Assessing the Adherence to Iron and Folic Acid vs. Multiple Micronutrient Supplements During Pregnancy: A Cluster Randomized Non-Inferiority Trial in Cambodia
Bibliographic record
Abstract
Objectives: Guidelines in Cambodia recommend iron and folic acid (IFA) supplementation during pregnancy. However, recent research has proven the superiority of multiple micronutrient supplementation (MMS) over IFA to reduce the risk of maternal anemia and adverse birth outcomes. The Cambodian Ministry of Health has expressed strong interest to transition from IFA to MMS during pregnancy but are seeking evidence in the Cambodian context to rigorously inform this policy change. Our primary objective was to assess adherence to MMS vs. IFA supplementation during pregnancy in Cambodia, as one of the first steps. Methods: We conducted a cluster-randomized non-inferiority trial across 48 health centers in Kampong Thom province. A total of 1,546 pregnant women were recruited at their first antenatal care visit and randomized to one of three arms at the health center-level: 1. IFA for 90 days (IFA-90, n=515), the current standard of care. 2. MMS for 180 days via one 180 tablet bottle (MMS-180, n=516). 3. MMS for 180 days via two 90-tablet bottles (MMS-90, n=515). The primary outcome was the non-inferiority of adherence rates to MMS-180 (180 days) compared to IFA-90 (90 days), assessed by tablet counts. Mixed-effects linear regression models were used to estimate the mean difference (95% CI) in adherence rates, controlling for health centers (clusters) and using an “a priori’ non-inferiority margin of 15%. Results: Overall, 87% of women completed the trial, with similar rates across IFA-90, MMS-180 and MMS-90 groups (89%, 88%, and 86% respectively). At enrollment, mean±SD age of women was 28±6 years and gestational age was 8±3 weeks. Overall, mean (95%CI) adherence rates groups were 91% (90, 92), 95% (94, 96), and 95% (94, 96), respectively; adherence was higher in both MMS groups as compared to IFA-90 (P< 0.001). The adjusted mean (95%CI) difference in adherence rates between MMS-180 and IFA-90 groups was 3.5% (1.3, 5.6), and between MMS-180 and MMS-90 groups was 0.3% (-2.5, 1.9). Conclusions: Adherence to MMS-180 during pregnancy was non-inferior to IFA-90; in fact, MMS-180 showed superiority to IFA-90. Adherence rates in the MMS groups did not differ when tablets were distributed via one vs. two bottles. These findings support the policy change for the use of MMS during pregnancy in Cambodia. Funding Sources: Vitamin Angel Alliance.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".