Prevalence of iron-deficiency anaemia and risk factors in 1010 adolescent girls from rural Maharashtra, India: a cross-sectional survey

The association between social support with compliance of IFA supplement intake among adolescent girls in Sidoarjo, Indonesia

Background: Anemia is a severe nutritional issue affecting people worldwide, including in Indonesia. One of the government's initiatives to alleviate anemia afflicting adolescent Indonesian girls is iron and folic acid supplementation (IFAS). However, this program has shown to be ineffective, which may be due to poor compliance of IFAS. Aim: This study aimed to identify the association of social support (sources of information and reminders) with compliance of IFA supplement intake among adolescent girls in Sidoarjo, Indonesia. Methods: This research was an observational analytic study with the cross-sectional method in three schools in Sidoarjo, Indonesia. A total of 202 high school adolescent girls were randomly selected. Bivariate statistics with the Spearman rank test determined associations and the strength of associations at a significant threshold of p < 0.05. Results: IFA compliance was low (11.4%). However, there was a significant association between the number of sources of information (r = 0.175, p = 0.013) and the number of reminders (r = 0.158; p = 0.025) with compliance of high school adolescent girls to consume IFA supplements regularly in Sidoarjo, Indonesia. Meanwhile, age did not significantly affect compliance of regular IFA supplement consumption. Conclusions: The compliance level was positively related to the number of sources of information and the number of reminders for taking IFA supplements among high school adolescent girls. Involvement from social environments such as teachers, parents, and health workers as a source of information and reminders can help improve high school adolescent girls' compliance.

A systematic analysis and future projections of the nutritional status and interpretation of its drivers among school-aged children in South-East Asian countries

Background

Nutrition inadequacy during childhood and adolescence can cause suboptimal growth, intergenerational effects on offspring and an increased risk of chronic diseases in adulthood. There is little information on the prevalence and drivers of malnutrition in children aged 5-19 years, in the South-East Asian setting, since most existing interventions have to date targeted undernutrition. We assessed the national prevalence of nutritional indicators, their trends, and associated risk factors among children aged 5-19 years from 11 countries of WHO South-East Asia Region (SEA Region) in order to provide evidence to guide future policy direction.

Methods

We included 5,210,646 children for analysis from 345 studies and 25 survey datasets. A Newcastle-Ottawa Scale was used to assess the quality of the study. Bayesian regression models were used to estimate the prevalence of malnutrition between 2000 and 2030, and a series of subgroup analyses were performed to assess variation in pooled estimates by different socio-demographic and lifestyle factors. The protocol was registered with PROSPERO database (CRD42023400104).

Findings

Overall, pooled analysis demonstrated that indicators of undernutrition in SEA is predicted to decrease between 2000 and 2030 including stunting (36.6%-27.2%), thinness (29.5%-6.2%), and underweight (29.2%-15.9%). However, a substantial increase in prevalence of overweight (6.0% in 2000-16.9% in 2030), and obesity (2.6%-9.5%) are predicted. The prevalence of micronutrient deficiencies between 2000 and 2030 is predicted to decrease-vitamin A by 84% and vitamin D by 53%. Parents' education levels and household wealth were inversely associated with malnutrition. Children's health-related behaviours, such as unhealthy dietary habits and spending more time watching TV, playing games, or using the computer, were associated with increased chance of overweight and obesity. There were no clear signs of publication bias in our study.

Interpretation

Our analysis highlights the pattern of a double burden of malnutrition, with clear differences between different socio-demographic groups. Despite a substantial reduction in the prevalence of stunting, underweight, and anaemia since 2000, an emerging increase in overweight/obesity and micronutrient deficiencies warrants urgent attention.

Funding

World Health Organization Regional Office for South-East Asia New Delhi, India.

Evaluation of the barriers and facilitators of iron supplementation program among adolescent females

BACKGROUND & AIMS

Iron deficiency anemia is a major health problem in female adolescents; so, the iron supplementation program has been implemented in Iranian female high school students for nearly two decades. This study aimed to assess the barriers and facilitators of the program.

METHODS

This cross-sectional study was conducted by cluster random sampling with a sample size of 399 high school girls from the northern, southern, eastern, western and central regions of Iran. To collect data, we applied valid and reliable researcher-made questionnaires. Data were analyzed by SPSS version 22 software using the chi-squared test.

