Intermittent iron folate supplementation: impact on hematinic status and growth of school girls.

UNLABELLED: In view of high iron needs for adolescent growth, this paper studied the impact of daily vs. intermittent (once and twice weekly) iron folic acid (IFA) supplementation on hemoglobin levels and pubertal growth among primary school girls in early adolescence (9-13 years) of Vadodara, India. Methods. Hemoglobin (Hb), height and weight of the girls were assessed using standard methods. In three experimental schools (ES) IFA tablets in a dose of 100 mg Fe + 0.5 mg folic acid was given either daily, once weekly or twice weekly for one year. The fourth school (control: CS) did not receive any intervention. Results. Hb levels significantly improved (P < 0.01) in all ES compared to CS. Body Mass Index (BMI) increment in ES vs CS was significant (P < 0.05) in twice weekly IFA and daily IFA. Within ES groups, mean Hb and BMI increments were comparable between twice weekly IFA and daily IFA. Anemic ES girls showed higher Hb and BMI increments vs. non-anemic girls. Better the Hb response, greater was the benefit on BMI. CONCLUSION: Twice-weekly IFA supplementation was comparable to daily IFA as regards impact on Hb and growth; at less cost and greater feasibility. Once-weekly dose was inadequate to significantly improve growth.

Growing normally in an urban environment: positive deviance among slum children of Vadodara, India.

OBJECTIVE: To assess factors contributing to positive deviance among the urban poor of Vadodara city. METHODS: Mothers of sixty 6-18 mo old children- 30 each in positive deviant (PD: normal by weight-age) and negative deviant (ND: grade II by weight-age) groups-were interviewed through home visits using semi-structured questionnaires. RESULTS: Factors contributing significantly to PD (p < 0.01): PD children (vs. ND), were older (12-18 mo vs. 6-11 mo); families were smaller (5-7 vs. >7 members), of lower parity (1-2 vs. 3-4), greater birth interval (>3 y vs. 1-2 y); received colostrum (96% vs. 26%), breastfed at least 8-9 times/d (86% vs. 20%); were started on complementary feeds (CF) at 6-8 mo (53% vs. 23%); given thicker consistency CF (73% vs. 36%); fed actively (40% vs. 23%), fewer had diarrhea episodes in past 15 d (26% vs. 83%). Mean calorie intake (% RDA) from CF among PD was significantly higher than in ND (68% vs.42%). CONCLUSIONS: Factors contributing to PD in urban poor families are similar to those reported in rural India; which implies that ICDS-Health services for both urban and rural poor need to ensure that national IYCF guidelines-healthcare recommendations are followed by communities. Further research relating PD to desirable complementary feeding and hygiene-healthcare practices in rural and urban areas is required.

Impact of iron-folic acid supplementation on cognitive abilities of school girls in Vadodara.

OBJECTIVES: To assess impact of daily and intermittent iron-folate (IFA) supplementation on cognition of underprivileged primary schoolgirls in Vadodara. DESIGN: Experimental-control longitudinal study. SETTING: Municipal primary schools. PARTICIPANTS: Schoolgirls (n=161) in the age group of 9 - 13 years. INTERVENTION: Participants at three randomly selected schools were given IFA tablets (100 mg elemental iron + 0.5 mg folic acid) either once weekly or twice weekly or daily for one year. The fourth was the control school. OUTCOME MEASURES: Digit span, maze test, visual memory test, and clerical task scores. RESULTS: IFA supplementation given daily and twice-weekly significantly improved cognition in most tests; the effect was not seen in once-weekly or control groups. In daily and twice weekly IFA groups, positive change in cognition test scores was relatively higher in girls with good compliance(< 70 % dose) vs. poor compliance; in anemic (hemoglobin < 11 g/dL) vs non-anemic girls and in those with higher hemoglobin (Hb) gain (< 1g/dL) vs. lower Hb gain. CONCLUSION: Twice weekly IFA supplementation is comparable to daily IFA in terms of beneficial effects on cognition in young adolescent girls.

