A study in low income communities of Kenya has found that support from family and friends, following the provision of health-related information from professionals, improves the use of calcium tablets by pregnant women.

The study looked at a particular method to mobilise this support without any direct engagement by health professionals with family members, based on the idea that such engagement requires substantial resources and is challenging to implement at scale. The solution that was tested was encouragement to women to identify an “adherence partner” among their family and friends and to take home information for them about IFA and calcium supplements.

A team of researchers from Cornell University in USA, recruited 1036 pregnant women in Kakamega Country in western Kenya.

The intervention consisted of the following simple steps:

• Train antenatal care providers to counsel women about the benefits of adherence partners.
• A card on the benefits of adherence partners, to be used in counselling women.
• Reminder calendars for women with a page encouraging adherence partners.
• Take-home posters for women to share with their adherence partner.

This approach was found to be highly acceptable to women. 90% of the women agreed they would find an adherence partner and 4-6 weeks later, 89% of them did have one, irrespective of social and demographic characteristics. The most frequent adherence partner was the husband (52%), the elder women (23%). 93% of the women reported that their adherence partner had been helpful.

When women were followed-up 4-6 weeks later, the researchers found women who reported having more support with taking tablets at home were more likely to take the calcium supplements. Being able to name a specific adherence partner at home did not correlate with taking calcium supplements, suggesting that the intervention was working by simulating more general support at home with taking tablets.

The association with adherence support at home was significant for calcium supplements, but not IFA supplements. The researchers suggest this could be because adherence was already high among the study population or because IFA pills are familiar and only 1 is needed a day, so having family support was less important. Calcium pills, however, are less familiar and require more per day. Indeed, when the study compared a regime of 2 pills and 3 pills a day, family support made a bigger difference to the higher dose.

Martin SL, Omotayo MO, Pelto GH, Chapleau GM, Stoltzfus RJ & Dickin KL (2017), Adherence-specific social support enhances adherence to calcium supplementation regimens among pregnant women, The Journal of Nutrition

Photo: The White Ribbon Alliance. Creative Commons.