Prenatal multiple micronutrient supplementation in the Parepare district, Indonesia; population characteristics and intake adherence

Background: Micronutrient deficiencies among pregnant women remain highly prevalent in low and middle-income countries. Multiple micronutrient supplementation (MMS) has been proven more beneficial than standard iron-folic acid supplementation in reducing adverse pregnancy outcomes. Limited data on adherence to MMS in pregnant women in programmatic settings is available. Therefore, our study aims to assess adherence to the recommended intake of a multiple micronutrient supplement (UNIMMAP-MMS) in relation to demographic characteristics alongside a community-based MMS program.

Method: A prospective longitudinal study was performed in the Parepare district, South Sulawesi province, Indonesia, including 1216 participants. MMS was provided at the first antenatal care visit and women were followed up until delivery. The number of MMS tablets consumed, the start of MMS intake and information regarding possible intake determinants were recorded. Adherence was defined as ≥ 90 tablets. Binary logistic regression was used to assess associations between characteristics of women and adherence.

Results: Among the 655 women (53.9%) who started MMS intake in the first trimester, approximately 90% continued using MMS in the following trimesters and 75.3% consumed MMS ≥ 90 tablets. Among the 41.2% of women who started in the second trimester, 90% continued intake in the third trimester and 32.3% consumed ≥ 90 tablets. Only 4.9% started MMS in the third trimester. Overall adherence to MMS was 53.9%. Factors that impacted MMS intake were pregnancy interval ≤ 2y (AOR = 0.65, 95% CI 0.46, 0.92), start of MMS use in the second trimester and third trimester (AOR = 0.15, 95% CI 0.12, 0.20) and (AOR = 0.01, 95% CI 0.00, 0.04) respectively, being overweight (AOR = 1.44, 95% CI 1.04, 2.00) and experiencing no side effects (AOR = 3.46, 95% CI 1.82, 6.58).

Conclusion: Implementation of MMS via community health centers resulted in high adherence once supplementation started. As many women started MMS late, attention to antenatal visit planning earlier in pregnancy can be further improved.