Addressing Anemia in Pregnant Women and School Children through a Field Tested Novel Strategy

• Published in: Annals of the National Academy of Medical Sciences (India) Vol. 56; no. 1; pp. 15 - 25
• Main Authors: Susheela, Andezhath Kumaran, Kumari, Chandrawati
• Format: Journal Article
• Language: English
• Published: A-12, Second Floor, Sector -2, NOIDA -201301, India Thieme Medical and Scientific publishers private Ltd 01.01.2020; Thieme Medical and Scientific Publishers Pvt. Ltd
• Subjects: anemia; children; hemoglobin; Original Article; pregnancy; urine fluoride level; water; urine fluoride level; children; water; anemia; hemoglobin; pregnancy
• ISSN: 0379-038X; 2454-5635; 0379-038X
• DOI: 10.1055/s-0040-1710161

Abstract Objective  To introduce a protocol for improving hemoglobin (Hb), rectifying anemia in pregnant women and school children through practice of interventions. Materials and Methods  Pregnant women ( n = 3,262) visiting antenatal clinics (ANCs) in two government hospitals in New Delhi were screened for Hb using a hemoglobinometer. Those anemic with Hb <12.0 g/dL were tested for fluoride in urine samples, using ion meter with F – -specific electrode. Those who are anemic with high urine fluoride level (UFL ≥1.0 mg/L) were tested for fluoride in drinking water. If water fluoride is ≥1.0 mg/L, a large number of samples were tested from the neighborhood water sources. Besides, the pregnant women were advised to use water from safe sources for cooking and drinking purposes. The pregnant women, who visited ANCs were retested for Hb and UFL during every visit and introduced to diet editing and diet counseling. Body mass index was calculated initially and prior to delivery. Delivery outcome information was collected and recorded from labor room register. Girls and boys ( n = 2,420) attending six schools in the national capital were inducted in the study. “Informed consents” were obtained from the parents of the recruited children and the principal of the school. The “ascent” was obtained from the children. The protocol comprised screening for Hb and testing of fluoride levels in the urine and drinking water. Diet editing and counseling were introduced to parents/mothers during parent–teacher meetings and impact of the interventions was assessed at 1, 3, and 6 months postintervention and the recorded data were evaluated and analyzed statistically. Results  It was observed that 83% of pregnant women in whom anemia was corrected delivered normal birth weight infants (2.5–3.89 kg). The 17% women in whom anemia was not corrected gave birth to low birth weight infants (1.87–2.48 kg). The school children in whom the diet editing was used as an intervention showed statistically significant enhanced Hb levels. These children did not require weekly iron and folic acid supplementation. It appears that educating parents to provide nutrient-rich food for correcting anemia seems to be an important intervention. Conclusion  Fluoride from water, food, beverages, use of rock salt with high F – 157 ppm in cooking and churans when withdrawn, structural changes in the gastrointestinal system was rectified, thus enhanced absorption of nutrients. The nation should have a meaningful protocol to do justice to pregnant women and school children afflicted with anemia.