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Ghimire M, Bhandari S, Rajbanshi M. Prevalence of anemia and its associated factors among school-going adolescent girls in schools of Dhankuta municipality, Nepal. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003684. [PMID: 39288117 PMCID: PMC11407645 DOI: 10.1371/journal.pgph.0003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024]
Abstract
Adolescent girls are more vulnerable to anemia, especially in low and middle-income countries like Nepal. It is due to early marriage and pregnancy, rapid physical growth, low body weight, economic disparities, heavy menstrual bleeding, and inadequate iron diet. This study aimed to determine the prevalence of anemia and its associated factors among school-going adolescent girls. A cross-sectional study was conducted among 405 adolescent girls using a stratified random sampling technique from both public and private schools. A statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 25 software. The frequencies, percentages, mean, and standard deviation were used to describe the characteristics of the participants. Binary logistic regression was performed for multivariable analysis. All the tests were performed at a 95% Confidence Interval (CI) and p-value of <0.05. The mean (± SD) age of the participants was 14.2 ± 1.2 years. The majority of the participants (64.7%) were from government schools. Around 18% (95% CI: 13.8, 21.2) of the participants were anemic in the study. Poor knowledge of anemia (AOR = 3.3, CI: 1.0, 11.1), incomplete iron and folic acid intake (AOR = 26.8, CI: 8.3, 86.4), and absence of dietary diversity (AOR = 2.5, CI: 1.1, 9.2) were significantly associated with the higher prevalence of anemia among the adolescent girls. To reduce the risk of anemia among adolescent girls, a comprehensive strategy involving a school health intervention package on anemia, IFA supplements, and deworming program should be promoted. Besides, community-focused awareness programs should be strengthened to increase dietary diversity and improve awareness of anemia in the community.
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Affiliation(s)
- Milan Ghimire
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Manish Rajbanshi
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Biswas B, Gautam A, Jahnavi G, Richa, Gupta P, Varshney S. Barriers, Facilitators of Iron and Folic Acid Supplementation, and Deworming Program among School-Going Adolescents of Deoghar, Jharkhand, India: A Mixed-Methods Study. Korean J Fam Med 2024; 45:274-282. [PMID: 38414372 DOI: 10.4082/kjfm.23.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/03/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND This study aimed to identify barriers and facilitators of iron and folic acid supplementation and deworming programs among school-going adolescents. METHODS A mixed-method observational study was conducted among adolescents in the 8th to 10th standards and their teachers across four schools in Deoghar, Jharkhand, India, using simple random sampling. The study included a questionnaire on socio-demographics, knowledge (34 items) (α=0.894), attitudes (2 items) (α=0.711) toward iron deficiency anemia, awareness of the Weekly Iron and Folic Acid Supplementation (WIFS) program and deworming (20 items) (α=0.783), and practices related to iron folic acid supplementation (IFS) and deworming, along with qualitative components. Data were analyzed using jamovi. RESULTS Compliance rates for IFS and deworming were 27.5% and 67.9%, respectively. The multivariable logistic regression analysis showed that sex, religion, caste, father's educational status, per capita monthly family income (PCMI), diet type, adequate knowledge, and positive attitude toward anemia influenced IFS compliance. Religion, PCMI, and prior information on the importance of deworming facilitate compliance. Implementation barriers included irregular medication supply and a lack of student awareness. CONCLUSION Periodic evaluation, regular sensitization, and a consistent drug supply are necessary to effectively implement WIFS and deworming programs in the study area.
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Affiliation(s)
- Bijit Biswas
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, India
| | - Anuradha Gautam
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, India
| | - G Jahnavi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, India
| | - Richa
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, India
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Deoghar, India
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Khanal A, Paudel R, Wagle CN, Subedee S, Pradhan PMS. Prevalence of anemia and its associated factors among adolescent girls on Weekly Iron Folic Acid supplementation (WIFAS) implemented and non-implemented schools at Tokha municipality, Kathmandu. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002515. [PMID: 38277373 PMCID: PMC10817172 DOI: 10.1371/journal.pgph.0002515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/01/2023] [Indexed: 01/28/2024]
Abstract
Anemia, the prevailing nutritional disorder worldwide, exerts its greatest impact on individuals in developing nations, exhibiting a heightened prevalence among adolescents. There is a window of opportunity for children to improve their nutritional status during their adolescence period. Weekly iron-folic acid supplementation is the preventive measure to break the intergenerational cycle of anemia. The correlation between the consumption of iron folic acid supplements and the prevention of anemia has been firmly established by numerous studies, revealing a statistically significant association. Therefore, this study was undertaken with the aim to assess the difference in the prevalence of anemia and its associated factors among adolescent girls in Weekly Iron Folic Acid Supplementation (WIFAS) implemented and non-implemented schools at Tokha Municipality, Kathmandu. A cross-sectional study was carried out among 602 adolescent girls from grade six to ten equally divided into WIFAS implemented and WIFAS non-implemented schools. Hemoglobin estimation was done using the HemoCue Hb 301 method. The descriptive, univariate and multivariable logistic regression analysis was done using SPSS version 25 to identify a significant association between anemia and its associated variables at p-value<0.05. The overall prevalence of anemia among adolescent girls was found to be 17.4% out of which, 14% and 20.9% from WIFAS-implemented and non-implemented schools respectively. The factors like type of school, fathers' education and dietary diversity were found to be statistically significant with anemia during multivariable logistic regression analysis. Given the findings of this research, proper counseling and promotion of utilization of WIFAS in order to decrease the prevalence of anemia among adolescent girls are recommended.
