Efficacy of Iron Fortified Food/ Supervised Iron-Folic Acid (IFA) Supplementation on the Hemoglobin Status of Pregnant Women from Urban Slums of Delhi, India
Consensus exists on a number of evidence-based iron supplementation and food fortification interventions to reduce anemia and micronutrient deficiencies among pregnant women and women of reproductive age. The objective of this study was to investigate the efficacy of Iron fortified food/ supervised IFA supplements on the hemoglobin status of the pregnant women. Iron-fortified biscuits and Iron-folic acid tablets were used for the intervention. However, Non-fortified biscuits were given to the control group as well as IFA tablets intake was not supervised. A total of 320 subjects at 18+2 weeks of gestation were enrolled for the study from the three different urban slums colonies of south-west Delhi. Employing cluster sampling approach, by draw of lots, these subjects were divided into three intervention group (Intr. Gr): Intr. Gr-I (supervised IFA with no food supplementation; n=110), Intr. Gr-II (Non-fortified biscuits supplementation + unsupervised IFA; n=105), Intr. Gr-III (Iron-fortified biscuits supplementation + unsupervised IFA; n=105). Further, on the basis of hemoglobin status of the subjects at enrolment, a fourth group comprising of the severely anemic subjects drawn from all the three areas of the study was formed (Intr. Gr-IV, severely anemic group: Iron-fortified biscuits supplementation + supervised IFA; n=48). A single tablet containing 100 mg of elemental iron and 500 μg folic acid was supposedly to be taken daily by the subjects from enrolment till delivery in all the groups, but supervised in Intr Gr I and Intr Gr IV only. Both the iron/ non-fortified biscuits were similar in terms of shape, size and all the nutrients except iron. Eight biscuits providing 40 mg of iron per day were given from enrolment till term in the Intr Gr III and Intr Gr IV; and the same number of non-fortified biscuits for the same period was given to the Intr Gr II (control group). The total supplementation period was nearly 145 days and final data could be obtained from 305 subjects. Results of the study indicated that after an intervention period of 140-150 days, a significant (p<0.001) increase in hemoglobin levels was seen among all the groups. The mean increase in hemoglobin levels in the four intervention groups were 0.95±0.95 g/dL (Intr GrI), 0.50±1.67 g/dL (Intr Gr II), 1.06±1.06 g/dL (Intr Gr III) and 3.23±0.98g/dL (Intr Gr IV), but the increment was least in the control group (Intr Gr II). Thus, it may be inferred that both the Iron-fortified food as well as supervised Iron-folic acid tablets supplementation could be used as an effective tool in the intervention programs for combating maternal anemia.
Keywords: Maternal Anemia, Hemoglobin, Pregnancy, Iron Supplements, Iron-Folic Acid Tablets
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