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Adherence in a pragmatic randomized controlled trial on prophylactic iron supplementation during pregnancy in Maputo, Mozambique

  • Bright I Nwaru (a1) (a2), Graça Salomé (a3), Fatima Abacassamo (a4), Orvalho Augusto (a4), Julie Cliff (a4), Cesar Sousa (a4), Elena Regushevskaya (a5), Saara Parkkali (a5) and Elina Hemminki (a5)...
Abstract
Objective

Assessing the level of adherence and its determinants is important in appraising the overall effectiveness of trials. The present study aimed to evaluate the extent of adherence and its determinants in a pragmatic randomized controlled trial of Fe prophylaxis during pregnancy in Maputo, Mozambique.

Design

A pragmatic randomized controlled trial.

Setting

Two health centres (1o de Maio and Machava) in Maputo, Mozambique.

Subjects

Pregnant women (≥12 weeks’ gestation, ≥18 years old, non-high-risk pregnancy; n 4326) attending prenatal care consultations at two health centres were randomized to receive routine Fe (n 2184; 60 mg ferrous sulfate plus 400 μg folic acid daily throughout pregnancy) or selective Fe (n 2142; screening and treatment for anaemia and daily intake of 1 mg folic acid).

Results

The level of adherence was 79 % for having two or more visits, 53 % for adequate prenatal care and 67 % for complete intake of Fe/folic acid tablets during the trial. The correlation between the adherence measures ranged between 0·151 and 0·739. Adherence did not differ by trial arm, but there were centre differences in adequate prenatal visits and intake of tablets. Older women (>20 years) and those with a history of abortion were more likely to achieve greater adherence, whereas an increased number of previous births decreased the likelihood of adherence. HIV positivity decreased the likelihood of adherence in one trial centre and increased it in the other.

Conclusions

The variation in adherence by trial centre, women’s characteristics and outcome measures suggests that adherence in trials fully depends on participants’ behaviour and can be increased by paying attention to contextual factors.

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Corresponding author
* Corresponding author: Email bright.nwaru@ed.ac.uk
References
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1. Osterberg, L & Blaschke, T (2005) Adherence to medication. N Engl J Med 353, 487497.
2. Hays, RD, Kravitz, RL, Mazel, RM et al. (1994) The impact of patient adherence on health outcomes for patients with chronic disease in the Medical Outcomes Study. J Behav Med 17, 347360.
3. Muyingo, SK, Walker, AS, Reid, A et al. (2008) Patterns of individual and population-level adherence to antiretroviral therapy and risk factors for poor adherence in the first year of the DART Trial in Uganda and Zimbabwe. J Acquir Immune Defic Syndr 48, 468475.
4. Ajose, O, Mookerjee, S, Mills, EJ et al. (2012) Treatment outcomes of patients on second-line antiretroviral therapy in resource-limited settings: a systematic review and meta-analysis. AIDS 26, 929938.
5. Rachlis, BS, Mills, EJ & Cole, DC (2011) Livelihood security and adherence to antiretroviral therapy in low and middle income settings: a systematic review. PLOS One 6, e18948.
6. Koethe, JR, Chi, BH, Megazzini, KM et al. (2009) Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings. Clin Infect Dis 49, 787798.
7. Chudi, IP (2010) Healthcare problems in developing countries. Med Pract Rev 1, 911.
8. Razzak, JA & Kellermann, AL (2002) Emergency medical care in developing countries: is it worthwhile? Bull World Health Organ 80, 900905.
9. United Nations System Standing Committee on Nutrition (2004) Fifth Report on the World Nutrition Situation: Nutrition for Improved Development Outcomes. http://www.unsystem.org/scn/Publications/AnnualMeeting/SCN31/SCN5Report.pdf (accessed October 2013).
10. McLean, E, Cogswell, M, Egli, I et al. (2009) Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr 12, 444454.
11. Stoltzfus, RJ, Mullanny, L & Black, RE (2004) Iron deficiency anaemia. In Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, vol. 1, pp. 163209 [M Ezzati, AD Lopez, A Rodgers et al., editors]. Geneva: WHO.
12. Peña-Rosas, JP & Viteri, FE (2009) Effects and safety of preventive oral iron or iron + folic acid supplementation for women during pregnancy. Cochrane Database Syst Rev issue 4, CD004736.
13. Nwaru, BI, Parkkali, S, Abacassamo, F et al. (2012) A pragmatic randomised controlled trial on routine iron prophylaxis during pregnancy in Maputo, Mozambique (PROFEG): rationale, design, and success. Matern Child Nutr (Epublication ahead of print version).
14. Prentice, AM (2008) Iron metabolism, malaria, and other infections: what is all the fuss about? J Nutr 138, 25372541.
15. Gera, T & Sachdev, HPS (2002) Effect of iron supplementation on incidence of infectious illness in children: systematic review. BMJ 325, 1142.
16. Parkkali, S, Abacassamo, F, Nwaru, BI et al. (2013) Comparison of routine prenatal iron prophylaxis and screening and treatment for anaemia: pregnancy results and preliminary birth results from a pragmatic randomised controlled trial (PROFEG) in Maputo, Mozambique. BMJ Open 3, e001948.
17. MacPherson, H (2004) Pragmatic clinical trials. Complement Ther Med 12, 136140.
18. Roland, M & Torgerson, DJ (1998) Understanding controlled trials: what are pragmatic trials? BMJ 316, 285.
19. Zwarenstein, M, Treweek, S, Gagnier, JJ et al. (2008) Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ 337, a2390.
20. Kulkarni, B, Christian, P, LeClerq, SC et al. (2010) Determinants of compliance to antenatal micronutrient supplementation and women’s perceptions of supplement use in rural Nepal. Public Health Nutr 13, 8290.
21. Lutsey, PL, Dawe, D, Villate, E et al. (2008) Iron supplementation compliance among pregnant women in Bicol, Philippines. Public Health Nutr 11, 7682.
22. Hill, Z, Kirkwood, B, Kendall, C et al. (2007) Factors that affect the adoption and maintenance of weekly vitamin A supplementation among women in Ghana. Public Health Nutr 10, 827833.
23. Knudsen, VK, Orozova-Bekkevold, I, Rasmussen, LB et al. (2004) Low compliance with recommendations on folic acid use in relation to pregnancy: is there a need for fortification? Public Health Nutr 7, 843850.
24. Kotelchuck, M (1994) An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 84, 14141420.
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