A Comparative Evaluation of Maternal Micronutrient Supplementation And Neonatal Outcomes In Urban And Rural Tertiary Hospitals Of India And Uzbekistan (Article)
Abstract
Background: Micronutrient supplementation is a cornerstone of antenatal care, yet its effectiveness is often mediated by socioeconomic and geographic factors. Disparities in adherence and subsequent neonatal outcomes between urban and rural settings in low- and middle-income countries require detailed investigation. Objective: This study aimed to comparatively evaluate the adherence to maternal micronutrient supplementation and its correlation with key neonatal outcomes in matched urban and rural tertiary care hospitals in India and Uzbekistan. Methods: A prospective observational cohort study was conducted from January to December 2024. A total of 200 pregnant women (n=50 each from urban Delhi, India; rural Bihar, India; urban Tashkent, Uzbekistan; and rural Tashkent Region, Uzbekistan) enrolled at ≤20 weeks gestation were followed until 6 months postpartum. Data collected included adherence to Iron-Folic Acid (IFA), calcium, and vitamin D supplements; maternal haemoglobin levels; and neonatal outcomes (birth weight, gestational age, Apgar scores, Denver Developmental Screening Test (DDST) at 6 months). Statistical analysis was performed using ANOVA, Chi-square tests, and multivariate regression in SPSS v25.0 (p<0.05 significant). Results: Significant disparities were observed. IFA adherence was highest in urban centres (Delhi: 90%; Tashkent: 84%) compared to rural areas (Bihar: 66%; Tashkent Region: 60%; p=0.001). Consequently, anaemia prevalence (Hb<10g/dL) was significantly higher in rural cohorts (Bihar: 40%; Tashkent Region: 38%) versus urban (Delhi: 18%; Tashkent: 22%; p=0.003). Mean birth weight was significantly lower in rural groups (Bihar: 2.55kg; Tashkent Region: 2.6kg) compared to urban (Delhi: 3.1kg; Tashkent: 3.05kg; p<0.001). Rates of low birth weight (<2.5kg), preterm birth, and delayed DDST milestones at 6 months were consistently and significantly higher in the rural populations from both countries (p<0.05). Histopathological analysis of placentas from preterm/LBW cases revealed higher incidences of villous infarction and syncytial knotting in rural subjects. Conclusion: Despite similar national policies providing free antenatal supplements, rural populations in both India and Uzbekistan exhibited significantly poorer adherence and worse neonatal outcomes. This underscores the critical need for strengthened, targeted interventions focusing on patient education, supply chain reliability, and context-specific support programs to bridge the urban-rural health divide. Keywords: Micronutrient Supplementation, Pregnancy, Neonatal Outcomes, Urban-Rural Disparities, Iron Deficiency Anaemia, Low Birth Weight, Developmental Screening, India, Uzbekistan