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Can iron status be improved in each of the three trimesters? A community-based study
R Abel1, J Rajaratnam, A Kalaimani
1RUHSA Department, Christian Medical College and Hospital, Vellore District, Tamil Nadu, India.
Objective:
Intervention with iron supplementation, deworming, and information, education and communication (IEC) to improve the haematological status among each of the three trimesters of pregnant women in a rural community.
Design:
A community-based study was carried out using a two-group pre-post experimental design in a rural community.
Setting:
Two rural blocks in Vellore district were selected for the study. KV Kuppam block with a population of 120,000 and the adjacent Gudiyatham block with a population of 132,000 served as study and control areas for the study.
Subjects:
Using a multistage sampling, initially 50% of the panchayats, the local village administrative units, were randomly selected and all pregnant women were the subjects. In the pre-intervention survey 458 and 387 pregnant women had haemoglobin tested and the post-intervention survey covered 403 and 425 pregnant women in the study and control areas, respectively. Similarly serum ferritin was tested in a randomly selected sub-sample with 254 and 191 pregnant women before intervention and in 216 and 223 pregnant women after intervention in both study and control areas, respectively.
Intervention:
Iron supplementation and deworming were provided to all pregnant women in the study area from the fourth month of their pregnancy. An intensive information, education and communication was carried out with facts on anaemia and diet modification to each pregnant woman, using a one-to-one approach in the community, and a group method in the mobile clinics. This was carried out for a period of 18 months.
Results:
A significant decrease in the prevalence of anaemia was found, from 56.1% to 25.07% (P<0.001), 73. 4% to 49.2% (P<0.001) and 68.8% to 56.8% (P<0.01) among women in the first, second and third trimesters, respectively, in the intervention area. Significant (P<0.001) increases in the mean haemoglobin of 0.85 g/dl (95% CI 10.18-10.84, 11.09-11.63), 0.59 g/dl (95% CI 9.98-10.34, 10.55-10.95) and 0.36 g/dl (95% CI 9.93-10. 33, 10.25-10.73) were also observed in each of the groups.
Conclusion:
A comprehensive community-based intervention with iron supplementation, helminthic treatment and increase in knowledge using IEC through effective strategies can improve the haematological status of pregnant women in each trimester.