Abstract
Introduction
Maternal and child under-nutrition is particularly widespread in low and middle-income nations, increasing the overall disease burden due to poor nutritional status. The aim of this study was to develop nutrition intervention for the prevention and control of anaemia among women of reproductive age.
Methods
Community-based intervention study was conducted among 443 women of reproductive age group (15–49 years) to determine the effectiveness of a 6-month nutrition intervention package. The nutrition intervention was developed by using Precede-Proceed model and the trans-theoretical model of behavior change. Multi-channel communication approach was adopted and nutrition intervention package was provided. Assessment of haemoglobin, red blood cells, platelet, ferritin, folate, vitamin B12, haematocrit test, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red cell distribution width and total leucocyte count was compared at the baseline and endline after the intervention among the participants. The chi-square test of independence and t-test were performed.
Results
The only mean ferritin level shows significant improvement (p < 0.001). A significant decrease (~ 15%, p = 0.027) in anaemia was observed after the intervention.
Conclusions
Improvement in anaemic status of women was observed. National schemes and programs require a more robust strategical implementation like food fortification/bio fortification and behaviour change communication at village level to enhance the availability and accessibility of fortified food.
Significance
What is already known on this subject? Anaemia is highly prevalent among women and child in India. In reproductive aged women, there is some evidence of a link between nutrition and anaemia.
What this study adds? The study recommends that trans-theoretical model of behaviour construct was an effective way to reduce the prevalence of anaemia among reproductive aged women of India. Multi-channel communication and household level interaction can be considered for significant implementation of nutrition intervention.
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Data Availability
Primary Data.
Code Availability
No code was used during the data analysis or manuscript preparation.
References
Aitsi-Selmi, A., Bell, R., Shipley, M. J., & Marmot, M. G. (2014). Education modifies the association of wealth with obesity in women in middle-income but not low-income countries: An interaction study using seven national datasets, 2005–2010. PloS one, 9(3), e90403. https://doi.org/10.1371/journal.pone.0090403.
Al Kibria, G. M., Swasey, K., Hasan, M. Z., Sharmeen, A., & Day, B. (2019). Prevalence and factors associated with underweight, overweight and obesity among women of reproductive age in India. Global Health Research and Policy, 4, 24. https://doi.org/10.1186/s41256-019-0117-z.
Anemia Alert: Is the Government Aiming for Cost-Effective Interventions? | NITI Aayog (2019). Retrieved from https://niti.gov.in/anemia-alert-government-aiming-cost-effective-interventions
Waist-to-height (2012). ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and meta-analysis, 13275–286
Avoid using hemoglobin to evaluate patients for iron deficiency in susceptible populations, & Instead (2021). use ferritin. Retrieved from https://www.aafp.org/afp/recommendations/viewRecommendation.htm?recommendationId=432
Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., de Onis, M., Ezzati, M., & Rivera, J. (2008). Maternal and child undernutrition: Global and regional exposures and health consequences. The Lancet, 371, 243–260. https://doi.org/10.1016/S0140-6736(07)61690-0.
Chakrabarti, S., Kishore, A., Raghunathan, K., & Scott, S. P. (2019). Impact of subsidized fortified wheat on anaemia in pregnant indian women. Maternal and Child Nutrition, 15(1), e12669. https://doi.org/10.1111/mcn.12669.
Community-Based Interventions: Implications for childhood anemia prevention and control in India (2018). Retrieved from https://openarchive.ki.se/xmlui/handle/10616/46387
Ergul, A., Kelly-Cobbs, A., Abdalla, M., & Fagan, C., S (2012). Cerebrovascular complications of diabetes: Focus on Stroke. Endocrine, metabolic & Immune Disorders - drug targets (12 vol., pp. 148–158). Bentham Science Publishers Ltd.
Gautam, S., Min, H., Kim, H., & Jeong, H. S. (2019). Determining factors for the prevalence of anemia in women of reproductive age in Nepal: Evidence from recent national survey data. PloS one, 14(6), e0218288–e0218288. https://doi.org/10.1371/journal.pone.0218288.
Girard, A. W., & Olude, O. (2012). Nutrition education and counselling provided during pregnancy: Effects on maternal, neonatal and child health outcomes. Paediatric And Perinatal Epidemiology, 26(Suppl 1), 191–204. https://doi.org/10.1111/j.1365-3016.2012.01278.x.
Hurrell, R. F. (2009). Preventing Iron Deficiency through Food Fortification. Nutrition Reviews, 55(6), 210–222. https://doi.org/10.1111/j.1753-4887.1997.tb01608.x.
Ibrahim, H. A. F., Sayed, H. A. E. E., & El-aal, E. M. A. (2017). Diet Behavior modification of pregnant woman with Iron Deficiency Anemia using construct of the trans-theoretical model: A theory-based study. IOSR Journal of Nursing and Health Science (Vol, 06, 72–85.
