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Background and Objectives: Initiation and adherence are both critical challenges for micronutrient supplementation programs, especially during the preconceptional period. This study examines factors influencing initiation of supplement use and continued adherence among women participating in PRECONCEPT, a double-blind randomized controlled trial of preconception micronutrient supplementation.Methods: In-depth interviews were conducted with 39 participants during different periods (prepregnancy [n = 15], pregnancy [n = 8], postpartum [n = 8], and dropouts [n = 8]). We examined participants' knowledge about nutritional needs and micronutrient deficiencies, individual experience with nutritional supplements, and perceived benefits and side effects of supplements. Four focus groups were conducted with 24 village health workers (VHWs) to collect information on VHWs' perceptions of factors influencing participants' adherence and logistics of supplement distribution. Influences on initiation and adherence were examined within the Health Belief Model framework.Results: Primary barriers to initiation of supplement use were low perceptions of severity of nutrient deficiencies and personal susceptibility. These are associated with low knowledge and awareness around deficiencies. Perceived seriousness and susceptibility varied by nutrient: high for iron during pregnancy but low for all other micronutrient deficiencies, including iron outside pregnancy. Continued maintained adherence to an initiated regimen was influenced by the woman's perceptions of the health benefits of, and barriers to, regular supplement use.Conclusion: Initiation of supplement use was influenced by perceived susceptibility and severity of nutrient deficiencies, while maintained adherence to consistent use was influenced by perceived benefits and barriers. Recognizing the influences on each stage may help improve adherence and maximize positive effects of future interventions. [ABSTRACT FROM AUTHOR]

Background. Mid-upper-arm circumference (MUAC) and calf circumference (CC) are correlated with body mass index (BMI) in adults and may be useful for screening women with underweight (BMI < 18.5 kg/m2). However, there is no consensus on appropriate MUAC and CC cutoff points in diverse populations, especially in women of reproductive age. Objective. To assess the accuracy of different MUAC and CC cutoff points to screen for underweight and to identify the most appropriate cutoff points in a sample of women of reproductive age from rural northern Vietnam. Methods. Anthropometric measurements (weight, height, MUAC, CC, and triceps and subscapular skinfold thicknesses) were obtained for 4,981 women of reproductive age who participated in a micronutrient intervention trial (PRECONCEPT) in Thai Nguyên Province, Vietnam. Receiver operating characteristic (ROC) analysis was used to evaluate different cutoff values of MUAC and CC and identify the most appropriate cutoff values to predict underweight. Results. The overall prevalence of underweight was 32%. The MUAC value of 23.5 cm and the CC value of 31 cm were identified as the best cutoffs based on low misclassification (16% for MUAC and 21% for CC) and good balance of sensitivity (89% and 85%, respectively) and specificity (71% and 67%, respectively. The ROC curves were similar across different ethnic groups, with the area under the curve (AUC) values reaching 0.89 to 0.93 for MUAC and 0.83 to 0.89 for CC. Conclusions. MUAC and CC perform adequately in screening for underweight in women. The utility of these measurements in predicting functional outcomes should be examined. [ABSTRACT FROM AUTHOR]