Revitalising iron and folic acid (ifa) supplements for pregnant women as a key component of the antenatal care (anc) package: program experiences of a demonstration project in Bangladesh

Background: Anaemia has been a long standing public health problem in Bangladesh, particularly amongst the children and women. BDHS, 2011 showed that 42% of the women aged 15-49 years (pregnant women 49.6% and 48% lactating women) were anaemic. Nutrition International (Formerly known as Micronutrient Initiative) supported Government of Bangladesh in revitalising IFA as a key component of the ANC package through demonstration of strategies to improve the coverage and adherence of IFA among pregnant women in selected districts with the objective of reducing iron deficiency anaemia. Methods and Materials: The program package consisted of strengthening the supply chain of the IFA supplements; capacity building of health staff in estimation of IFA requirements, monitoring and tracking adherence, behavior Change interventions for increasing adherence with a focus on improved interpersonal counselling, modifying monitoring system to track coverage and improving supportive supervision. The demonstration projects were implemented in Narsinghdi and Satkhira districts of Bangladesh. The program was assessed by a pre-post intervention study design with intervention and comparison areas in the country. Socio-demographically similar districts were considered as comparison areas. Results: In the intervention areas, adherence to 90+ IFA tablets was found to be more than 50% and binary logistic regression revealed that among all women interviewed, those who were exposed to improved interpersonal counseling were 7 times more likely to consume 90+ IFA in the most recent end-line survey undertaken [UOR: 7.560 (95% CI: 3.850-14.486, p=0.000)]. Conclusions: Considering the positive results of the program package, as demonstrated by the program evaluation findings, it is being scaled up in 10 low performing districts of Bangladesh with a focus on improved inter-personal counselling.