Neural tube defects (NTDs) occur in the third or fourth week of pregnancy, before many women even know they are pregnant, and are highly prevalent in China. It is often advised that women take 400mg of folic acid daily to prevent neural tube defects.
National birth surveillance in China shows they occur in 13 of every 10,000 births, with incidence higher in rural areas.
Therefore, academics from the Xiangya School of Public Health in Hunan tested the effectiveness of a village-based nutrition intervention to promote folic acid use among women.
Sixty villages were randomly selected and divided into control and intervention groups.
The intervention included nutritional education at village clinics, written materials, and text messages reminders to take supplements (SMS).
Folic acid use knowledge and behaviour was assessed at baseline and after the intervention.
Self-reported compliance with folic acid supplement use increased from 17.0% to 29.2% at baseline to 41.7% to 59.2% one-year post-intervention.
During the same period, the folic acid knowledge score in the intervention group increased from 3.07 to 3.65, significantly higher than the control group (3.11 to 3.35).
Analysis showed that women who received education and SMS intervention were more likely to comply with folic acid supplement recommendations.
Witing in the journal Nutrients, the researchers stated: “The majority of the women in the intervention group (85.4%) reported having obtained folic acid supplements after intervention, significantly higher than the control group (68.6%). Compliance with folic acid use was also significantly higher in the intervention group (41.7% — 59.2%) compared with the control group (17.0% — 29.4%).”
The researchers said the study found a wide deficiency in folic acid knowledge and the use of supplements.
A large proportion of the sample was unaware of the need for folic acid supplementation, and while most of the respondents indicated that they had heard of folic acid, only 32.8% knew that it could protect against NTDs.
The researchers said SMS was a useful tool to overcome such barriers.
“SMS interventions have been shown to improve outcomes in rural health care settings,” they wrote.
“Our study also indicated that SMS text messages encouraged rural women to use folic acid supplements.
“In addition to providing reminders, the periodic SMS text messages sent information about folic acid to the rural women. Integrating SMS text messages into village-based health education may promote the delivery of folic acid information.”
They concluded that a lack of professional training for village doctors and too few female health professionals could stifle progress.
Nevertheless, they asserted: “Our integrated intervention increased folic knowledge and compliance with folic acid supplement use among rural women. Future studies should be conducted to evaluate which components of the interventions are most effective.”
“A Village-Based Intervention: Promoting Folic AcidUse among Rural Chinese Women”
Authors: Qian Lin, et al.