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Research article
Roselyter Monchari Riang'a
Moi University School of Arts and Social Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0688-5244
License:
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Introduction While Iron and Folic Acid Supplementation (IFAs) policy is offered free of charge in Kenya and has been implemented in Kenya and other low and middle-income-countries for decades, effectiveness of this intervention in improving maternal nutrition status has been inadequate. This study aims to acquire insight into the degree to which IFAs policy guidelines during pregnancy have been implemented as intended and the challenges to implementation fidelity.
Methods Data was collected in rural Uasin Gishu County in the western part of Kenya through document analysis, questionnaires among programme recipients (n=188) and semi-structured interviews with programme implementers (n=6). Themes emerging from data are critically discussed using a conceptual framework based on programme theory and the programme implementation fidelity framework.
Results Coverage of IFAs is widespread. However, policy content, frequency and participant responsiveness is not fully implemented. Only 10% accessed intervention within the first trimester as recommended by policy guidelines, only 18% and 15% of the respondents received 90 or more iron and folic acid pills respectively during their entire pregnancy period only 28% reported receiving nutritional counselling, and 66% completed taking the IFAs pills that were issued to them. Late initial bookings to antenatal care, drug stock shortage, staff shortage and long queues, confusing dosage instructions, side effects of the pills were established to be the main challenges to effective implementation fidelity. Anticipated health consequences and emphasis by the health officer to take the pills were established to be motivations for adherence to supplements.
Conclusions Rather than targeting pregnant women who turn up for care at the health facilities, IFAs interventions should introduce community-based outreach programmes and make use of community-based health workers. This will not only relief the crowded health facilities for effective implementation integrity, but will also reach out to pregnant women within the first trimester when IFAs impact on health is greater and reach out to those women do not turn up at all for interventions at a health facility. Due to shortage and low compliance to IFAs pills, nutritional counselling is vital to promote consumption of locally available micro-nutrient rich food sources.
Keywords
Maternal nutrition, pregnancy, programme evaluation, implementation fidelity, nutrition interventions, iron and folic acid supplementation, Kenya
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CURRENT STATUS: Published
View the published article at BMC Nutrition.
No community comments so far
Submission checks complete
On 04 Dec, 2020
Editorial decision: Accept
On 29 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 23 Nov, 2020
Editor assigned
On 21 Nov, 2020
Submission checks complete
On 21 Nov, 2020
Editor invited
On 21 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 10 Nov, 2020
Review #1 received
Received 03 Nov, 2020
Reviewer #1 agreed
On 06 Oct, 2020
Reviewers invited
Invitations sent on 01 Oct, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Editorial decision: Major revision
On 21 Aug, 2020
Review #1 received
Received 08 Aug, 2020
Reviewer #2 agreed
On 30 Jul, 2020
Review #2 received
Received 30 Jul, 2020
Reviewer #1 agreed
On 16 Jul, 2020
Reviewers invited
Invitations sent on 13 Jul, 2020
Editor assigned
On 08 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Editor invited
On 07 Jul, 2020
Version 1
Posted 09 Apr, 2020
No comments provided
Editorial decision: Major revision
On 27 May, 2020
Review #2 received
Received 23 May, 2020
Review #1 received
Received 17 May, 2020
Reviewer #1 agreed
On 25 Apr, 2020
Reviewer #2 agreed
On 25 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Editor assigned
On 16 Apr, 2020
Submission checks complete
On 07 Apr, 2020
Editor invited
On 07 Apr, 2020
First submitted
On 31 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Nutrition & Dietetics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Nutrition.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Roselyter Monchari Riang'a
Moi University School of Arts and Social Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0688-5244
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Nutrition.
No community comments so far
Submission checks complete
On 04 Dec, 2020
Editorial decision: Accept
On 29 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 23 Nov, 2020
Editor assigned
On 21 Nov, 2020
Submission checks complete
On 21 Nov, 2020
Editor invited
On 21 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 10 Nov, 2020
Review #1 received
Received 03 Nov, 2020
Reviewer #1 agreed
On 06 Oct, 2020
Reviewers invited
Invitations sent on 01 Oct, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Editorial decision: Major revision
On 21 Aug, 2020
Review #1 received
Received 08 Aug, 2020
Reviewer #2 agreed
On 30 Jul, 2020
Review #2 received
Received 30 Jul, 2020
Reviewer #1 agreed
On 16 Jul, 2020
Reviewers invited
Invitations sent on 13 Jul, 2020
Editor assigned
On 08 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Editor invited
On 07 Jul, 2020
Version 1
Posted 09 Apr, 2020
No comments provided
Editorial decision: Major revision
On 27 May, 2020
Review #2 received
Received 23 May, 2020
Review #1 received
Received 17 May, 2020
Reviewer #1 agreed
On 25 Apr, 2020
Reviewer #2 agreed
On 25 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Editor assigned
On 16 Apr, 2020
Submission checks complete
On 07 Apr, 2020
Editor invited
On 07 Apr, 2020
First submitted
On 31 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Nutrition & Dietetics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Nutrition.
Introduction While Iron and Folic Acid Supplementation (IFAs) policy is offered free of charge in Kenya and has been implemented in Kenya and other low and middle-income-countries for decades, effectiveness of this intervention in improving maternal nutrition status has been inadequate. This study aims to acquire insight into the degree to which IFAs policy guidelines during pregnancy have been implemented as intended and the challenges to implementation fidelity.
Methods Data was collected in rural Uasin Gishu County in the western part of Kenya through document analysis, questionnaires among programme recipients (n=188) and semi-structured interviews with programme implementers (n=6). Themes emerging from data are critically discussed using a conceptual framework based on programme theory and the programme implementation fidelity framework.
Results Coverage of IFAs is widespread. However, policy content, frequency and participant responsiveness is not fully implemented. Only 10% accessed intervention within the first trimester as recommended by policy guidelines, only 18% and 15% of the respondents received 90 or more iron and folic acid pills respectively during their entire pregnancy period only 28% reported receiving nutritional counselling, and 66% completed taking the IFAs pills that were issued to them. Late initial bookings to antenatal care, drug stock shortage, staff shortage and long queues, confusing dosage instructions, side effects of the pills were established to be the main challenges to effective implementation fidelity. Anticipated health consequences and emphasis by the health officer to take the pills were established to be motivations for adherence to supplements.
Conclusions Rather than targeting pregnant women who turn up for care at the health facilities, IFAs interventions should introduce community-based outreach programmes and make use of community-based health workers. This will not only relief the crowded health facilities for effective implementation integrity, but will also reach out to pregnant women within the first trimester when IFAs impact on health is greater and reach out to those women do not turn up at all for interventions at a health facility. Due to shortage and low compliance to IFAs pills, nutritional counselling is vital to promote consumption of locally available micro-nutrient rich food sources.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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