Evaluating the Impact of an Iron Supplementation Program for Combating Anemia in School-Age and Adolescent Females by a Grassroots Organization in India.

Background And Objective: Iron deficiency anemia (IDA) is a prominent cause of anemia adversely affecting the physical, mental, and social well-being of an individual. It is a major health concern and has impacted more than two billion people worldwide. It is necessary to implement programs to increase compliance rates for iron and folic acid (IFA) supplementation and educate individuals about anemia. In this study, we evaluate the impact of a non-profit organization's IFA supplementation program for school-age and adolescent females to combat anemia.

Methodology: This study was conducted via a grassroots organization that used a peer network to integrate with the existing national anemia campaign in school-age and adolescent females. This single-arm preintervention and postintervention study conducted over four months from June to September 2023 evaluated the effect of a one-time anti-helminthic treatment and weekly IFA supplementation (45 mg elemental iron and 0.4 mg folic acid per tablet for seven to nine-year-old females; 60 mg elemental iron and 0.5 mg folic acid per tablet for 10 to 19-year-old females) for 90 days. Hemoglobin levels at baseline and post-IFA supplementation were assessed using point-of-care direct reading hemoglobinometers. The pre- and post-test hemoglobin values were compared by a paired t-test.

Results: A total of 160 females visiting the foundation were approached, out of which 146 agreed to participate in the study. The baseline hemoglobin levels among 146 females were 10.9 ± 1.7 g/dL, and 103 (70.5%) of them were observed to have anemia. Due to a loss of follow-up, 99 participants were evaluated for pre- and post-IFA supplementation hemoglobin levels. Among 99 females, anemia was observed in 68.7% at baseline. The baseline hemoglobin level of 11.1 ± 1.7 g/dL significantly raised to 11.7 ± 1.4 g/dL after IFA supplementation (p<0.001). After IFA supplementation, the baseline distribution of participants with normal hemoglobin rose to 47.5% (post-test) from 31.3% (pre-test), showing a difference of 16.2%. The normal hemoglobin level distribution across the age groups after the weekly IFA supplementation program improved by 17.2% in participants aged seven to 10 years (from 31.4% to 48.6%), 17.7% in 11 to 14 years (from 29.45% to 47.1%), and 7.7% in those aged 15 to 19 years (from 38.5% to 46.2%).

Conclusion: Grassroots organizations can be pivotal in enhancing the efficacy of IFA supplementation programs, particularly in combating anemia among children. Behavior change communication and peer networks of such organizations can be integrated into existing programs to significantly contribute to improving the compliance rate of IFA supplementation programs.