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Affiliation(s)
- Anita Khanal
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rajan Paudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Chetan Nidhi Wagle
- National Health Training Center, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Shantos Subedee
- Nepal Public Health Laboratory, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Silitonga HTH, Salim LA, Nurmala I, Wartiningsih M. Compliance of Iron Supplementation and Determinants among Adolescent Girls: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:37-48. [PMID: 36824244 PMCID: PMC9941429 DOI: 10.18502/ijph.v52i1.11664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/16/2022] [Indexed: 01/19/2023]
Abstract
Background Iron deficiency anemia in children or women in pregnancy, is a public health problem in some countries. The World Health Organization (WHO) has called on all countries to achieve a 5% reduction in anemia in women of childbearing age, including adolescent girls, by 2025. One of the programs is iron supplementation. The success depends on the adherence of adolescent girls to consume iron tablets. This systematic review aimed to find the level of compliance to iron supplementation consumption among adolescent girls and explore barriers and facilitator factors to such adherence. Methods This article was a systematic review and conducted a multi-database search. The articles passed the PRISMA flow diagram process. The inclusion and exclusion rules decided the qualification of studies included. Of 1066 articles, we obtained 20 studies for the systematic review. Result The lowest compliance found were 26.2% and 26.3%, and was high (>80%) in intervention studies involving supervision and monitoring and peer educator. All articles' barrier and facilitator factors were classified into four categories; personal, social, environmental, and regimen. Conclusion Efforts to improve adolescent compliance to take iron tablets should consider all of these factors.
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Affiliation(s)
| | - Lutfi Agus Salim
- Faculty of Public Health, Universitas Airlangga Surabaya, Surabaya, Indonesia
| | - Ira Nurmala
- Faculty of Public Health, Universitas Airlangga Surabaya, Surabaya, Indonesia
| | - Minarni Wartiningsih
- Department of Public Health, Preventive Medicine and Community Medicine, Faculty of Medicine, Universitas Ciputra Surabaya, Surabaya, Indonesia
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Handiso YH, Belachew T, Abuye C, Workicho A, Baye K. A community-based randomized controlled trial providing weekly iron-folic acid supplementation increased serum- ferritin, -folate and hemoglobin concentration of adolescent girls in southern Ethiopia. Sci Rep 2021; 11:9646. [PMID: 33958657 PMCID: PMC8102612 DOI: 10.1038/s41598-021-89115-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
Adequate micronutrient status during adolescence can break the inter-generational cycle of malnutrition. This study evaluated the effect of community-based weekly iron-folic acid supplementation (WIFAS) on serum ferritin (SF), serum folate (SFol) and hemoglobin concentration (Hb) among adolescent girls. A community-based, individually randomized-controlled trial (RCT) was conducted in four villages of Wolaita and Hadiya zones. Adolescent girls (n = 226) aged 10-19 years were recruited and randomly assigned (n = 113/group) into: (i) WIFAS and (ii) control (no intervention) groups. Anthropometry, Hb concentration, and serum ferritin (SF), SFol, and C-reactive protein (CRP) was analyzed at baseline and endline. Baseline Hb, SF, SFol and CRP concentrations were similar in both groups (P > 0.05). About 47-49% of adolescents had marginal iron store (< 50 µg/l). Hb, SF, and SFol concentrations increased in the intervention group, but not in the control group (P < 0.05). Marginal iron store decreased from 49 to 12% after 3-months of WIFAS; whereas, the proportion of adolescents with elevated SF (> 15 µg/l) was slightly higher in the WIFAS than in the control group (P = 0.06). After adjusting for confounding factors in the multiple linear regression model, a three-months WIFAS intervention was associated with an improvement of 4.10 ng/ml in serum folate, 39.1 μg/l in serum ferritin, and 1.2 g/dl in hemoglobin concentration relative to the control group (P < 0.001). WIFAS intervention for three-months was effective in reducing iron and folate deficiency in adolescent girls. Future studies should evaluate the long-term impact of intermittent WIFAS.
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Affiliation(s)
- Yoseph Halala Handiso
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- Center for Food Science and Nutrition, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | | | - Abdulhalik Workicho
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Kaleab Baye
- Center for Food Science and Nutrition, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Apriningsih, Madanijah S, Dwiriani CM, Kolopaking R. Determinant of Highschool Girl Adolescent' Adherence to Consume Iron Folic Acid Supplementation in Kota Depok. J Nutr Sci Vitaminol (Tokyo) 2021; 66:S369-S375. [PMID: 33612627 DOI: 10.3177/jnsv.66.s369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Anemia is one of the major problems among female adolescents in Indonesia. Weekly iron-folic acid supplementation was a cost-effective measure to tackle adolescent anemia. However, adherence to the supplementation is low. This study was aimed to explore the determinants of t highschool females' adherence to consume iron-folic acid tablets. Using cross sectional design with 274 subjects. After obtaining consent the data were collected, coded and analysed using SPSS23. The inclusion criteria were high school female from 18 schools which had iron tablets program. The majority of subjects was 14-16 y old (73.7%). The majority of schools gave iron tablets to students without organizing taking iron tablets together (63.5%). The adherence to consume iron and folic acid tablets in this study was 45.6% (n=125). Almost half of highschool female (36.1%) cited they did not think that iron tablets are necessary while 12.4% cited experiencing side effects. Factors that were correlated (p<0.005) were school organizing taking iron tablets together, the student's age, knowledge, motivation, self efficacy, prior Hb level examination, and teacher educating the benefits of iron tablets to students (OR=9.5, CI=5.4-16.8, OR=0.43, CI=0.23-0.78, OR=2.12, CI=1.29-3.48, OR=6.55, CI=3.77-11.4, OR=6.39, CI=3.7-10.9 respectively). The most important factors which determined highschool female's adherence were school organizing students to take iron tablets together at school (OR=7.2, CI=3.5-14.6, p=0.000), student's motivation (OR=5.3, CI=2.5-11.3, p=0.000), and class teacher educating students on anemia and IFA (OR=2.3, CI=1.2-4.6) meanwhile student's knowledge, self efficacy, and prior Hb level examinations were confounding factor.
