Evaluation of a calcium supplementation program for pregnant women in Dailekh district, Nepal

Abstract

Executive Summary: Introduction: This study was conducted to assess the coverage and compliance of the calcium pilot programme implemented by Family Health Division with the technical and financial support from the Maternal and Child Health Integrated Program (MCHIP), led by Jhpiego, to provide calcium supplements to pregnant women for prevention of Pre/ Eclampsia (PE/E) in Dailekh district for one year ending in August 2013.

Dailekh district located in mid-western hills of Nepal has 55 Village Development Committees (VDCs) and one Municipality and according to the 2011 population census an estimated 63,073 women of reproductive age (15-49) have been living there.

Methodology With the guidance from the Technical Working Group, FHD and MCHIP designed an evaluationstudy to assess the coverage and compliance of calcium supplementation programme. This includes a post-intervention household survey of recent mothers. The household survey used a cluster sampling method to identify respondents but the sampling units were recently delivered women (RDW) who had given birth in the last 6 months. In all, 62 clusters were chosen on the basis of probability proportional to population size and from each cluster 20 RDW were randomly chosen for interview. In order to interview a woman who had either a still birth or live birth in the last 6 months preceding the survey date over 10 households were visited. The total sample size was 1,240 RDW. In addition 109 health care providers (half of them were either staff nurse or auxiliary nurse midwives) and 112 FCHVs from the respective health facilities/wards from where RDWs were selected, were also administered separate questionnaires to assess their knowledge on calcium use and their experience of implementing the pilot calcium programme.

The data processing was done in FoxPro software to generate a “cleaned” data set. The FoxPro data was transferred to SPSS system file for analysis. Data analysis was performed using simple frequency tables and two/three way cross tables. Basic statistical techniques have also been used in the analysis. The survey results have been compared with the national NDHS 2011 wherever appropriate. Characteristics of respondents or RDW The median age of mothers participating in the household survey was 23 years. About 18 percent of the RDW were under 20 years of age, 76 percent between 20-34 years of age and about 6 percent were 35-49 years of age. Thirty-nine percent of the respondents had no education, 14 percent had completed School Leaving Certificate (SLC) or more and 47 percent had completed primary or secondary education. In terms of caste/ethnicity, 43 percent of all respondents belonged to Chhetri/Thakuri group, followed by Dalit - 34 percent, Janjati 12 percent and Bahun/ Sanyasi 12 percent.

Antenatal care (ANC) The survey showed 95% mothers giving birth in the last 6 months reported that they attended at least one ANC visit during their last pregnancy which is higher than the national average (85%) shown by NDHS, 2011. The median duration of pregnancy at the first antenatal care visit for those with ANC was 4 months regardless of residence. In Dailekh 71 percent of pregnant women made 4or more antenatal care visits during their entire pregnancy. More urban women (90%) have had four or more antenatal visits than rural women (69%). More mothers (75%) receiving calcium tablets had four or more antenatal visits during their pregnancy than those (71%) without calcium. Eightytwo percent of mothers received ANC from a skilled provider (a doctor, nurse, or midwife) for their most recent pregnancy.

Among those mothers who did not go for ANC, over half (55%) of them said that the health facility was too far followed by the reason "it is not necessary" (45%), "not customary" (33%), "no good service" (19%), and 9 percent each said they "did not know" and "too expensive".

Of the total respondents 95 percent received iron tablets and of them 99 percent got advice on iron tablets and 95 percent received iron tablets from a health worker or FCHVs. Most (95%) mothers receiving iron tablets at ANC visits also got resupply of iron tablets.