Multiple Micronutrient Supplements Versus Iron Folic Acid Supplementation on Pregnancy Outcomes in Nandi County, Kenya

Abstract

According to World Health Organization use of more than two micronutrients is beneficial to pregnant women. However, anemia prevalence, labor duration, neonatal Apgar score, blood loss and lochia loss, have not been studied in relation to multiple micronutrient use. The study supplemented maternal micronutrients to influence anemia, pregnancy weight gain, labor and birth duration, blood loss, lochia loss and infant development in Kenya. The study using convenience sampling, defined sub-populations at risk of nutritional deficiencies and provided opportunities, for early intervention through use of multiple micronutrients on pregnancy outcomes. The study objective was to determine the effect of multiple micronutrient supplements and Iron Folic acid supplementation on maternal infant health outcomes. This was through a Cluster Randomized Controlled study. The treatment arm was administered with a daily multiple micronutrients while the control arm took the standard care; iron folic acid. A semi structured questionnaire and focus group discussion were applied to collect data on effect of prenatal multiple micronutrients among the pregnant women. The study demonstrated that the difference in means of: hemoglobin levels was 12.1 (11.6, 12.4) in MM group and 11.3 (9.7, 11.8) p=0.038, duration of labor was; 8.0 (6.0,20.0) hours for the MMs and 20.0 (15.0,30.0) for IFA p=0.023. Average birthweight in kilograms at birth; 3.3 (3.2,4.1) for MM and 3.2 (3.0,3.5) kgs for IFA (p=0.024). Blood and lochia loss: light (MM) 79%; (IFA) light- 21%, p=0.001; heavy (MM) 10.5%, (IFA) 48.2% p=0.001 Breastmilk was available within thirty minutes in 85.7% of MM group and 20% of IFA group p=0.001. Third trimester weight gain mean was 67.89 kilograms (SD: 8.5) for MM and 62.7 kilograms (SD: 6.4) for IFA p=0.032. There was significance in subjects effects for labor duration in hours p=0.006, blood loss p=0.001 and lochia loss p, 0.025. Roy’s Largest Root was equivalent to Hotellings’ Trace; therefore, the effect observed was associated with; labor duration p=0.003, blood loss p=0.001 and lochia loss p=0.001. Contrast results demonstrated that there was a significant effect difference observed in the model in the dependent variables; labor duration p=0.003, blood loss p=0.001 and lochia loss p=0.001. Since the significance levels for the dependent variables were less than 0.05, the study concluded that the difference observed was not due to chance variation, therefore, contrast concludes that the multiple micronutrients reduces labor duration during pregnancy, postpartum hemorrhage, lochia loss amount and duration. The study recommends a policy change from iron folic acid use to multiple micronutrients to promote reduced; labor duration, postpartum hemorrhage, lochia loss amount and duration.