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Affiliation(s)
- Apriningsih
- University Pembangunan Nasional Veteran Jakarta
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Alfiah E, Briawan D, Khomsan A, Dewi M, Ekayanti I, Mardewi, Raut MK, Zakaria A, Roche ML. Coverage and Adherence of Weekly Iron Folic Acid Supplementation among School Going Adolescent Girls in Indonesia. J Nutr Sci Vitaminol (Tokyo) 2021; 66:S118-S121. [PMID: 33612579 DOI: 10.3177/jnsv.66.s118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Weekly Iron Folic Acid (WIFA) supplementation program for school going adolescent girls has been implemented by Indonesian Government since 2016. The objective of this study was to assess the coverage and adherence toward the WIFAS among school going adolescent girls, as part of a baseline assessment of the new intervention. METHODS A cross-sectional survey was conducted in East Java (EJ) and East Nusa Tenggara (ENT) in year 2018. The samples were drawn from 60 high schools from 20 districts. The data collection was done by using a semi-structured, self-administered questionnaire. RESULTS The total number of respondents in EJ and ENT was 934 and 922 adolescent girls respectively, with a mean age of 17 y. The percentage of girls who reported to have received WIFAS tablet in the last six months was only 10% in ENT and 31% in EJ. The average number of WIFA tablet received was only 0.4-1.4 tablets and the average number of tablets consumed was only 0.4-0.7 tablet in the last 6 mo. Adolescent girls, who consumed at least 1 tablet was only 9% in ENT and 18% in EJ. The frequently causes of not consuming WIFA were that they forgot; did not think it was necessary; and were scared side effects. CONCLUSION The coverage and adherence to WIFA program among school going adolescent girls in EJ and ENT provinces were low.
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Affiliation(s)
- Elma Alfiah
- Nutrition Study Program, Science and Technology Faculty, Al Azhar University
| | - Dodik Briawan
- Department of Community Nutrition, Human Ecology Faculty, Bogor Agricultural University.,SEAFAST Center, Bogor Agricultural University
| | - Ali Khomsan
- Department of Community Nutrition, Human Ecology Faculty, Bogor Agricultural University
| | - Mira Dewi
- Department of Community Nutrition, Human Ecology Faculty, Bogor Agricultural University.,SEAFAST Center, Bogor Agricultural University
| | - Ikeu Ekayanti
- Department of Community Nutrition, Human Ecology Faculty, Bogor Agricultural University
| | - Mardewi
- Nutrition International, Country Office
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Apriningsih A, Madanijah S, Dwiriani CM, Kolopaking R, Crosita Y. School Readiness in Weekly Iron Folic Acid Supplementation Program in Urban Area, West Java, Indonesia. AMERTA NUTRITION 2020. [DOI: 10.20473/amnt.v4i4.2020.291-298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:School based weekly iron and folic acid supplementation (WIFAS) program was aimed to decrease anemia prevalence and improve the adherence to consume iron tablet.Limited information on the school perspective and their readiness to implement the program.Objectives:To analyze program guidelines, stakeholders’ perspective and school readiness to implement the program which will help evaluate and improve adherence to WIFAS.Methods:Using cross sectional design with mixed method approach to utilize social ecological model and community readiness model.Results: Most of schools received awareness campaign regarding the program,only 38,9% have conducted a drinking together session once a week,only 27,8% recorded their students’ adherence.The average score for the school readiness was 3.36 (SD ±0.82), the school was in the vague awareness stage.There is a correlation between the score of school’s knowledge, attitude toward WIFAS program,City Health Authority and Education Regional Office ‘s support score, the total score of the school readiness, ever got socialization with implementation of WIFAS (r= 0.35, r=0.2, r=0.49, r=0.21, r= 0.66, r= 0.43, p value <0.005).The strongest correlation with implementation of WIFAS at school was the school readiness total score, ever received socialization and score school’s knowledge on WIFAS (p value <0.005) and City health Authority and Education regional office’s support score for WIFAS program as covariant (p >0.05).Conclusions: School readiness is important factor of community and environment which contribute to behavior change.School realize that anemia and schoolgirl adherence to consume WIFAS had to solved but did not know how and assume outside parties can help solve the problem.The City Health Authority and Education Regional Office is expected to help improve the school readiness to implement the program.
