The effect of short message service SMS reminders on adherence with intravenous iron sucrose IVIS during pregnancy in primary care setting of district Nuh Haryana

Abstract

The present study included a total of 634 pregnant women with moderate anemia, including 317 women from rural areas and 317 women from urban areas. The comparator arm was also selected in a 1:1 ratio from both rural and urban areas. newline newlineAim of the study was to assess the effect of interactive SMS reminders on adherence with intravenous iron sucrose among study subjects. This study also assessed effectiveness of IVIS in terms of the change in Hb and serum ferritin levels among study subjects. Factors associated with non-adherence to IVIS therapy were also explored by qualitative analysis. newline newlineOut of a total of 1268 pregnant women, 74.1% (n=940) demonstrated adherence to IVIS therapy. Out of the total 634 subjects who received SMS, 495 (78.1%) adhered to IVIS therapy. In comparison, out of the total 634 who did not receive SMS, 445 (70.2%) adhered to IVIS therapy. This difference was found to be statistically significant. newline newlineThe mean change in haemoglobin level among pregnant women between baseline and endline was noted to be 2.6 ± 0.84 g/dL. The mean (SD) hemoglobin level increased from 8.026 g/dL (0.5036) initially to 10.75 g/dL (0.85) after 6 weeks of IVIS therapy, resulting in mean rise of 2.724 g/dL. This difference was found to be statistically significant. The mean (SD) Serum Ferritin level increased from 10.441 ng/mL (3.11759) at baseline (Before IVIS therapy), to 43.616 ng/mL (27.3020) at 6 weeks post IVIS therapy. This difference was found to be statistically significant. newline newlineNet improvement to normal hemoglobin levels i.e. change to normal (%) between baseline and end line was 46.5%, post IVIS therapy. Net improvement to normal hemoglobin levels among pregnant women receiving two additional top-up doses i.e. change to normal (%) between baseline and end line was 72.7%, respectively. Statistically significant association was also observed between the educational status, occupational status of husband of pregnant women, type of family, age at marriage (and#8804; 21 years or gt 21 years), gravida status, number of living children, age at first child birth, date of enrolment and last child birth, place of delivery of last child birth, mode of delivery of last child birth, previous ANC visits with compliance to IVIS therapy. newline newlineNo statistically significant association was noted between religion, age at marriage (and#8804; 18 years or gt 18 years), family size (and#8804;10 or gt10), ANC registration status of pregnant mother with compliance to IVIS therapy. newline newlineSix themes identified from the in-depth interview conducted among non- compliant study subjects were: Fear of side effects, Subjective feeling of well-being, Inadequate family support, Inadequate knowledge about disease and its management, Poor functioning of public health care facilities and Administrative weakness. newline newline