RESULTS

From the students' point of view, the most important reasons for not taking iron supplements were the bad taste of iron supplements, nausea after consumption, and not prescription of the iron supplement by physicians. Most the students believed that inviting health care professionals and movies or clips had the greatest impact on encouraging students to take supplements. About 45% of students reported that educational programs were not held for them, and only 28% of students received educational content/educational media about iron supplement. Also, 71% of students reported that there are not enough glasses for the consumption of supplement iron. There were significant relationships between iron supplements distributors (deputy assistant: 22.6% vs. 14.1%, P = 0.045), allocated enough time to intake iron supplements (72.0% vs. 37.1%, P < 0.001), implemented the educational program in schools (61.8% vs. 33%, P < 0.001), and the educator person of the program (health teachers: 42.7% vs. 35.7%, P = 0.039) with consumption of iron supplement by the students.

CONCLUSION

To achieve the goals of the program, it is necessary paying attention to various aspects of the program such as providing better quality iron supplements, providing more appropriate environmental conditions, designing more attractive training programs, strengthening general announcement, and employing more experienced executive staff.

CONCLUSION

Prevalence of anaemia among adolescent girls (10-19 years) in India: A systematic review and meta-analysis

Background Anaemia is a serious public health problem. It is the second-commonest contributing factor to years lost by adolescents to disability and death. Targeting adolescent girls will allow a window of opportunity to correct their nutritional health and improve their obstetric outcomes. Studies in India have reported varying prevalence rates of anaemia among adolescent girls. Hence, we did a systematic review and meta-analysis of community-based studies to obtain a comprehensive pooled estimate of the prevalence of anaemia among adolescent girls in India. Methods We did a systematic electronic search in PubMed, Embase, Cochrane Library and Google scholar to retrieve community-based studies that reported the prevalence of anaemia among adolescent girls (10-19 years) in India, without any date or language restriction. To estimate the pooled prevalence and heterogeneity, the random-effects model and I2 statistical methods were used. We did subgroup analyses based on geographical region, study setting, method used to measure haemoglobin concentration, and year of publication. Results We included 35 studies in this meta-analysis comprising 152 640 participants. The pooled prevalence of anaemia among adolescent girls was 65.7% (95% CI 59.3%- 71.9%). There was significant heterogeneity between the studies (I2 99.6%; p<0.001). Conclusion There is a high prevalence of anaemia among adolescent girls in India. While all regions of the country have a high prevalence, tribal areas need special attention. Targeted actions need to focus on the identification of determinants of anaemia apart from iron supplementation.

A Review of the Risk Factors for Iron Deficiency Anaemia among Adolescents in Developing Countries

Introduction

Identifying the root causes of iron deficiency anaemia is a prerequisite for effective management and prevention in adolescents. This systematic review assessed risk factors of iron deficiency anaemia among adolescents living in developing countries.

Method

Electronic databases such as PubMed, Cochrane Library, Science Direct, Google Scholar, and SCOPUS were comprehensively searched for studies published between 1990 and 2020 that involved risk factors of iron deficiency anaemia among adolescents living in developing countries. The quality of the included studies was assessed using the American Dietetic Association Quality Criteria Checklist.

Results

A total of 2,252 publications were reviewed, and only fifteen cross-sectional studies were eligible for inclusion, eight of which focused on female adolescents and seven on both genders. Direct risk factors contributing to anaemia among adolescents included food intake practices (n = 10 studies), female adolescents (n = 8 studies), menstruation (n = 5 studies), and parasitic infection (n = 6 studies). Indirect risk factors found to be associated with anaemia among adolescents included low educational status (n = 4 studies) and low socioeconomic status (n = 3 studies). All fifteen studies were of good quality.

Conclusion

Food intake practices, female adolescents, menstruation, parasitic infection, and low educational status were the leading risk factors of iron deficiency anaemia among adolescents. Further research should concentrate on assessing the effectiveness and efficacy of existing interventions aimed at preventing iron deficiency among vulnerable groups in developing countries.

Prevalence of Anemia Among Adolescent Girls Residing in Rural Haryana: A Community-Based Cross-Sectional Study

Background

Anemia continues to be a major public health problem in India despite multiple initiatives to address it among various vulnerable groups including adolescents.

Aim

This study was conducted to assess the prevalence of anemia among rural adolescent girls who had attained menarche.