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Klemm GC, Birhanu Z, Ortolano SE, Kebede Y, Martin SL, Mamo G, Dickin KL. Integrating Calcium Into Antenatal Iron-Folic Acid Supplementation in Ethiopia: Women's Experiences, Perceptions of Acceptability, and Strategies to Support Calcium Supplement Adherence. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:413-430. [PMID: 33008855 PMCID: PMC7541115 DOI: 10.9745/ghsp-d-20-00008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/16/2020] [Indexed: 01/10/2023]
Abstract
Recommendations for antenatal calcium supplementation to prevent preeclampsia could substantially reduce maternal mortality, but adherence to multiple daily doses may constrain effectiveness. World Health Organization guidelines recommend 3 daily calcium supplements (1.5-2 g/d), taken separately from 1 iron-folic acid (IFA) supplement; however, limited data suggest lower calcium doses may also be effective. We conducted mixed-methods household trials to identify strategies for supporting adherence and integrating calcium into antenatal IFA supplementation programming in Ethiopia. Participants were randomly assigned to 3 regimens varying in dose and timing and were later given a choice of regimens. Semistructured interviews conducted over 6 weeks explored acceptability, barriers, and facilitators and offered opportunities to choose calcium pill type. Interviews were transcribed, translated, and analyzed thematically. Calcium adherence was measured using medication event monitoring. All participants (N=48) agreed to try supplementation. Adherence barriers included forgetting to take pills when busy or travelling and perceived side effects. Midday doses were the most challenging because of farming, market, and social events; women avoided taking supplements in public due to fear of being perceived as HIV positive. Social support from families, visual reminders, and anticipated benefits motivated adherence. More participants (75%) selected chewable versus conventional supplements due to organoleptic properties, but this preference declined over time. Adherence rates did not substantially differ across regimens with 2 (81.1%), 3 (83.4%), or 4 (77.1%) pill-taking events. Women indicated that the 2-event regimen was more acceptable than 3- and 4-event regimens, but this acceptability was not associated with higher adherence. Consequently, mean daily calcium consumption (811.3 mg) was lower than for 3-event (1,251.1 mg) and 4-event (1,156.4 mg) regimens. Integrating calcium into antenatal IFA supplementation is acceptable to Ethiopian women, with a 3-event regimen yielding the highest consumption rates. Despite women experiencing challenges with midday dosing and stigma, using simple home-based strategies and being counseled on the purpose of supplementation were more effective than reducing dosage for mitigating barriers and improving adherence.
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Affiliation(s)
- Gina C Klemm
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Zewdie Birhanu
- Faculty of Public Health, Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Stephanie E Ortolano
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Yohannes Kebede
- Faculty of Public Health, Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Stephanie L Martin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Girma Mamo
- Ethiopia-Canada Cooperation Office, Nutrition International, Addis Ababa, Ethiopia
| | - Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
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Yilma H, Sedlander E, Rimal RN, Pant I, Munjral A, Mohanty S. The reduction in anemia through normative innovations (RANI) project: study protocol for a cluster randomized controlled trial in Odisha, India. BMC Public Health 2020; 20:203. [PMID: 32033546 PMCID: PMC7007687 DOI: 10.1186/s12889-020-8271-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than half of women in India are anemic. Anemia can result in fatigue, poor work productivity, higher risk of pre-term delivery, and maternal mortality. The Indian government has promoted the use of iron-folic acid supplements (IFA) for the prevention and treatment of anemia for the past five decades, but uptake remains low and anemia prevalence high. Current programs target individual-level barriers among pregnant women and adolescents, but a more comprehensive approach that targets multiple levels among all women of reproductive age is needed to increase uptake of IFA and iron-rich foods. METHODS The Reduction in Anemia through Normative Innovations (RANI) project is a norms-based intervention to reduce anemia among women of reproductive age. We will evaluate the intervention through a clustered randomized controlled trial in Odisha, India. We will collect data at three time points (baseline, midline, and end line). For the study, we selected 89 clusters of villages, which we randomized into treatment and control on a 1:1 basis. The treatment arm will receive the RANI project components while the control arm will receive usual care. Fifteen clusters (40-41 villages) were selected and 4000 women (2000 in each arm) living in the selected clusters will be randomly selected to take part in data collection. Women in both study arms will have their hemoglobin concentrations measured. They will also complete in-person surveys about their knowledge, attitudes, perceptions of iron folic acid supplements, and nutritional intake. We will also select a smaller cohort of 300 non-pregnant women (150 in each arm) from this cohort for additional physical activity and cognitive testing. We will conduct both within- and between-group comparisons (treatment and control) at baseline, midline and end line using t-tests. We will also conduct structural equation modeling to examine how much each factor accounts for IFA use and hemoglobin levels. DISCUSSION This RCT will enable us to examine whether a social norms-based intervention can increase uptake of iron folic acid supplements and iron rich foods to reduce anemia. TRIAL REGISTRATION This trial was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.
