gold_effective programming calcium supplementation and pre eclampsia eclampsia
TRANSCRIPT
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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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