Training healthcare workers increases IFA use and adherence: Evidence and cost‐effectiveness analysis from Bangladesh

• Published in: Maternal and child nutrition Vol. 17; no. 2; pp. e13124 - n/a
• Main Authors: Kurzawa, Zuzanna, Cotton, Christopher S., Mazurkewich, Natasha, Verney, Allison, Busch‐Hallen, Jennifer, Kashi, Bahman
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.04.2021; John Wiley and Sons Inc; Wiley
• Subjects: Adherence; anaemia; Analysis; Anemia; Bangladesh; Capacity building approach; Capacity development; Clinical outcomes; Communication; Consumption; Cost analysis; Cost benefit analysis; cost‐effectiveness analysis; Counseling; Dietary Supplements; Disability; Disease management; Dosage; Experimental design; Female; Folic Acid; Health care; health care worker training; Health education; Health information; Health Personnel; Health promotion; Humans; Information systems; Interpersonal communication; Intervention; Iron; iron and folic acid supplements; Knowledge; Management information; Management information systems; Medical personnel; Nutrition; Original; Physical fitness; Pregnancy; Pregnant women; Prenatal Care; programme evaluation; Quasi-experimental methods; Regression analysis; Thresholds; Training; Womens health; Workers; Bangladesh; Bangladesh; anaemia; interpersonal communication; adherence; iron and folic acid supplements; pregnancy; health care worker training; cost-effectiveness analysis; programme evaluation
• ISSN: 1740-8695; 1740-8709
• DOI: 10.1111/mcn.13124

Iron and folic acid (IFA) supplementation programmes are important for preventing and controlling anaemia among pregnant women in low‐ and middle‐income countries. However, frontline health care workers often have limited capacity and knowledge, which can compromise such programmes' effectiveness. Between 2012 and 2014, Nutrition International and the Government of Bangladesh implemented a programme intended to increase IFA supplement consumption during pregnancy. The programme provided frontline health care workers with training on the benefits of IFA supplementation, the use of interpersonal communication and health promotion materials during antenatal care visits and health management information systems to track reported adherence to IFA supplementation. Using a quasi‐experimental design, this study investigates the programme's effectiveness and cost‐effectiveness at increasing IFA supplement consumption and adherence among pregnant women. The difference‐in‐differences regression analysis comparing outcomes in an intervention and comparison group concluded that the programme increased IFA consumption by an average of 45.05 supplements (P value = 0.018) and increased the share of women that reported adherence to a regime of at least 90 supplements by 40.35 percentage points (P value = 0.020). Knowledge of IFA supplement dosage and benefits also increased among frontline health care workers and pregnant women. The programme cost $47.11 USD (2018) per disability‐adjusted life year averted, which is considered highly cost‐effective when evaluated against several cost‐effectiveness thresholds. This study suggests that the capacity building of frontline health care workers is an effective and cost‐effective method of preventing and controlling anaemia among pregnant women in resource‐constrained areas.