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Affiliation(s)
- Hagere Yilma
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA.
| | - Erica Sedlander
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ichhya Pant
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Ashita Munjral
- Department of Social and Economic Empowerment, IPE Global Limited, New Delhi, Delhi, India
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Compliance with Weekly Iron and Folic Acid Supplementation and Its Associated Factors among Adolescent Girls in Tamale Metropolis of Ghana. J Nutr Metab 2019; 2019:8242896. [PMID: 31885910 PMCID: PMC6927017 DOI: 10.1155/2019/8242896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/02/2019] [Accepted: 11/29/2019] [Indexed: 11/17/2022] Open
Abstract
Background In Ghana, anaemia is a severe public health problem among adolescent girls. In an attempt to deal with this phenomenon, Ghana Ministry of Health in collaboration with other development partners developed and launched weekly iron and folic acid supplementation program for adolescent girls in Ghanaian junior high schools. Therefore, the main aim of this study was to determine the level of compliance with iron and folic acid supplementation (IFAS) and its associated factors among adolescent girls in the Tamale Metropolis of Ghana. Methods A cross-sectional study was conducted among 424 randomly sampled adolescent girls in the Tamale Metropolis of Ghana from April to July 2019 using an interviewer-administered structured questionnaire. Twenty school health coordinators were purposively selected to answer questions on the challenges they face in implementing the IFAS program at the school level. Bivariate logistic regression and multivariate logistic regression were used to determine associations and strength of associations, respectively, at a significant threshold of p < 0.05. Results Compliance with the IFAS was low (26.2%). Adolescent girls who were aware of anaemia (AOR = 3.57 (95% CI: 1.96, 6.51) p < 0.01), had good knowledge of anaemia (AOR = 1.82 (95% CI: 1.17, 2.81) p=0.01), and had good knowledge of the IFAS program (AOR = 2.29 (95% CI: 1.47, 3.57) p < 0.01) were significantly associated with compliance with the IFAS. The majority (60%) of the adolescent girls have ever missed taking the iron and folic acid (IFA) tablet because it was not issued to them by the teacher's concern while about 48.3% (169) of the adolescent girls are taking the tablet because it prevents anaemia. Adolescent girls perceiving the tablet as family planning medicine (88.8%) and unavailability of water in classrooms (18.8%) were cited as the major challenges by school health coordinators. Conclusion Compliance with the IFAS among adolescent girls was low. Level of education and occupation of mothers of adolescent girls, awareness on anaemia, and good knowledge of anaemia and of the IFAS program were significant predictors of compliance with the IFAS. Educating the adolescent girls on anaemia and benefits of the IFAS, constant supply of the IFA tablet, and engaging parents of the adolescent girls on the program will help improve the compliance level of the adolescent girls with the IFAS.
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Effectiveness of Workplace Nutrition Programs on Anemia Status among Female Readymade Garment Workers in Bangladesh: A Program Evaluation. Nutrients 2019; 11:nu11061259. [PMID: 31163648 PMCID: PMC6627420 DOI: 10.3390/nu11061259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 12/21/2022] Open
Abstract
Eight in ten female readymade garment (RMG) workers in Bangladesh suffer from anemia, a condition which damages both health and productivity. This study evaluated the effectiveness of a workplace nutrition program on anemia reduction in female RMG workers of Bangladesh. A quasi-experimental mixed method study was conducted on 1310 non-pregnant female RMG workers from four factories. Two types of intervention packages (A and C) were tested against their respective controls (B and D) over a 10-month period. Among factories that already provided lunch to workers with regular behavior change counseling (BCC), one intervention (A) and one control (B) factory were selected, and among factories that did not provide lunches to their workers but provided regular BCC, one intervention (C) and one control (D) factory were selected: (A) Lunch meal intervention package: daily nutritionally-enhanced (with fortified rice) hot lunch, once weekly iron-folic acid (IFA) supplement and monthly enhanced (with nutrition module) behavior change counseling (BCC) versus (B) Lunch meal control package: regular lunch and BCC; and (C) Non-meal intervention package: twice-weekly IFA and enhanced BCC versus (D) Non-meal control package: BCC alone. Body weight and capillary hemoglobin were measured. Changes in anemia prevalence were estimated by difference-in-difference (DID) method. Thematic analysis of qualitative in-depth interviews with RMG workers was performed and findings were triangulated. Anemia was reduced significantly in both lunch meal and non-meal intervention (A and C) group (DID: 32 and 12 percentage points, p: <0.001 and <0.05 respectively). The mean hemoglobin concentration also significantly increased by 1 gm/dL and 0.4 gm/dL in both A and C group (p: <0.001 respectively). Weight did not change in the intervention groups (A and C) but significantly increased by more than 1.5 kg in the comparison groups (B and D). The knowledge of different vitamin and mineral containing foods and their benefits was increased significantly among all participants. Workplace nutrition programs can reduce anemia in female RMG workers, with the greatest benefits observed when both nutritionally enhanced lunches and IFA supplements are provided.
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Karkada S, Upadhya S, Upadhya S, Bhat G. Beneficial Effects of ragi (Finger Millet) on Hematological Parameters, Body Mass Index, and Scholastic Performance among Anemic Adolescent High-School Girls (AHSG). Compr Child Adolesc Nurs 2019; 42:141-150. [PMID: 29595341 DOI: 10.1080/24694193.2018.1440031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adolescence is a period characterized by rapid physical, emotional, and mental growth and changes potentially resulting in health challenges. Anemia, which is a fairly common complication in this age group, is reported to negatively affect the cognitive ability of adolescents. Traditionally, ragi (Finger millet: Eleusine coracana), a cereal available in India, has been recommended as nutritional supplement to combat anemia because of its high protein and mineral content as well as anti-microbial property. This study sought to establish the effect of ragi in improving hematological parameters, body mass index, and scholastic performance among adolescent school girls. Sixty adolescent girls were randomly selected and divided into intervention (n = 30) and control groups (n = 30). The effect of dietary supplementation of ragi porridge on hematological parameters was evaluated on the intervention group at 45 and 90 days. Both groups were monitored for changes in body mass index and scholastic performance. A statistically significant increase in hemoglobin levels was observed in the intervention group after 90 days (from a mean of 11.3 g% to 12.54 g%; t (29) = 7.514, p < .0001), with no significant changes in the control group. No statistically significant differences between the two groups were observed for mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular volume, red cell distribution width, body mass index, and scholastic performance. The data show that daily dietary supplementation with ragi porridge has a positive effect on hemoglobin levels in adolescent high schools girls. A well planned nutrition education with dietary supplementation is thus recommended for better outcomes.
