Achieving Coverage and Compliance of Antenatal Calcium Supplementation for Prevention of Pre-eclampsia – Findings from Nepal

Session: Nutrition Across the Continuum of Care for Maternal and Newborn Health

Presenter: Kusum Thapa, Jhpiego
Download presentation slides

Background: Calcium consumption during pregnancy reduces the incidence of pre-eclampsia/eclampsia among women with low calcium intake. Nepal implemented a pilot program to ascertain the feasibility of distributing calcium during antenatal care (ANC) services and follow-up by community health volunteers (FCHVs). We conducted a study to assess the effectiveness of the program.

Methodology: A post-intervention cluster household survey of women who had given birth in the last six months (recent mothers) was conducted. Secondary data from supervision visits to antenatal health care workers and FCHVs were analyzed.

Results: 1,240 recent mothers were interviewed and 109 ANC health worker and 112 FCHV questionnaires were analyzed. Most recent mothers (95%) attended at least one ANC visit with a median gestational age of four months at visit one. 94.6% of recent mothers (100% of those attending ANC) were counseled on calcium and received it. 67% of women who received calcium reported taking the full course (150 days), and nearly all (99.2%) said they took it as instructed with respect to dosage, frequency and timing. Significant predictors of completing a full course are gestational age at first ANC visit and number of ANC visits (p<.01). Among recent mothers who took both calcium and iron during pregnancy, 98% reported taking them at different times of the day. Cost and bulky size of tablets remain challenges.

Conclusions: Calcium distribution through ANC was feasible and effective, achieving 94.6% coverage of pregnant women in the district. Most (over 80%) of women attended ANC early enough in pregnancy to receive the full course and benefit from the intervention. Distribution of calcium through ANC services achieved high coverage and compliance among pregnant women and was feasible to incorporate into ANC health workers’ current responsibilities, this intervention is recommended for scale-up in Nepal.