Compliance to Prescription of Routine Vitamin D Supplementation in Infants
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Compliance to Prescription of Routine Vitamin D Supplementation in Infants
which supplementation was given as a proportion of the duration of prescription till enrolment. We also ascertained the proportion of infants who had received oral vitamin D supplementation (400 IU) in last 7 days and in previous month, to minimize recall bias.
We assessed compliance to routine vitamin D supplementation in 330 infants (age 6 wk to 9 mo), who were prescribed supplemen-tation at birth. 137 (41.5%) had received vitamin D supplemen-tation at some point of time till enrolment. Median (IQR) compliance to routine vitamin D supplementation was 66.7% (50%, 83.3%) in those who ever received supplementation. Only 29 (8.8%) were receiving appropriate routine vitamin D supple-mentation in terms of dose, frequency and duration. There was low level of reinforcement (35%) from healthcare workers and low parental awareness (34%) of the need of supplementation. Keywords: Adherence, Guidelines, Prevention, Rickets.
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outine daily vitamin D supplementation in infants is recommended by the Global consensus on rickets prevention, American Academy of Pediatrics and the Indian Academy of Pediatrics [1-3]. However parental adherence is key to its success, which has been shown to be sub-optional worldwide, resulting in poor outcome of the supplementation [4-8]. There is no relevant Indian data. We conducted this survey to estimate the proportion of infants adhering to prescription of routine vitamin D supplementation between birth and 9 months of age. This cross-sectional study was conducted in the department of pediatrics of a public medical college-affiliated hospital in Delhi. An approval from the institutional ethics committee was obtained. Considering parental adherence of 68.9% [4], with alpha error of 5%, absolute precision of 5%, and confidence level of 95%, 330 mother-infant pairs were required to be enrolled. Healthy infants between 6 weeks to 9 months of age, who were prescribed vitamin D at birth, were recruited from the immuni-zation clinic, after obtaining written informed consent from the mother. We included only those infants who were born in a health facility and having documents showing prescription of vitamin D at birth. The hospital policy is to prescribe routine vitamin D supplementation at the time of discharge from the health facility at birth. Term and preterm infants are prescribed 400 IU and 800 IU vitamin D, to be given daily till 12 months of age, irrespective of mode of feeding. No specific measures for reinforcement of supplementation are in place on follow-up. Baseline socio-demographic information was recorded. Mothers were asked whether they are still providing routine vitamin D supplementation to their infant. If not, whether they administered vitamin D to their child at any time and if yes, for how long along with the dose. Compliance was the duration for
INDIAN PEDIATRICS
Parental understanding of the prescription was also assessed for their knowledge regarding total duration for which they needed to give the
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