. 2017 Oct 24;21(2):346–354. doi: 10.1017/S1368980017002828

Table 1.

Summary of key findings from articles included in the present review of community-based distribution of iron–folic acid supplementation in low- and middle-income countries

Reference	Year	Country	Study description and type of community-based distributor	Key findings: knowledge/awareness, side-effects, IFA counselling, consumption and compliance, anaemia prevalence, ANC attendance
Aguayo et al. ⁽ ²⁵ ⁾	2005	Mali	IFA supplement distribution to pregnant and lactating women through health workers	∙ Key elements for adherence and effective programming include access and provision of clear information and counselling
Alam et al.⁽ ¹⁷ ⁾	2015	Bangladesh	IFA supplement distribution and counselling through CHW early in pregnancy	∙ Barriers identified included the belief that IFA supplementation would increase fetus size and cause complications, and concerns from decision makers about starting IFA supplementation early in pregnancy
Angeles-Agdeppa et al.⁽ ³⁰ ⁾	2005	Philippines	Weekly IFA distribution for WRA by physicians, nurses and midwives, assisted by volunteer barangay health workers. Also had a strong social mobilization and marketing component	∙ Awareness of the role of IFA supplementation in anaemia prevention increased to more than 80 % after 12 months ∙ Positive attitudes towards IFA supplementation and knowledge of food sources of iron increased throughout the study ∙ Self-reported compliance increased to over 95 % by the end of 12 months
Bharti⁽ ³⁴ ⁾	2004	India	Directly observed home-based twice daily therapy through village youth volunteers	∙ Documented compliance was 87 % ∙ Anaemia prevalence decreased by 40 % in the first 3 months ∙ Occasional side-effects were seen as a barrier by some participants
Bhutta et al.⁽ ³⁵ ⁾	2009	Pakistan	Randomized fortnightly IFA supplementation or multiple micronutrient distribution to pregnant women through home visits by CHW	∙ Documented compliance in both groups was about 75 % ∙ 10 % fewer LBW infants among women receiving multiple micronutrients compared with IFA supplementation ∙ Side-effects were noted as a barrier
Casey et al.⁽ ⁴⁰ ⁾	2009	Vietnam	Weekly distribution of universal IFA supplementation and deworming medication for WRA through village health workers and integration into existing health services	∙ Anaemia prevalence decreased from 14·0 to 5·9 % after 3 months and to 4·5 % after 12 months ∙ Literacy and education levels were associated with compliance
Dickerson et al.⁽ ³¹ ⁾	2010	Tibet	Distribution of safe and clean birth kits, newborn hats and blankets, and micronutrient supplements to pregnant women through home and community visits by local health-care workers and laypersons	∙ Nearly 100 % of outreach recipients received micronutrient supplements and safe and clean birth kits
Garcia et al.⁽ ³⁸ ⁾	2005	Philippines	Marketing and educational programmes from a private pharmaceutical company to promote weekly IFA supplementation for pregnant and non-pregnant women through local health workers and health unit staff	∙ Increased awareness of iron-deficiency anaemia, its causes and effects, and the importance of weekly IFA supplementation
Kanal et al.⁽ ¹⁸ ⁾	2005	Cambodia	Pilot programme of social marketing and community mobilization in secondary-school girls, women working in urban garment factories and women in rural villages. Supplements were distributed or sold by volunteer school-based peer educators, garment factory team leaders and rural peer educators, respectively	∙ Substantial improvements in knowledge about the causes, consequences and prevention of anaemia ∙ Majority of participants showed interest in continuing to take supplements
Khan et al.⁽ ²⁴ ⁾	2005	Vietnam	Community mobilization and social marketing to promote weekly IFA supplementation in WRA. Supplements were distributed at health stations or were sold through the Women’s Union network	∙ Increased knowledge and participation in preventive weekly IFA supplementation ∙ Purchasing and consuming weekly IFA supplements were between 55 and 92 %
Lutsey et al.⁽ ²⁸ ⁾	2008	Philippines	Community-based IFA supplementation programme at village health stations through the Philippine iron supplementation programme	∙ Self-reported compliance was 85 %, compliance measured by pill count was 70 % ∙ Self-reported compliance, timing of prenatal care and number of living children were associated with Hb concentration ∙ Forgetfulness in adhering to supplements, side-effects, inconvenience and running out of supplements were seen as barriers
