Evaluating a delivery model to ensure feasible and effective reduction of childhood anaemia

By Lindsey Peugh, Research Associate – ICTPH

The period between 6 and 24 months of age is a critical stage during which nutritional deficiencies can cause deleterious and irreversible effects on a child’s growth and cognitive development. Iron deficiency is considered to be the most common micronutrient deficiency in the world and anaemia is the most frequent clinical classification of this deficiency. Infants with iron deficiency anaemia score lower on tests of motor and mental development and are at-risk for long-term developmental disadvantages compared with non-anemic infants. The Indian National Health and Family Survey-3 (NFHS) conducted in 2005-2006, found that anemia among children less than three years of age is extremely widespread. Results from Tamil Nadu show that 72.7 percent of children aged 6-35 months of age are anaemic and the prevalence has actually increased from the NFHS-2 at which time 69.1 percent of this age group was anaemic.

Typically, in low-income regions the iron density of food is largely is composed of non-heme iron from grains, fruits, and vegetables, which is poorly absorbed. Depending on the region, diets in India usually contain an adequate amount of iron but the absorption of iron is inadequate. When foods do not provide the recommended intake of micronutrients, research recommends micronutrient supplementation as a strategy to combat micronutrient deficiencies in children under five. In non-malarial regions, iron supplementation for children of this age group can be used as an effective strategy to reduce iron deficiency anaemia and should be coupled with long-term strategies as well. The goal of iron supplementation is to restore normal levels of iron storage and hemoglobin levels.

In India, national programs have attempted to tackle anaemia among the population. For instance, the National Nutritional Anaemia Prophylaxis Programme recommends routine iron supplementation and folic acid for children aged 6-60 months regardless of anaemia status. However, due to practical difficulties, the system has failed to deliver as expected. Likewise, iron drops are available through the Integrated Child Development System yet research and observations has shown that utilization is low. Iron drops are often difficult to use, cause uncomfortable side effects, and have an unpleasant taste lending to their unfavorable use. On the other hand, microencapsulated Sprinkles for home fortification has been a well-received and effective method to raise blood hemoglobin and reduce anaemia prevalence among children.

Despite the evidence of its effectiveness, research on specific delivery models of Sprinkles is limited, especially in the Indian context. In order to ensure the feasible and effective delivery of a proven strategy to improve nutrition is achieved, research is needed to evaluate the effectiveness of a delivery model and identify potential bottlenecks and barriers in the delivery pathway. Our nutrition program will focus on this end with the goal of evaluating the feasibility of combining the delivery of Sprinkles from the RMHC with social marketing and education messages delivered through the network of SughaVazhvu nurses and guides. Children in the 6-24 month age group will be identified through our PLSP and SVGs will visit these households to provide social marketing and educational messages on nutrition, particularly anaemia, to consenting caregivers. At the RMHC, children can have their nutritional status assessed (e.g. hemoglobin level, anthropometric measurements, etc.) and nurses will provide additional educational messages on available strategies to reduce anaemia. Caregivers will be able to decide whether or not they want to purchase Sprinkles or another iron supplement at the RMHC, or elsewhere. SVGs will then conduct fortnightly follow-up visits to assess the compliance of caregivers who purchased Sprinkles and will also assess any side effects experienced by the child and the caregiver perceptions of the product and delivery system. Also important is the insight from caregivers who do not purchase or use Sprinkles. Information at each step of the intervention will be collected through structured questionnaires and will be analyzed to identify ways in which the delivery system can be improved. Key to this intervention is the delivery of consistent, quality messages to caregivers to increase awareness and encourage healthy behaviors to improve child nutrition as well as the reduction of barriers which prevent the healthy behaviors in the first place.

For detailed information on each step of the Sprinkles intervention, download the intervention manual here.