Table of Contents List of Tables ............................................................................................................................. ii List of Figures ........................................................................................................................... iv Abbreviations ............................................................................................................................. v Executive Summary .................................................................................................................. 1 Chapter 1 Introduction ............................................................................................................. 3 1.1 Maternal Health Situation in Nepal ........................................................................ 3 1.2 Study Conceptualization and Planning ................................................................... 4 1.3 Calcium Intervention Design within the Study ....................................................... 5 1.4 Objectives of the study ............................................................................................ 6 1.5 Methodology ............................................................................................................. 6 Chapter 2 Findings for CPWs and Their Families ................................................................. 11 2.1 Number of Respondents in the First and Second Phase of the Study ............... 11 2.2 Characteristics of the respondents ...................................................................... 13 2.3 Knowledge about calcium supplementation........................................................ 14 2.4 Calcium Preference and Compliance ................................................................... 17 2.5 Side effects from calcium ...................................................................................... 27 2.6 Clarity of instructions ............................................................................................. 28 2.7 Opinions on calcium and its distribution .............................................................. 28 2.8 Family Support Regarding Calcium Use ............................................................... 32 2.9 Antenatal Care (ANC) and Delivery services ........................................................ 34 Chapter 3 Findings on FCHVs and Health Workers .............................................................. 37 3.1 Characteristics of the Respondents ..................................................................... 37 3.2 Awareness of Calcium ........................................................................................... 37 3.3 Experiences with Acceptability and Compliance of Calcium Supplement ......... 40 3.4 Training and Supervision ....................................................................................... 41 3.5 Calcium DIstribution and Reporting...................................................................... 42 3.6 Suggestions to Improve Calcium Supplement Program ...................................... 42 Chapter 4 Conclusions and Recommendations ................................................................... 45 4.1 Summary and Conclusions .................................................................................... 45 4.2 Recommendations for Future Calcium Supplementation Activities ................... 48 Appendix A. BCC Materials Used During the Study............................................................... 51 Nepal: A Study on Acceptability and Compliance of Calcium Supplementation i List of Tables Table 1. Timing of Semi-structured Interviews and Focus Group Discussions .................... 7 Table 2. Number of Semi-structured Interviews and Focus Group Discussions by Respondent Type and VDC ...................................................................................................... 7 Table 3. Distribution of Respondents by VDC, Month and Calcium Form (Tablet or Powder) ................................................................................................................................... 12 Table 4. Participant Attrition and Reasons during Study Period ........................................ 12 Table 5. Distribution of Respondents by Type in the First and Second Phases of the Study ................................................................................................................................................. 12 Table 6. Distribution of CPW by Age, Ethnicity and Literacy Status.................................... 13 Table 7. Percent Distribution of CPW, Husbands and MIL by Knowledge about the Danger Signs that can be Prevented from the Use of Calcium ........................................................ 15 Table 8. Percent Distribution of CPW, Husbands and MIL by Knowledge about Importance of Preventing Danger Signs during Pregnancy ..................................................................... 15 Table 9. Distribution of CPW, Husbands and MIL by Knowledge about Duration and Timing of Consuming Calcium during Pregnancy ................................................................ 16 Table 10. Percent Distribution of CPW, Husbands and MIL by Knowledge about the Correct Dose of Calcium Tablets and Powder to be Consumed During Pregnancy .......... 16 Table 11. Distribution of CPW by Knowledge about Frequency and Timing of Taking Calcium Tablets and Powder ................................................................................................. 17 Table 12. Percent Distribution of CPW by Initiation of Calcium Tablets and Powder in the First and Second Phase of the Survey .................................................................................. 18 Table 13. Percent Distribution of CPW by Reasons for Preferring to Continue Specific Form of Calcium ..................................................................................................................... 19 Table 14. Percent Distribution of CPW by their Preference of Calcium at the End of First Phase (n=75).......................................................................................................................... 19 Table 15. Percent Distribution of CPW by Number of Days Calcium Taken in the Last Three Months ......................................................................................................................... 20 Table 16. Percent Distribution of CPW by Utilization of Missing Calcium Tablets and Powder .................................................................................................................................... 21 Table 17. Percent Distribution of CPW by Number of Calcium Tablets and Powder Taken in the Last Three Months ...................................................................................................... 22 Table 18. Percent Distribution of CPW by Reasons for Not Taking the Complete Dose of Calcium Tablets and Powder ................................................................................................. 22 Table 19. Percent Distribution of CPW by Ways of Handling the Leftover Calcium .......... 23 Table 20. Percent Distribution of CPW by Frequency of Taking Calcium Tablets in the First and Second Phase of the Survey .......................................................................................... 24 Table 21. Percent Distribution of CPW by Frequency of Taking Calcium Powder in the First and Second Phase of the Survey .......................................................................................... 24 Table 22. Percent Distribution of CPW by Number of Days and Doses They Consumed the Calcium Supplements over 90 Days .............................................................................. 26 Table 23. Percent Distribution of CPW by Type of Foods Consumed during Their Pregnancy by Phase of Survey .............................................................................................. 27 Table 24. Percent Distribution of CPW Experiencing Side-effects from the Use of Calcium Tablets and Powder ............................................................................................................... 27 ii Nepal: A Study on Acceptability and Compliance of Calcium Supplementation Table 25. Percent Distribution of CPW by Opinion Regarding the Size of Calcium Tablets ................................................................................................................................................. 28 Table 26. Percent Distribution of CPW by Opinion Regarding the Taste of the Calcium Tablets and Powder ............................................................................................................... 29 Table 27. Percent Distribution of CPW by Reasons for Recommending Other Pregnant Women to Use Calcium in the Future ................................................................................... 31 Table 28. Percent Distribution of CPW by Place of Storing the Calcium Supplements and Problems Faced in Storing Them .......................................................................................... 31 Table 29. Percent Distribution of CPW Reporting the Persons in Their Family Who were Aware about Their Consumption of Calcium Supplements; First Phase ............................ 32 Table 30. Percent Distribution of Husbands and MIL by Type of Support Providing to Their Wives/DIL for Taking Calcium ..............................................................................................