Gold_Effective Programming Calcium Supplementation and Pre Eclampsia Eclampsia

7/30/2019 Gold_Effective Programming Calcium Supplementation and Pre Eclampsia Eclampsia

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Effective Programming:

Calcium Supplementationand Pre-

eclampsia/eclampsia

Presented by:

Emily Gold

14 April, 2013


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Objectives of this presentation

Highlight gaps in our knowledge needed for the

translation of the evidence into program design and

initiate a discussion on appropriate ways to move

programs forward while awaiting this additionalevidence

Reflect on lessons from IFA programming that can be

applied to Calcium supplementation programs

Share preliminary findings from research underway

in collaboration with Cornell University


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Current research (including randomized control trials)

do not provide critical information for the design of

programs

What is appropriate delivery strategy for calcium?

Will calcium supplementation inhibit absorption of

iron?

How can IFA programs and Ca. supplementation

programs co-exist/ be integrated?

How do we ensure high compliance?


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The impact in a program does not depend only on the

biological potential but also the potential of the program to

deliver the intervention

Calcium

supplementreceived

ABSORPTION ANDBIOLOGICAL

PATHWAYSReducedpreeclampsia

Inadequate calcium

intake

Timely care-seeking

during pregnancy

Calcium

supplementconsumed

regularly

Calcium

supplement

available

Care provider

knows to give Ca,

provides education

to use

Side effects

managed

Procurement

and distribution

Culture, traditions,

availability of services

Barriers managed (e.g.

Memory, acceptance,

taste, etc)

Quality of services and

counselling


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External Factors

Socio-cultural

Technical Economic

Political

Provision

Quantity

Quality

Timeliness

Uptake

Awareness

Attitude

Accessibility

Utilization

Uptake + Knowing benefits &

how to use + External

motivation

Impact

Nutritional Need + Coverage + Utilization

Impact of interventions dependant on multiple factors

Contextually relevant package of interventions

Coverage

Provision +

Uptake by those in

need

NEED


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Some of the challenges that we have seen for IFA programs

are likely to be similar for Calcium supplementation programs

Demand side:

Contact with women may begin only late in pregnancy

Irregular and infrequent contact may limit effectivecoverage, opportunities for encouragement to comply

Care providers may not be effective to council compliance Possible issues with uptake and compliance

Lack of information on managing side effects

Supply side:

Budget allocation donor dependency

Poorly functioning supply chains


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Some of the challenges that we have seen for IFA programs

are likely to be similar for Calcium supplementation programs

Demand side:

Contact with women may begin only late in pregnancy

Irregular contact may limit effective coverage,

opportunities for encouragement to comply Possible issues with uptake and compliance

Supply side:

Budget allocation donor dependency

Poorly functioning supply chains

Although well recognized, many of these issues

have not been adequately addressed for IFAprograms. Now we should:

Avoid Ca programs likely to suffer from similar

supply and demand-side problems

Take advantage to renew efforts to strengthen

IFA and Ca programs simultaneously

Be aware of additional challenges related to

compliance and interactions


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.:.

MIs Maternal and Neonatal Health and

Nutrition Program

MIs Maternal and Neonatal Health and

Nutrition Program

Some lessons learnt and common

sense responses to these challenges

Intense and effective training will be required for

health care providers

Motivation to accept and implement programs

effectively, including supply management andcommunication with pregnant women

Alternative delivery strategies should be

examined

Effective behaviour change communication Requires an understanding of the barriers and

factors that would facility uptake and

adherence


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MIs Calcium project (Ethiopia and Kenya) to be

implemented in 2 phases to address specific challenges

for program design. In Phase 1:

, 2006.

Challenge 1: Low uptake of IFA, low ANC and late /infrequent contact

with health care system

Potential for greater risk with additional supplement (larger,

additional tablet, side effects etc.)

Aiming to identify optimal delivery platform

.:.

Challenge 2: Poor compliance with IFA supplementation

Potential for greater risks with addition of calcium

Collecting and assimilate information on the perspectives ofhealth

care providers and beneficiaries to inform BCI

Designing models for delivery and promotion of Ca and IFA

supplements in pregnancy.


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Some results from Phase 1:

FAQs Calcium Supplementation include:

Dosage- better bioavailability when taken in smaller (< 500 mg)divided doses

Formulation-benefits of both Ca. Carbonate and Ca. Citrate

Malate. Time of dosing can affect absorption depending on

formulation

Malaria- at this time there are no data or evidence to suggest

that calcium interacts with typical anti-malarial drugs

FAQs IFA lessons for Calcium include:

Successful strategies for improving ANC

Successful strategies for improving supplies of supplements

Successful strategies for improving adherence

Alternate ways of reaching women with micronutrients

Discussion paper on implications of new Ca recommendation for

biomedical practices


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Trial of Improved Practice (TIPs) methodology used to

test delivery, acceptance and compliance with several

dosages and regiments of Calcium and IFA supplements

in Kenya and Ethiopia

Test of 2 delivery systems

Explore innovative packaging ideas to limit cost &

complexity &permit procurement

Explore potential to reduce calcium dosage without

compromising impact

Next steps in Phase 1:


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Phase 2 will include pilot testing the new delivery

model in both countries

, 2006.

Objective 1: Test models developed in Phase 1 by implementingCa and IFA supplementation within the health system

Objective 2: Evaluate the implementation process and

effectiveness of the model strategies.

Objective 3: Refine models and make recommendations for

improving implementation and effectiveness.

Objective 4: Disseminate results to provide policy makers,

program developers and health care providers

.:.


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Some countries may wish to move programs forward before

results from these studies are available a few suggestions in

doing so:

Programs in all countries should invest in the formative researchand information collection that will ensure appropriate program

design in their context:

Innovative alternatives for delivery (particularly if IFA programs

have not been successful) Eg. Using community level health agents

Identification and resolution of forecasting and supply chain

issues for IFA and Calcium

Effective training for health care providers and relevant andeffective communication to promote update and utilization

Requires understanding of the barriers that they perceive both

for providers and pregnant women and those who may influence

their decision related to ANC and supplement use


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Gold_Effective Programming Calcium Supplementation and Pre Eclampsia Eclampsia

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