Methods

The community-based cross-sectional study was conducted in 28 villages of Ballabgarh Block of district Faridabad, Haryana. From the computerized Health Management Information System data (HMIS), a random list of 363 adolescent girls was generated. Adolescent girls who had attained menarche were included in the study. Hemoglobin level was measured for all the consented or assented participants using a digital hemoglobinometer (HemoCue201+ photometer, HemoCue AB, Angelholm, Sweden).

Results

A total of 272 participants were enrolled in the study. Mean (SD) age at menarche was 13.2 (1.2) years. Prevalence of anemia among adolescent girls who had attained menarche was observed to be 71.7% (95% CI: 66.3 - 77.1) as per the WHO classification. Among the 195 anemic adolescent girls, severe, moderate, and mild anemia was observed in 4.8%, 41.2%, and 25.7%, respectively. In multivariable analysis, after adjusting for the age, the mother’s education was significantly associated with anemia (Adjusted Odds Ratio = 0.46, 95% CI: 0.22 - 0.96, p-value = 0.04).

Conclusion

The prevalence of anemia among rural adolescent girls who had attained menarche was high. Mother’s education status had a protective effect on anemia among adolescent girls.

Prevalence, knowledge, and related factor of anemia among school-going adolescent girls in a remote area of western Rajasthan

Introduction:

Methods:

Results:

Conclusion:

Effect of education through video and packaging modifications of iron tablets on female adolescent behavior in the iron supplementation intake in SMPN 2 and SMPN 1 Parigi

OBJECTIVE

The purpose of this study was to reveal the effect of providing education by video and modification of iron tablet packaging on young women's behaviour in the iron supplementation intake in SMPN 2 and SMPN 1 - Parigi.

METHODS

This research was a quasi-experimental design with pretest-posttest control group design along with stratified random sampling, which was SMPN 2 Parigi as an Intervention group and SMPN 1 Parigi as a control group. The total sample of 62 respondents in each group.

RESULT

In the Wilcoxon Signed Ranks Test analysis, the Intervention group (video+modification of iron tablet packaging) valued p=0.001 <0.05. It means that there were differences in female students' knowledge, attitudes, and intentions in the pretest-posttest, while in the control group (video) obtained p-value=0.001 <0.05, which showed differences in knowledge, attitudes, and intentions of female students in the pretest-posttest.

CONCLUSION

The development of educational media for iron tablet intake through the video along packaging modification of iron tablet contributed a significant effect on the knowledge, attitudes, and intentions of young women in the iron supplementation intake.

Access to a piped water supply is positively associated with haemoglobin levels in females living in rural Maharashtra State, India

OBJECTIVES

There is a high prevalence of anaemia in individuals living in rural India, which may be modified by a number of environmental factors. The association between access to water, toileting facilities and healthcare services with the prevalence of anaemia was explored to determine potentially modifiable community-level risk factors.

STUDY DESIGN

This was a cross-sectional survey.

METHODS

Data were collected from adolescent females (aged 13-17 years) living in 34 villages in rural areas of the Maharashtra state of India on measures of sanitation facilities and access to health care along with haemoglobin measurements. Linear and logistic regression analyses were conducted to investigate associations between environmental (community) factors and adolescent haemoglobin levels and anaemia, respectively.

RESULTS

Data were available from 1010 individuals, which represented a response rate of over 97% of those who were approached for the study. The prevalence of anaemia was very high (87%) when measured using haemoglobin levels. Access to a piped water supply was associated with 0.59 g/dL of increase in haemoglobin levels (95% confidence interval: 0.10-1.09). Associations between access to communal toilets, travel time to the hospital, health centres or nurses and haemoglobin levels or anaemia were not statistically significant.

CONCLUSIONS

Anaemia prevalence was very high in our study population. Simple improvements such as provision of regular piped water is associated with an increase in haemoglobin levels in rural Indian females. These are consistent with the hypothesis that chronic exposure to higher levels of microbes in the living environment contributes to the risk of anaemia.

Anemia and associated factors among adolescent girls and boys at 10-14 years in rural western China

Background

Evidence on anemia and associated factors among young adolescent girls and boys in rural western China is limited.

Methods

We used data from a follow-up study of adolescents (10–14 years) born to women who participated in a randomized trial of antenatal micronutrient supplementation in western China. Anemia was defined by World Health Organization standards. Logistic regression was used to examine the factors associated with anemia.

