Preference and Acceptability of Alternative Delivery Vehicles for Prenatal Calcium Supplementation among Pregnant Women in Urban Bangladesh.

ABSTRACT

Objectives: Prenatal calcium supplementation is recommended by the WHO to decrease the risk of preeclampsia when dietary calcium intake is low; yet, this recommendation has not been successfully implemented to date. We aimed to evaluate the preference and acceptability of 4 different options for delivering prenatal calcium supplements (conventional tablets, chewable tablets, unflavoured powder, and flavoured powder) at the WHO recommended dose among pregnant women in urban Bangladesh. Methods: In a modified discrete-choice experiment, pregnant women (n = 132) completed a 4-day ‘run-in period' in which each delivery vehicle was sampled once, followed by a 21-day ‘selection period' during which participants freely selected a single vehicle per day. Preference was objectively based on the probability of selection of each vehicle; acceptability was assessed using questionnaires. Results: Conventional tablets had the highest probability of selection (62%); the probability of selection of chewable tablets (19%), flavored powder (12%), and unflavored powder (5%) were all significantly lower than for conventional tablets (P < 0.001). Palatability and product characteristics of the conventional tablets were more acceptable based on subjective report than for the other delivery vehicles. Conclusions: Our methodological approach used both objective and subjective measures to consistently identify the most preferred and accepted prenatal calcium delivery vehicle. Observation of participants' actual supplement use, in addition to expressed perceptions of acceptability, demonstrated that a conventional tablet is likely to be the most successful calcium delivery vehicle for future use in field studies and scale-up of the WHO recommendation for prenatal calcium supplementation in Bangladesh.