Grandmothers' influence on child care.

OBJECTIVE: This paper compares child care-giving and child's nutritional status among rural families where grandmothers were present and those where grandmothers were absent. METHODS: From 27 villages in rural Vadodara, four were randomly selected and all the families (n=31) with children (3-24 months) where grandmothers were present (GMP) were compared with 39 families where grandmothers were absent (GMA). Semi structured questionnaires were used to assess beliefs-practices of mothers and grandmothers regarding breastfeeding and complementary feeding (BF-CF). Nutrient intake of the children and nutritional status were measured using standard procedures. RESULTS: Some deleterious practices were present in a similar proportion of both GMP and GMA groups: giving prelacteals, delaying initiation of BF, exclusive breastfeeding < 3 months and delaying initiation of CF. Favorable practices present in significantly more GMP were: active feeding and use of anganwadi services. Grandmother's help enabled mother to practice more care-giving behaviors. However, children in both the groups had low calorie intake CONCLUSION: Role of family members in childcare and the benefits of including them in interventions to improve child survival, health and nutrition status need to be further researched.

Women's perceptions of iron deficiency and anemia prevention and control in eight developing countries.

The World Health Organization estimates that 58% of pregnant women in developing countries are anemic. In spite of the fact that most ministries of health in developing countries have policies to provide pregnant women with iron in a supplement form, maternal anemia prevalence has not declined significantly where large-scale programs have been evaluated. During the period 1991-98, the MotherCare Project and its partners conducted qualitative research to determine the major barriers and facilitators of iron supplementation programs for pregnant women in eight developing countries. Research results were used to develop pilot program strategies and interventions to reduce maternal anemia. Across-region results were examined and some differences were found but the similarity in the way women view anemia and react to taking iron tablets was more striking than differences encountered by region, country or ethnic group. While women frequently recognize symptoms of anemia, they do not know the clinical term for anemia. Half of women in all countries consider these symptoms to be a priority health concern that requires action and half do not. Those women who visit prenatal health services are often familiar with iron supplements, but commonly do not know why they are prescribed. Contrary to the belief that women stop taking iron tablets mainly due to negative side effects, only about one-third of women reported that they experienced negative side effects in these studies. During iron supplementation trials in five of the countries, only about one-tenth of the women stopped taking the tablets due to side effects. The major barrier to effective supplementation programs is inadequate supply. Additional barriers include inadequate counseling and distribution of iron tablets, difficult access and poor utilization of prenatal health care services, beliefs against consuming medications during pregnancy, and in most countries, fears that taking too much iron may cause too much blood or a big baby, making delivery more difficult. Facilitators include women's recognition of improved physical well being with the alleviation of symptoms of anemia, particularly fatigue, a better appetite, increased appreciation of benefits for the fetus, and subsequent increased demand for prevention and treatment of iron deficiency and anemia.

Toward better compliance with iron-folic acid supplements: understanding the behavior of poor urban pregnant women through ethnographic decision models in Vadodara, India.

This study made an attempt to develop ethnographic decision models to understand and improve iron-folic acid supplement procurement and compliance-related behaviors of poor urban pregnant women in Vadodara, India, based on data obtained through the use of qualitative research tools. Open-ended, in-depth interviews were conducted with 36 pregnant women (17-32 weeks of gestation) purposively selected from four urban slums. Fortnightly home visits were made to the houses of 20 pregnant women-family member pairs to elicit behaviors related to iron-folic acid supplement procurement and compliance at the household level, from which the ethnographic decision models were developed. The hemoglobin levels of these women were also assessed. Regular counseling until delivery, based on the ethnographic data, helped to improve compliance, which resulted in 95% of the women consuming over 90% of the required dose. The mean hemoglobin level also improved from 9.6 to 11.08 g/dl until the end of the last trimester. This study highlighted the need for qualitative ethnographic data to develop such models that would help in the understanding of specific behaviors that influence program acceptance. Such data would have policy-level implications, for example, developing appropriate information-education-communication material and counseling strategies.