Results

The overall prevalence of anemia was 11.7% (178/1517). Female adolescents were 1.73 (95% CI 1.21, 2.48) times more likely to have anemia as compared to males. Adolescents whose mothers had completed high school were 0.35 (95% CI 0.13, 0.93) times less likely to be anemic, compared to those of whom had < 3 years of formal education. Household wealth was also inversely associated with anemia. The association of puberty status with anemia was modified by adolescent sex (P-value for interaction was 0.04); males with greater than mild pubertal development had reduced odds (OR 0.35, 95% CI 0.15, 0.83) of anemia while there was no association among females (OR 0.72, 95% CI 0.29, 1.78). Consumption of flesh foods (OR 0.58, 95% CI 0.38, 0.89), eggs (OR 0.60, 95% CI 0.38, 0.93), and having a meal frequency of three times or more per day (OR 0.68, 95% CI 0.48, 0.96) were also associated with a lower likelihood of anemia.

Conclusions

Anemia was a mild public health problem among young adolescents in rural western China. Nutritional and social determinants were identified as predictors, warranting interventions to reduce the risk of anemia among this critical age group.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10268-z.

Practical intervention on quality of life of anemic girls and their mothers

BACKGROUND

Anemia is the most prevalent disease in teenage girls and like other chronic diseases not only affects different aspects of their quality of life (QOl) but also quality of life of their parents.

OBJECTIVE

The aim of present study is investigating the effectiveness of family centered empowerment model (FCEM) on adolescent girls with anemia and their mother's quality of life.

METHODS

Semi-experimental practical research is performed by choosing 60 girls with anemia and their mothers classified in two case and control groups based on random allocation in Tehran city. The eight sessions of educational program based on educational needs of girls & mothers in case group done for two months. The post test was carried out 1/5 month after the end of intervention through QOl questionnaire in case and control groups. Data analysis was performed using statistical methods including t-test, paired t-test.

RESULTS

There was no significant difference in the QOl in adolescent girls and their mothers between the two case and control groups before intervention (P=0/473 & P=0/94 respectively). While, after the intervention independent t-test showed a significant difference between the two case and control groups (P>0/001).

CONCLUSIONS

Findings showed that the FCEM promote the QOl in adolescent girls with anemia and their mothers. It is recommended that extensive studies be performed on the effectiveness of this model for other chronic diseases in different age groups.

Two measures of systemic inflammation are positively associated with haemoglobin levels in adolescent girls living in rural India: a cross-sectional study

OBJECTIVE

This study tested the hypothesis that systemic inflammation is inversely associated with haemoglobin levels in adolescent girls in India.

METHODS

The study population consisted of adolescent girls aged between 10 and 19 years living in a remote rural region in Maharashtra State, India. Data were collected on anthropometric measures, and a venous blood sample was taken and tested for complete blood count and C-reactive protein (CRP).

RESULTS

Of 679 individuals who were invited to the research site to participate, data were available from 401 participants giving a response rate of 59%. Median blood CRP was 1.26 mg/l (Range 0.00 to 26.33), and 167 (41.6%) participants had CRP level < 1.0 mg/l. The mean haemoglobin was 12.24 g/dl (standard deviation [SD] 1.51), and the mean total white blood cells (WBC) count was 9.02 × 10³ /μl (SD 2.00). With each g/dl increase in blood haemoglobin, the risk of having an elevated CRP of ≥ 1 mg/l increased with an odds ratio of 1.16 (95% CI 1.01 to 1.33, P = 0.03). Total WBC count was also positively associated with blood haemoglobin, increasing by 0.24 × 10³ /μl (95% CI 0.11 to 0.37, P < 0.001) per g/dl increase in haemoglobin. Both analyses were adjusted for age.

CONCLUSIONS

In this population, blood haemoglobin levels were positively associated with two measures of systemic inflammation, contrary to the primary hypothesis being tested. Other unmeasured environmental exposures may modify haemoglobin levels in this population. Understanding this observation may help design better public health interventions to improve the well-being of adolescent girls in India.

