Adherence to Intake Recommendations of Lipidbased Nutrient Supplements (LNS) and Iron/Folic Acid (IFA) among Pregnant and Lactating Women (PLW) in a Community Health Program Setting.

ABSTRACT

Objectives: Limited knowledge exists on sustained adherence to small quantity LNS for PLW and how this compares to other prenatal supplements, particularly in programmatic settings. We aimed to address these gaps. Methods: A random subsample of women (n=360) from an ongoing LNS effectiveness trial were selected for home interviews about use and preferences of LNS or IFA. Purposively selected women (n=16) and key informants (n=18) participated in in-depth interviews about perceptions and acceptability of LNS. Results: Prevalence of high-adherers (≥70%) based on self-reported supplement consumption was 67%, 68%, 81%, 87% and 71% among LNS recipients during pregnancy, early and late lactation and IFA recipients during pregnancy and early lactation, respectively (P=0.044). Programmatic factors (e.g. distribution and visits by program staff) were significantly associated with reported high adherence in all groups. Among LNS recipients, overall supplement acceptability score was positively associated (odds ratio (OR) 2.94; P<0.0010) and reports of previous stillbirths were negatively associated (OR 0.12; P=0.0054) with reported high-adherence. In in-depth interviews, women reported benefits of taking LNS to both themselves and their infants, but some faced barriers to consumption such as aversion to LNS odor and taste during pregnancy, forgetfulness, and disruptions in supply. Conclusions: Adherence to LNS was sustained throughout the physiological periods at levels comparable to other supplementation programs. To achieve high adherence, these results suggest that maternal supplementation programs should focus on programmatic barriers and consider counseling on reminder techniques. Odor and taste acceptability of LNS, particularly during pregnancy, may also need to be addressed.