%. To understand demand side risk factors of anaemia specifically related to IFA intake, an in-depth survey was conducted on pregnant women (n = 436) in 50 villages and wards of Sirohi district of Rajasthan, India. At the demand side, consistent IFA consumption in the previous trimester was inversely and strongly associated with anaemia (OR: 0.26, 95% CI: 0.12, 0.55). Reasons for inconsistent consumption included not registering to antenatal clinic, not receiving IFA tablets from the health worker and perceived lack of need. At the supply side, an analysis of IFA stock data at various levels of the health care (n = 168) providers from primary to tertiary levels showed that 14 out of 52 villages surveyed did not have access to IFA tablets. The closest availability of an IFA tablet for 16 villages, was more than 5 km away. To improve the uptake of IFA supplementation and thereby reduce iron deficiency anaemia in pregnant women, a constant supply of IFA at the village or sub-centre level, where frontline workers can promote uptake, should be ensured.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Findings from National Family Health Survey-4 related to anaemia in pregnant women.
(A) Anaemia among Pregnant women and (B) percentage of women consuming 100 or more IFA tablets in India by district (NFHS-4). The maps were created from shapefiles available freely from datameet.org using tmap package (https://cran.r-project.org/web/packages/tmap/index.html) in R.
Fig 2
Fig 2. Reporting of consumption and receipt of iron and folic acid supplements.
Values are number of subjects.
Fig 3
Fig 3. Geographical distribution of health facilities, inter-facility relationships and availability of IFA supplementation.
The polygon was filtered from the shape file and modified using ggplot2 package (https://cran.r-project.org/web/packages/ggplot2/index.html) in R.
See this image and copyright information in PMC

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