Weight, height, and midupper arm circumference are associated with haemoglobin levels in adolescent girls living in rural India: A cross-sectional study

We aimed to explore the association of physical parameters with haemoglobin (Hb) levels to test the hypothesis that impaired physical development is associated with anaemia. A cross‐sectional survey study recruited adolescent girls (13 to 17 years) living in rural areas of Maharashtra state of India. Data were collected on physical parameters include height, weight, and midupper arm circumference (MUAC). Hb levels were measured using Sahli's haemometer. Linear regression was conducted to test the hypothesis. Data were collected from 1,010 girls on physical parameter and Hb levels. The majority of the adolescent girls were diagnosed with anaemia (87%). The regression analysis adjusted for age gave a significant association of Hb levels with all three variables (MUAC, weight, and height). Hb increased by 0.11 g/dl with an each centimetre of increase in MUAC (95% confidence interval, CI, [0.08, 0.15], P < .001). Each kilogram of increase in the body weight showed an increase in Hb levels (0.02 g dl, 95% CI [0.01, 0.03], P = .001). With an each centimetre of increase in height, Hb increased by 0.01 g dl (95% CI [0.00, 0.02], P = .022). There was a consistent association between three measures of somatic growth and anaemia in the study population. It is likely that life‐course exposures from conception onwards contribute to this, and the public health implications are that preventing anaemia is a challenge that requires a multifaceted interventional approach. Understanding the importance of the timing of these life exposures will help design interventions that can achieve optimal results.

aDolescents gEnder surVey, rEsponsible coupLes evaluatiOn, and capacity building Project in India (DEVELOP): a study protocol

Gender-based violence against women is a serious concern in India. This affects the health and wellbeing of victims and their dependents. Published evidence has documented a variety of reasons for such violence in Indian societies, paving a pathway to design, implement, and evaluate intervention models to address this issue. DEVELOP is a research study designed by UK and Indian research teams to plan future projects to address gender-based discrimination and violence against women and girls in India. This study protocol provides detailed information on the objectives, research methods, data collection, storage, analysis, and dissemination plans of the DEVELOP. The first component is a survey of adolescent boys and girls from rural areas of Maharashtra state of India to understand their gender equality related knowledge and beliefs. The insight gathered will be used to design interventions targeted at adolescent populations through future research and development programmes. Secondly, an evaluation of the 'Responsible Couples' project will be conducted to assess its success and challenges, and to design suitable programme activities and models. The 'Responsible Couples' project is implemented in 40 villages of Maharashtra state to improve relationships in married couples, prevent violence against women, intervene during violence, and to provide support services for women and their family members. Research findings will be disseminated though public engagement events in India, international conferences, and peer reviewed publications. This will impact on the policy and work models of Indian partners to plan future project investments. Research findings will be also useful for local government authorities and non-government agencies striving to advance gender equality.

aDolescents gEnder surVey, rEsponsible coupLes evaluatiOn, and capacity building Project in India (DEVELOP): a study protocol

Domestic violence and assault (DVA) against women is a serious concern in India. This affects the health and wellbeing of victims and their dependents. Published evidence has documented a variety of reasons for such violence in Indian societies, paving a pathway to design, implement, and evaluate intervention models to address this issue. DEVELOP is a research study designed by UK and Indian research teams to plan future projects to address gender-based discrimination and DVA against women and girls in India. This study protocol provides detailed information on the objectives, research methods, data collection, storage, analysis, and dissemination plans of the DEVELOP phase 1 work (2018-19). The first component is a survey of adolescent boys and girls from rural areas of the Maharashtra state of India to understand their gender equality related knowledge and beliefs. The insight gathered will be used to design interventions targeted at adolescent populations through future research and development programmes. Secondly, an evaluation of the 'Responsible Couples' project will be conducted to assess its success and challenges, and to inform future programme activities and strategy. The 'Responsible Couples' project is implemented in 40 villages of Maharashtra state to improve relationships in married couples, prevent violence against women, intervene during violence, and to provide support services for women and their family members. Research findings will be disseminated though public engagement events in India, international conferences, and peer reviewed publications. Secondly, our two key partners (SWISSAID and HMF) will benefit from such evidence to inform their on-going as well as forthcoming projects on gender equality in India.  Research findings will be also useful for local government authorities and non-government agencies striving to advance gender equality.

Genetic basis of unexplained erythrocytosis in Indian patients

OBJECTIVE

To evaluate the spectrum of genetic defects in Indian patients with unexplained erythrocytosis.

METHODS

Fifteen families (18 patients) with unexplained erythrocytosis were enrolled after excluding polycythemia vera and secondary erythrocytosis. Focused Sanger sequencing from genomic DNA was performed for EPOR (exon 8), VHL (exons 2-3), EGLN1 (exons 2-5), EPAS1 (exon 12), and all exons of HBB, HBA1, and HBA2 genes.