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Affiliation(s)
- Suja Karkada
- a College of Nursing , Sultan Qaboos University , Muscat , Oman
| | - Sharmila Upadhya
- b School of Medicine , St. George's University , Grenada , Grenada
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Fernández-Gaxiola AC, De-Regil LM. Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women. Cochrane Database Syst Rev 2019; 1:CD009218. [PMID: 30699468 PMCID: PMC6360921 DOI: 10.1002/14651858.cd009218.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Anaemia is a condition in which the number of red blood cells is insufficient to meet physiologic needs; it is caused by many conditions, particularly iron deficiency. Traditionally, daily iron supplementation has been a standard practice for preventing and treating anaemia. However, its long-term use has been limited, as it has been associated with adverse side effects such as nausea, constipation, and teeth staining. Intermittent iron supplementation has been suggested as an effective and safer alternative to daily iron supplementation for preventing and reducing anaemia at the population level, especially in areas where this condition is highly prevalent. OBJECTIVES To assess the effects of intermittent oral iron supplementation, alone or in combination with other nutrients, on anaemia and its associated impairments among menstruating women, compared with no intervention, a placebo, or daily supplementation. SEARCH METHODS In February 2018, we searched CENTRAL, MEDLINE, Embase, nine other databases, and two trials registers. In March 2018, we also searched LILACS, IBECS and IMBIOMED. In addition, we examined reference lists, and contacted authors and known experts to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs with either individual or cluster randomisation. Participants were menstruating women; that is, women beyond menarche and prior to menopause who were not pregnant or lactating and did not have a known condition that impeded the presence of menstrual periods. The intervention was the use of iron supplements intermittently (one, two or three times a week on non-consecutive days) compared with placebo, no intervention, or the same supplements provided on a daily basis. DATA COLLECTION AND ANALYSIS Both review authors independently assessed the eligibility of studies against the inclusion criteria, extracted data from included studies, checked data entry for accuracy, assessed the risk of bias of the included studies, and rated the quality of the evidence using GRADE. MAIN RESULTS We included 25 studies involving 10,996 women. Study methods were not well described in many of the included studies and thus assessing risk of bias was difficult. The main limitations of the studies were lack of blinding and high attrition. Studies were mainly funded by international organisations, universities, and ministries of health within the countries. Approximately one third of the included studies did not provide a funding source.Although quality across studies was variable, the results consistently showed that intermittent iron supplementation (alone or with any other vitamins and minerals) compared with no intervention or a placebo, reduced the risk of having anaemia (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.49 to 0.87; 11 studies, 3135 participants; low-quality evidence), and improved the concentration of haemoglobin (mean difference (MD) 5.19 g/L, 95% CI 3.07 to 7.32; 15 studies, 2886 participants; moderate-quality evidence), and ferritin (MD 7.46 μg/L, 95% CI 5.02 to 9.90; 7 studies, 1067 participants; low-quality evidence). Intermittent regimens may also reduce the risk of having iron deficiency (RR 0.50, 95% CI 0.24 to 1.04; 3 studies, 624 participants; low-quality evidence), but evidence was inconclusive regarding iron deficiency anaemia (RR 0.07, 95% CI 0.00 to 1.16; 1 study, 97 participants; very low-quality evidence) and all-cause morbidity (RR 1.12, 95% CI 0.82 to 1.52; 1 study, 119 participants; very low-quality evidence). Women in the control group were less likely to have any adverse side effects than those receiving intermittent iron supplements (RR 1.98, 95% CI 0.31 to 12.72; 3 studies, 630 participants; moderate-quality evidence).In comparison with daily supplementation, results showed that intermittent supplementation (alone or with any other vitamins and minerals) produced similar effects to daily supplementation (alone or with any other vitamins and minerals) on anaemia (RR 1.09, 95% CI 0.93 to 1.29; 8 studies, 1749 participants; moderate-quality evidence). Intermittent supplementation may produce similar haemoglobin concentrations (MD 0.43 g/L, 95% CI -1.44 to 2.31; 10 studies, 2127 participants; low-quality evidence) but lower ferritin concentrations on average (MD -6.07 μg/L, 95% CI -10.66 to -1.48; 4 studies, 988 participants; low-quality evidence) compared to daily supplementation. Compared to daily regimens, intermittent regimens may also reduce the risk of having iron deficiency (RR 4.30, 95% CI 0.56 to 33.20; 1 study, 198 participants; very low-quality evidence). Women receiving iron supplements intermittently were less likely to have any adverse side effects than those receiving iron supplements daily (RR 0.41, 95% CI 0.21 to 0.82; 6 studies, 1166 participants; moderate-quality evidence). No studies reported on the effect of intermittent regimens versus daily regimens on iron deficiency anaemia and all-cause morbidity.Information on disease outcomes, adherence, economic productivity, and work performance was scarce, and evidence about the effects of intermittent supplementation on these outcomes unclear.Overall, whether the supplements were given once or twice weekly, for less or more than three months, contained less or more than 60 mg of elemental iron per week, or given to populations with different degrees of anaemia at baseline did not seem to affect the findings. Furthermore, the response did not differ in areas where malaria was frequent, although very few trials were conducted in these settings. AUTHORS' CONCLUSIONS Intermittent iron supplementation may reduce anaemia and may improve iron stores among menstruating women in populations with different anaemia and malaria backgrounds. In comparison with daily supplementation, the provision of iron supplements intermittently is probably as effective in preventing or controlling anaemia. More information is needed on morbidity (including malaria outcomes), side effects, work performance, economic productivity, depression, and adherence to the intervention. The quality of this evidence base ranged from very low to moderate quality, suggesting that we are uncertain about these effects.
