To design and evaluate an integrated Ca + IFA supplementation program in western Kenya.
We provided healthcare providers with job aids and trained them on counseling techniques and supplementation guidelines, and developed calendars for pregnant women to take home. We allocated health facilities to prescribe either 1.0 or 1.5 g / d Ca, along with standard IFA. We collected data from 16 health facilities and 1,019 pregnant women through facility spot-checks and client exit interviews, including pill counts.
Supplements and job aid were available during 90% of facility spot-check episodes; calendar availability was lower (78%). 91% of clients during 1st ANC visits had calendars at exit interviews and over 80% reported being counseled with counseling guides. Over 98% of clients received Ca and IFA supplements, but only 76% received enough Ca supplements to last until return date. Among clients that still had pills by return date, 77% and 83% were adherent to the IFA and Ca regimen respectively. Nevertheless, over 90% of all clients met daily Ca requirements in all subgroups except in the 2nd month for those prescribed 1.0 g / d (65%).
This comprehensive program model illustrates how Ca supplementation could be integrated with IFA supplementation in primary ANC delivery.