RESULTS

Eleven of the 18 patients (including two pairs of brothers) had Chuvash polycythemia, that is, homozygosity for VHL:c.598C > T (p.Arg200Trp). Three patients (two of whom were brothers) had HBB mutations associated with increased oxygen-affinity hemoglobin-one had a heterozygous Hb McKees Rocks HBB:c.438T > A (p.Tyr146*), and two brothers showed heterozygous Hb Rainier HBB:c.437A > G (p.Tyr146Cys). No pathogenic variants were found in the remaining four cases.

CONCLUSION

A gene-by-gene Sanger sequencing approach could determine a genetic basis for erythrocytosis in 11 of the 15 (73%) Indian families, with homozygous VHL:c.598C > T (p.Arg200Trp) being the commonest pathogenic variant. This first study from the Indian subcontinent provides a rationale for analyzing this variant in patients with suspected congenital erythrocytosis from this region. Rare first occurrences of Hb McKees Rocks and Hb Rainier in Indians are also being reported.

The usefulness of reticulocyte haemoglobin content, serum transferrin receptor and the sTfR-ferritin index to identify iron deficiency in healthy children aged 1-16 years

This cross-sectional study, conducted on a population-based representative sample, evaluates the usefulness of reticulocyte haemoglobin content (CHr), serum transferrin receptor (sTfR) and sTfR/log ferritin (sTfR-F index) to recognise iron deficiency (ID) without anaemia, provides specific cut-off points for age and gender, and proposes a new definition of ID. A total of 1239 healthy children and adolescents aged 1-16 years were included. Complete blood count, iron biomarkers, erythropoietin, C-reactive protein, CHr, sTfR, and sTfR-F index were determined. ROC curves were obtained and sensitivity, specificity, predictive values, likelihood ratios, and accuracy for each specific cut-off points were calculated. Seventy-three had ID without anaemia. Area under the curve for sTfR-F index, sTfR and CHr were 0.97 (CI95% 0.95-0.99), 0.87 (CI95% 0.82-0.92) and 0.68 (CI95% 0.61-0.74), respectively. The following cut-off points defined ID: sTfR-F Index > 1.5 (1-5 years and 12-16 years boys) and > 1.4 (6-11 years and 12-16 years girls); sTfR (mg/L) > 1.9 (1-5 years), > 1.8 (6-11 years), > 1.75 (12-16 years girls) and > 1.95 (12-16 years boys); and CHr (pg) < 27 (1-5 years) and < 28.5 (6-16 years).Conclusions: CHr, sTfR and the sTfR-F index are useful parameters to discriminate ID without anaemia in children and adolescents, and specific cut-off values have been established. The combination of these new markers offers an alternative definition of ID with suitable discriminatory power. What is Known: • In adults, reticulocyte haemoglobin content (CHr), serum transferrin receptor (sTfR) and sTfR/log ferritin index (sTfR-F index) have been evaluated and recognised as reliable indicators of iron deficiency (ID). • Clinical manifestations of ID may be present in stages prior to anaemia, and the diagnosis of ID without anaemia continues to pose problems. What is New: • CHr, sTfR and the sTfR-F index are useful parameters in diagnosis of ID in childhood and adolescence when anaemia is not present. • We propose a new strategy for the diagnosis of ID in childhood and adolescence, based on the combination of these measures, which offer greater discriminatory power than the classical parameters.

Trends and drivers of change in the prevalence of anaemia among 1 million women and children in India, 2006 to 2016

Introduction

India carries the largest burden of anaemia globally. Progress to reduce anaemia has been slow despite substantial economic growth and 50 years of programmatic efforts. Identification of the factors that contribute to anaemia reductions is needed to accelerate progress. We examined changes in haemoglobin (Hb) and anaemia among women and children in India from 2006 to 2016 and identified drivers of changes in these outcomes over time.

Methods

We used two rounds of National Family Health Survey data collected in 2005–2006 and 2015–2016 (n=245 346 children 6–59 months; 37 165 pregnant women (PW) 15–49 years; 760 460 non-pregnant women (NPW) 15–49 years). We first examined trends in Hb and anaemia, and changes in 30 selected variables (including immediate and underlying determinants, and nutrition and health interventions (NHIs)). We identified drivers of Hb and anaemia using multivariate regression and estimated their contribution to changes in these outcomes over time using regression-based decomposition.