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Birhanu Z, Chapleau GM, Ortolano SE, Mamo G, Martin SL, Dickin KL. Ethiopian women's perspectives on antenatal care and iron-folic acid supplementation: Insights for translating global antenatal calcium guidelines into practice. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 1. [PMID: 29493899 DOI: 10.1111/mcn.12424] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 01/10/2023]
Abstract
After decades of global response to iron-deficiency anemia, lessons learned from antenatal iron-folic acid (IFA) supplementation can inform new micronutrient supplementation efforts. The World Health Organization recommends calcium supplementation for the prevention of preeclampsia; however, little is documented on how to design programs to integrate calcium into the standard of care. Twenty interviews with pregnant women and 22 interviews with health providers and volunteers in two districts in Ethiopia were conducted to examine how barriers and facilitators to antenatal care, IFA supplementation, and initial reactions to calcium supplements and regimen might influence adherence and inform future programs. Women viewed supplementation positively but cited lack of information on benefits and risks, forgetfulness, and inconsistent IFA supply as challenges. Though knowledge and awareness of anemia and IFA supplements were widespread, preeclampsia was mostly unknown. Some symptoms of preeclampsia were viewed as normal in pregnancy, making it difficult to convey risk to motivate supplement use. Some women viewed co-consumption of IFA and calcium as potentially harmful and were confused regarding the simultaneous risks of anemia and hypertension, understood as "low" and "high" blood levels in pregnancy. However, most said they would take both IFA and calcium supplements if provided with supplements and counseling on purpose and benefits. Strategies such as social support from families, stronger community-based counseling, and increased health care provider and community awareness of preeclampsia are critical for women to understand the benefits of supplementation and resolve confusion caused by current descriptors used for anemia and hypertension.
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Affiliation(s)
- Zewdie Birhanu
- College of Health Sciences, Department of Health Education and Behavioral Sciences, Ginjo Guduru, Jimma University, Jimma, Oromia, Ethiopia
| | - Gina M Chapleau
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University Ithaca, New York, USA
| | - Stephanie E Ortolano
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University Ithaca, New York, USA
| | - Girma Mamo
- Ethiopia-Canada Cooperation Office (CIDA-ECCO), Micronutrient Initiative, Addis Ababa, Ethiopia
| | - Stephanie L Martin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University Ithaca, New York, USA
| | - Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University Ithaca, New York, USA
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Mbhenyane X, Cherane M. Compliance with the consumption of iron and folate supplements by pregnant women in Mafikeng local municipality, North West province, South Africa. Afr Health Sci 2017; 17:657-670. [PMID: 29085393 PMCID: PMC5656199 DOI: 10.4314/ahs.v17i3.8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Anaemia due to iron deficiency is recognized as one of the major nutritional deficiencies in women and children in developing countries. Daily iron supplementation for pregnant women is recommended in many countries. The aim of the study was to investigate the factors that contribute to compliance to the consumption of iron and folate supplements by pregnant woman in Mafikeng local municipality, North West Province, South Africa. RESEARCH METHODS A mixed method of descriptive, exploratory and cross-sectional design was used. Ten clinics were used as a sample frame where 57 pregnant women and 10 health workers were purposefully and conveniently selected. Quantitative techniques were used to collect data on attendance, consumption and nutrition knowledge using the self-reported questionnaire by pregnant women, and structured interview for health workers. Qualitative design was used to conduct in - depth focus-group discussions to gather information on compliance to the consumption of supplements by pregnant women. FINDINGS The findings of the study revealed good antenatal clinic attendance, availability of supplements and 93% compliance to the consumption of iron and folate supplements. RECOMMENDATIONS High compliance to the consumption of iron and folate supplements by pregnant women was reported, and this should be reinforced.
