Low Hemoglobin Is not Always Iron Deficiency Anemia-A Cross-Sectional Study in a Tribal Community in the Nilgiris,...

To determine the prevalence of anemia among tribal communities of Burliyar and to improve medication adherence to iron by implementing a daily monitoring system by the community health ambassadors (CHA) and to identify any other cause of anemia in patients who do not improve with the intervention.

This was a prospective cross-sectional community-based anemia study done from November 2023 to May 2024 in the tribal hamlets in Burliyar, Nilgiris, with a shifting population averaging 230.

A baseline hemoglobin screening was done on 184 participants using the Accusure Hb101 system with capillary blood. The cut off to define anemia in adults was Hb < 13 gm/dl in males and < 12 gm/dl in females. Based on this criterion, we had 131 (71%) participants with anemia of which 74 (56%) were females and 57 (44%) were males. Among these, 32 (24%) participants were children < 14 years of age. There was distribution of iron supplements for 100 days along with iron-rich ration to 110 participants, which was monitored daily by the CHA and the prevalence of anemia reduced from 71.2 to 61.8%. An additional 29 participants were added into the study during our monthly camps. Out of the 139 participants, 36 (26%) were suspected to have hemoglobinopathy. Of these, 30 participants underwent High Performance Liquid Chromatography (HPLC) and 7 among them were identified to have sickle cell trait and 1 had sickle cell disease. The remaining 22 underwent molecular testing and all were identified to have homozygous alpha 3.7 deletion (-α^3.7/-α^3.7).

Targeted intervention and careful monitoring help to reduce the burden of anemia in a community. Although iron deficiency anemia is the most common form of anemia, a quarter of the patient population in this study had hemoglobinopathy- predominantly alpha thalassemia.