Results

Hb and anaemia improved significantly between 2006 and 2016 in children (4.5  g/L and 11 percentage points (pp), respectively) and PW (3.2  g/L and 7.6 pp), but not in NPW. Despite these changes, anaemia is still very high (>50%) and progress varied considerably by state (−33 pp to +16 pp). Most immediate and underlying determinants, and NHIs improved significantly over time. Changes among a set of drivers common to children and PW accounted for the changes in Hb; these included maternal schooling (children, 10%; PW, 24%), coverage of NHIs (children, 18%; PW, 7%), socioeconomic status (children, 7%; PW, 17%), sanitation (children, 3%; PW, 9%), and meat and fish consumption (children, 3%; PW, 1%). The decomposition models moderately explained Hb changes over time (children, 49%; PW, 66%).

Conclusions

Multiple common drivers have contributed to the anaemia changes among children and pregnant women in India. Further improvements in these drivers can have population-level effects by simultaneously influencing both maternal and child anaemia.

Cognitive Performance in Indian School-Going Adolescents Is Positively Affected by Consumption of Iron-Biofortified Pearl Millet: A 6-Month Randomized Controlled Efficacy Trial

BACKGROUND

Iron deficiency remains the most prevalent micronutrient deficiency globally, but few studies have examined how iron status relates to cognition in adolescents. Iron biofortification of staple food crops is being scaled up, yet it is unknown whether consuming biofortified crops can benefit cognition.

Objective

Our objective was to determine the efficacy of iron-biofortified pearl millet in improving attention and memory in Indian school-going adolescents.

Methods

A double-blind, randomized, intervention study was conducted in 140 Indian boys and girls, aged 12-16 y, who were assigned to consume iron-biofortified [Fe = 86 parts per million (ppm)] or conventional (Fe = 21-52 ppm) pearl millet. Hemoglobin, ferritin, and transferrin receptor (TfR) were measured and body iron (BI) was calculated at baseline and after 4 and 6 mo. Five measures of cognitive function were obtained at baseline and 6 mo: simple reaction time (SRT), Go/No-Go (GNG) task, Attentional Network Task (ANT), Composite Face Effect (CFE) task, and Cued Recognition Task (CRT). Intention-to-treat analysis was used.

Results

Daily iron intake from pearl millet was higher in those consuming biofortified compared with conventional pearl millet (19.6 compared with 4.8 mg/d). Effects on ferritin, TfR, and BI at 4 mo, and on TfR at 6 mo (all P < 0.05), indicated efficacy of biofortified pearl millet over conventional pearl millet in improving iron status. Compared with conventional pearl millet, the consumption of biofortified pearl millet resulted in greater improvement in attention (SRT, GNG, and ANT) and memory (CFE and CRT). Reaction time decreased twice as much from 0 to 6 mo in those consuming biofortified compared with conventional pearl millet on attention tasks (SRT: -123 compared with -63 ms; GNG: -67 compared with -30 ms; ANT double cue: -74 compared with -32 ms; all P < 0.01).

Conclusion

Consuming iron-biofortified pearl millet improves iron status and some measures of cognitive performance in Indian adolescents. This trial was registered at http://www.clinicaltrials.gov as NCT02152150.

Healthcare benefits linked with Below Poverty Line registration in India: Observations from Maharashtra Anaemia Study (MAS)

A 2015 Lancet paper by Patel et al. on healthcare access in India comprehensively discussed national health programmes where some benefits are linked with the country’s Below Poverty Line (BPL) registration scheme. BPL registration aims to support poor families by providing free/subsidised healthcare. Technical issues in obtaining BPL registration by poor families have been previously reported in the Indian literature; however there are no data on family assets of BPL registrants. Here, we provide evidence of family-level assets among BPL registration holders (and non-BPL households) using original research data from the Maharashtra Anaemia Study (MAS).

Social and health data from 287 pregnant women and 891 adolescent girls (representing 1178 family households) across 34 villages in Maharashtra state, India, were analysed. Several assets were shown to be similarly distributed between BPL and non-BPL households; a large proportion of families who would probably be eligible were not registered, whereas BPL-registered families often had significant assets that should not make them eligible. This is likely to be the first published evidence where asset distribution such as agricultural land, housing structures and livestock are compared between BPL and non-BPL households in a rural population. These findings may help planning BPL administration to allocate health benefits equitably, which is an integral part of national health programmes.