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Ahankari AS, Dixit JV, Fogarty AW, Tata LJ, Myles PR. Comparison of the NBM 200 non-invasive haemoglobin sensor with Sahli's haemometer among adolescent girls in rural India. ACTA ACUST UNITED AC 2016. [DOI: 10.1136/bmjinnov-2016-000139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bansal PG, Toteja GS, Bhatia N, Vikram NK, Siddhu A. Impact of weekly iron folic acid supplementation with and without vitamin B12 on anaemic adolescent girls: a randomised clinical trial. Eur J Clin Nutr 2015; 70:730-7. [PMID: 26695724 DOI: 10.1038/ejcn.2015.215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 09/26/2015] [Accepted: 10/02/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES In India, approx. 70% of the adolescent girls are anaemic (haemolgobin <120 g/l). The present study was a supervised randomised double-blind clinical trial conducted among adolescent girls (11-18 years) to assess and compare the impact of weekly iron folic acid (IFA) supplementation with or without vitamin B12 on reduction in the prevalence of anaemia and on blood/serum levels of haemoglobin, serum ferritin, folic acid and vitamin B12. SUBJECTS/METHODS Community-based randomized controlled trial was carried out in Kirti Nagar slums of West Delhi. A total of 446 mild (100-119 g/l) and moderate (70-99 g/l) anaemic volunteer adolescent girls were identified and randomised into two groups. Weekly supervised supplementation was given for 26 weeks: Group A (n=222): iron (100 mg), folic acid (500 mcg) and placebo; Group B (n=224): iron (100 mg), folic acid (500 mcg) and cyanocobalamin (500 mcg for 6 weeks and 15 mcg for 20 weeks). Haemoglobin, serum ferritin, folic acid and vitamin B12 levels were assessed at baseline and after intervention. A total of 373 subjects completed 26 weeks of supplementation successfully. RESULTS The mean haemoglobin increased from 106.7±11.2 g/l and 108.9±8.91 g/l in Group A and Group B at baseline to 116.4±10.8 g/l (P<0.001) and 116.5±10.26 g/l (P<0.001) at post-intervention, respectively, with the reduction in the prevalence of anaemia by 35.9% in Group A and 39.7% in Group B (P>0.05). A total of 63.3% participants had deficient vitamin B12 levels (<203 pg/ml) at baseline, which reduced to 40.4% after intervention with cyanocobalamin, whereas no change was observed in vitamin B12 status in the other group. Significant reduction (P=0.01) in the prevalence of serum ferritin deficiency (<15 ng/ml) was observed in the group supplemented with vitamin B12 (from 36.5 to 6.4%) as compared with the other group supplemented with only IFA (from 39.1 to 15.2%). CONCLUSIONS IFA supplementation with or without vitamin B12 is an effective measure to cure anaemia. Although addition of vitamin B12 had similar impact on improving haemoglobin status as IFA alone, it resulted in better ferritin status. Hence, more multi-centre studies with a longer duration of supplementation or higher dose of vitamin B12 may be undertaken to assess the possible impact of vitamin B12 on improving haemoglobin levels in the population.
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Affiliation(s)
- P G Bansal
- Centre for Promotion of Nutrition Research and Training with Special Focus on North-East, Tribal and Inaccessible Population (Indian Council of Medical Research), New Delhi, India
| | - G S Toteja
- Centre for Promotion of Nutrition Research and Training with Special Focus on North-East, Tribal and Inaccessible Population (Indian Council of Medical Research), New Delhi, India
| | - N Bhatia
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - N K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A Siddhu
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
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Examining Means of Reaching Adolescent Girls for Iron Supplementation in Tigray, Northern Ethiopia. Nutrients 2015; 7:9033-45. [PMID: 26540071 PMCID: PMC4663577 DOI: 10.3390/nu7115449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/01/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Iron deficiency is the most prevalent nutritional deficiency in adolescent girls from the developing world. One of the recommended interventions to improve iron status in adolescent girls is iron supplementation. Yet the provision of iron supplements to adolescent girls proved to be a challenging task for the health systems across the developing world. Objective: The objective of the study was to examine means of reaching adolescent girls for iron supplementation in Northern Ethiopia. Methodology: Analytical cross-sectional study consisting of both quantitative and qualitative approaches to data collection and analysis was used in this study. Stratified multi-stage systematic random sampling technique was adopted and primary quantitative data were collected from 828 (578 school attending and 250 non school attending) adolescent girls recruited from nine districts of Tigray. The primary quantitative data were analyzed using SPSS version 20 software. The qualitative data collected through key informant interviews and focus group discussions were transcribed verbatim and qualitatively analyzed. Results: The mean (SD) age of the girls was 16.7 (1.4) years. Four hundred forty seven (54%), 355 (42.9%) and 26 (3.1%) of the adolescent girls had low, medium and high diet diversity scores, respectively. More than half, 467 (56%), of the adolescent girls believed that adolescent girls were overloaded with household jobs everyday compared to boys from their respective communities. Key informants said that, there is no adolescent nutrition message promoted in the study area. Low community awareness, perceiving iron tablet as a contraceptive, religious and cultural influences, and lack of confidence in supplementation value of iron tablets, are some of the potential barriers mentioned by the key informant and focus group discussion participants. Schools (45%), health centers (27%) and health posts (26%) were the preferred public facilities for provision of iron supplements to student adolescent girls whereas schools (11%), health centers (47%) and health posts (41%) were the preferred public facilities for provision of iron supplements to adolescent girls who were not attending schools from the study communities. Conclusion: The health posts and health centers were the preferred health facilities for iron supplementation to adolescent girls who were not attending schools while the school was the preferred facility for iron supplementation of student adolescent girls.
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Rustanti N, Murwani R, Anwar S. Combined Inorganic Iron (FeSO4) and Steamed Pumpkin (Cucurbita moschata) Fortification in Fresh Noodles Can Increase Hemoglobin Levels in Iron Deficient Mice. ACTA ACUST UNITED AC 2015. [DOI: 10.3923/pjn.2015.316.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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