Improving Iron-Folic Acid and Calcium Supplementation Compliance through Counseling, Reminder Cards and Cell Phone Messages in Kenya

Abstract

Objectives: To determine if compliance with daily iron-folic acid (IFA) supplementation to prevent anemia and daily IFA and calcium supplementation to prevent anemia and pre-eclampsia can be improved with counseling and by using reminder cards and cell phone messages to ensure daily intake. Methods: Implementation research conducted in Eastern region and Nyanza region of Kenya over six months with 120 pregnant women. Initial qualitative research determined women's perceptions about anemia and pre-eclampsia and experiences with taking IFA/calcium and was used to develop counseling messages. All women received standard antenatal care (ANC), counseling, and reminder cards. Women were randomized into one of four groups:  those receiving only IFA and no text messages; those receiving only IFA with text messages; those receiving IFA and calcium with no text messages; and those receiving IFA and calcium with text messages. Supplement compliance and barriers to compliance was assessed monthly during ANC or home visits and measured by self-reporting by women, reporting by a family member who observed intake, and by counting remaining pills.  Husbands, mothers-in-law, health workers and community leaders were interviewed for insights about how they can influence compliance. Results: Initial findings in Kenya suggest that less than 5% of women are taking 90+IFA supplements during pregnancy due to inadequate supplies, lack of counseling or compliance with IFA supplementation. Conclusions: This study will help inform future programming on the existing IFA supplementation policy and as the country introduces calcium supplementation.