Ndiaye et al.⁽ ³² ⁾	2009	Senegal	Monthly health promotion sessions for pregnant women through community volunteers	∙ Self-reported intake of iron supplements increased from 43 to 60 % ∙ Community-level distribution of supplements increased from 2·6 to 23·3 % ∙ Increased mean Hb level and significantly reduced the risk of anaemia after 9 months
Nisar et al.⁽ ²⁶ ⁾	2014	Pakistan	Most IFA supplement users got their supplements from either doctors or paid CHW. CHW provide health education and IFA supplements to pregnant women through home visits	∙ 24 % of women living in urban areas, 19 % of women being visited by a CHW and 12 % of women not being visited by a CHW consumed 90 or more IFA tablets during pregnancy ∙ 25 % of women receiving ANC services consumed 90 or more IFA supplements ∙ On average, IFA supplementation was initiated during the fifth month of pregnancy, with only 5 % of women initiating IFA supplementation during the first trimester
Nisar et al.⁽ ¹⁹ ⁾	2014	Pakistan	Most women get IFA tablets from paid lady health workers, government health facilities, and private clinics or pharmacies	∙ Rural women had less knowledge about the benefits of IFA supplementation than urban women ∙ Forgetting, unavailability of supplements, financial limitations, lack of ANC services, family members’ disapproval, lack of knowledge, side-effects, misconception that IFA supplementation is a form of contraceptive, and discontinuation due to feeling better were seen as barriers
Pal et al.⁽ ²⁰ ⁾	2013	India	Distribution of IFA supplements to pregnant women through village health workers	∙ Women who received counselling on IFA supplementation from the village health worker had 62 % higher compliance than women who did not receive counselling
Phuc et al.⁽ ³⁶ ⁾	2009	Vietnam	Weekly distribution of IFA supplements and regular deworming for women aged 15–45 years through village health workers was integrated into the existing health service infrastructure	∙ Full or partial compliance was 85 %
Seck and Jackson⁽ ⁴² ⁾	2009	Senegal	Factors affecting compliance with IFA supplementation in pregnant women	∙ Compliance was 86 % in the treatment group v. 48 % in the control group ∙ Side-effects, misconceptions about the length of treatment and forgetting to take IFA were barriers
Shivalli et al.⁽ ³⁷ ⁾	2015	India	Trials of Improved Practices to improve IFA supplement intake in pregnant women. IFA supplements were either purchased or received through the health-care system	∙ Prevalence of anaemia decreased by 50 % in the intervention group and increased by 2·4 % in the control group ∙ More than 85 % of pregnant women in the intervention group were compliant with IFA tablets, compared with only 38 % of the controls
Srivastava et al.⁽ ²² ⁾	2015	India	Social mobilization interventions to increase demand for consumption of IFA supplements distributed by health functionaries through a government programme	∙ Motivators for women to take IFA supplements included fear of anaemia risks to mother and child, health benefits, regular follow-up and availability, and inclusion of family members in counselling
Wendt et al.⁽ ²⁷ ⁾	2015	India	Determinants of IFA supplement receipt from health workers and consumption in pregnant women	∙ IFA supplement availability and attendance at ANC were associated with consumption of IFA tablets for 90 d during pregnancy ∙ Timing of ANC initiation and frequency of ANC attendance were associated with the receipt of IFA tablets ∙ 80·5 % of health facilities had a stock outage of IFA supplements on the day of the survey
Yekta et al.⁽ ²³ ⁾	2008	Iran	Distribution of IFA supplements to pregnant women through health workers at ANC	∙ Women reported low knowledge of IFA supplementation benefits and side-effects ∙ 13 % of women consumed IFA supplements during the first four months of pregnancy, 87 % took IFA supplements through the last five months of pregnancy ∙ Side-effects, family members’ disapproval, and belief that IFA supplementation is not necessary as iron is considered to be sourced only from food were seen as barriers
Young et al.⁽ ²⁹ ⁾	2009	Tanzania	Comparison of distribution of IFA supplements from health services via nurses v. private pharmacies through dispensers (pharmacists)	∙ Dispensers may not always ask about high-risk symptoms, yet have better hours, less waiting time, fewer stock outages, and also carry anthelminthic drugs ∙ Women are likely to visit them earlier in ANC ∙ Male dispensers or health workers may have difficulty counselling mothers ∙ IFA supplementation was generally accepted by women and seen as effective

IFA, iron–folic acid; ANC, antenatal care; CHW, community health workers; WRA, women of reproductive age; LBW, low birth weight.