Harding Kassandra L, Matias Susana L, Mridha Malay K, Moniruzzaman Md, Vosti Stephen A, Hussain Sohrab, Dewey Kathryn G, Stewart Christine P
Program in International and Community Nutrition, University of California, Davis, California, USA.
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Matern Child Nutr. 2017 Jan;13(1). doi: 10.1111/mcn.12252. Epub 2016 Feb 22.
Limited knowledge exists on sustained adherence to small-quantity lipid-based nutrient supplements for pregnant and lactating women (LNS-PL) and how this compares with that of other prenatal supplements. To address these gaps, a random subsample of women (n = 360) during pregnancy, early (6- to 12-week post-partum) and late (12- to 24-week post-partum) lactation, from an ongoing effectiveness trial in Bangladesh, was selected for in-home interviews about LNS-PL or iron/folic acid (IFA) use and preferences. Prevalence of high adherence (≥70% of the recommendation) based on self-reported supplement consumption was 67%, 68% and 81% among LNS-PL recipients during pregnancy, early and late lactation, and was 87% and 71% among IFA recipients during pregnancy and early lactation, respectively (P = 0.044). Programmatic factors (e.g. distribution and visits by programme staff) were consistently statistically significantly associated with reported high adherence. Among LNS-PL recipients, high overall supplement acceptability score [odds ratio (OR): 8.62; 95% confidence interval (CI) 3.53, 20.83] and use of reminder techniques (OR: 4.41; 95%CI 1.65, 11.76) were positively associated, and reported vomiting at enrollment was negatively associated (OR: 0.34; 95%CI 0.14, 0.80), with reported high adherence. Selected women (n = 16) and key informants (n = 18) participated in in-depth interviews about perceptions and acceptability of LNS-PL. Women perceived benefits of taking LNS-PL, but some faced barriers to consumption including aversion to odour and taste during pregnancy, forgetfulness and disruptions in supply. To achieve high adherence, results from this study suggest that maternal supplementation programmes should focus on programmatic barriers and consider incorporating reminder techniques. Organoleptic acceptability of LNS-PL, particularly during pregnancy, may also need to be addressed.
关于孕妇和哺乳期妇女持续坚持服用小剂量脂质营养补充剂（LNS-PL）以及与其他产前补充剂相比情况如何，目前了解有限。为填补这些空白，从孟加拉国一项正在进行的有效性试验中，选取了孕期、产后早期（产后6至12周）和晚期（产后12至24周）哺乳期的妇女随机子样本（n = 360），进行关于LNS-PL或铁/叶酸（IFA）使用及偏好的家庭访谈。根据自我报告的补充剂消费情况，LNS-PL服用者在孕期、产后早期和晚期高依从性（≥推荐量的70%）的患病率分别为67%、68%和81%，IFA服用者在孕期和产后早期的患病率分别为87%和71%（P = 0.044）。项目因素（如项目工作人员的分发和访视）在统计学上始终与报告的高依从性显著相关。在LNS-PL服用者中，总体补充剂高可接受性评分[比值比（OR）：8.62；95%置信区间（CI）3.53，20.83]和提醒技术的使用（OR：4.41；95%CI 1.65，11.76）与报告的高依从性呈正相关，而报告在入组时呕吐与报告的高依从性呈负相关（OR：0.34；95%CI 0.14，0.80）。选定的妇女（n = 16）和关键信息提供者（n = 18）参与了关于LNS-PL认知和可接受性的深入访谈。妇女们认识到服用LNS-PL的益处，但一些人在服用时面临障碍，包括孕期对气味和味道的厌恶、健忘以及供应中断。为实现高依从性，本研究结果表明，孕产妇补充剂项目应关注项目障碍，并考虑采用提醒技术。LNS-PL的感官可接受性，尤其是在孕期，可能也需要加以解决。