Kennedy, E., Stickland, J., Kershaw, M., & Biadgilign, S. (2018). Impact of Social and Behavior Change Communication in Nutrition Specific Interventions on selected indicators of Nu-tritional Status. Journal of human nutrition, 2(1), 34–46. https://doi.org/10.36959/487/280.
Krupp, K., Placek, C. D., Wilcox, M., Ravi, K., Srinivas, V., Arun, A., & Madhivanan, P. (2018). Financial decision making power is associated with moderate to severe anemia: A prospective cohort study among pregnant women in rural South India. Midwifery, 61, 15–21. https://doi.org/10.1016/j.midw.2018.02.014.
Little, M., Zivot, C., Humphries, S., Dodd, W., Patel, K., & Dewey, C. (2018). Burden and Determinants of Anemia in a Rural Population in South India: A Cross-Sectional Study. Anemia, 2018, 7123976. doi:https://doi.org/10.1155/2018/7123976
Miller, J. L. (2013). Iron deficiency anemia: A common and curable disease. Cold Spring Harbor perspectives in medicine, 3(7), a011866. https://doi.org/10.1101/cshperspect.a011866.
Mohamed, E., Ibrahim, H., & Sayed, H. (2017). Diet Behavior modification of pregnant woman with Iron Deficiency Anemia using construct of the trans-theoretical model: A theory-based study. IOSR Journal of Nursing and Health Science, 06(03), 72–85. https://doi.org/10.9790/1959-0603067285.
MoHFW - Programmes to Control Anaemia Among Women (2019). Retrieved from https://pib.gov.in/PressReleasePage.aspx?PRID=1596308
National Family Health Survey (NFHS-4) (2015–2016). Retrieved from http://rchiips.org/nfhs/nfhs-4Reports/India.pdf
National Nutrition Mission: Administrative Guidelines (2018). Retrieved from https://icds-wcd.nic.in/nnm/NNM-Web-Contents/UPPER-MENU/AdministrativeApproval-Guidelines/Administrative_Guidelines_NNM-26022018.pdf
Nishida, C. (2004). Appropriate body-mass index for asian populations and its implications for policy and intervention strategies. The Lancet, 363(9403), 157–163. https://doi.org/10.1016/s0140-6736(03)15268-3.
Patel, A., Prakash, A. A., Das, P. K., Gupta, S., Pusdekar, Y. V., & Hibberd, P. L. (2018). Maternal anemia and underweight as determinants of pregnancy outcomes: Cohort study in eastern rural Maharashtra, India. British Medical Journal Open, 8(8), e021623. https://doi.org/10.1136/bmjopen-2018-021623.
Raingruber, B. (2014). Health promotion theories. Contemporary health promotion in nursing practice, 53, 53–94.
Schneider, H. J., Friedrich, N., Klotsche, J., Pieper, L., Nauck, M., John, U., & Wittchen, H. U. (2010). The predictive value of different measures of obesity for Incident Cardiovascular events and mortality. The Journal of Clinical Endocrinology & Metabolism (Vol, 95, 1777–1785.
Short, M. W., & Domagalski, J. E. (2013). Iron deficiency anemia: evaluation and management. Am Fam Physician, 87(2), 98–104. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23317073
Snehalatha, C., Vishwnathan, V., & Ramachandran, A. (2003). Cutoff Values for Normal Anthropometric Variables in Asian Indian Adults. In Diabetes Care (Vol. 26, pp. 1380–1384).
Srivastava, A., Kumar, R., & Sharma, M. (2017). Nutritional anaemia in adolescent girls: An epidemiological study. International Journal of Community Medicine and Public Health, 3(4), 5. https://doi.org/10.18203/2394-6040.ijcmph20160687.
WHO (2012). WHA Global Nutrition Targets 2025: Anaemia Policy Brief. Retrieved from https://www.who.int/nutrition/topics/globaltargets_anaemia_policybrief.pdf
Acknowledgements
Author (s) would like to thank the Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, for financial and technical support and acknowledge Professor Rajesh Kumar, Dr. Naresh for their sincere support. Sincere thanks to Jyoti, Sonia, Dr Preeti Choudhary, Sai eye care society, Health staff, ANM, AWW, Sanghol community and sarpanch for their contribution and support during the project.
Funding
Intramural Research Grant (Grant No.- 71/2-EDU-16/107) funded by Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Study design and concept: P.K., R.Se., and M.K. Data management and data cleaning: R.J., S.K., and R.Se. Data analysis and interpretation: T.S. and S.S. Literature review of the study: R.J. and R.Sr. Drafting the manuscript or revising it critically for important intellectual content: S.K., N.V. and R.Sr. Final approval of the version to be published: P.K., M.K.
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Ethical clearance was obtained from the Institutional Ethical Committee, PGIMER, Chandigarh.
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Khanna, P., Kaur, M., Varma, N. et al. Impact of Community Based Nutrition Intervention in the Prevention and Control of Anaemia Among Reproductive Aged Women of India. Matern Child Health J 27, 1247–1253 (2023). https://doi.org/10.1007/s10995-023-03656-x
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DOI: https://doi.org/10.1007/s10995-023-03656-x