Can iron status be improved in each of the three trimesters? A community-based study

Abstract

Objective: Intervention with iron supplementation, deworming, and information, education and communication (IEC) to improve the haematological status among each of the three trimesters of pregnant women in a rural community. Design: A community-based study was carried out using a two-group pre ± post experimental design in a rural community. Setting: Two rural blocks in Vellore district were selected for the study. KV Kuppam block with a population of 120,000 and the adjacent Gudiyatham block with a population of 132,000 served as study and control areas for the study. Subjects: Using a multistage sampling, initially 50% of the panchayats, the local village administrative units, were randomly selected and all pregnant women were the subjects. In the pre-intervention survey 458 and 387 pregnant women had haemoglobin tested and the post-intervention survey covered 403 and 425 pregnant women in the study and control areas, respectively. Similarly serum ferritin was tested in a randomly selected subsample with 254 and 191 pregnant women before intervention and in 216 and 223 pregnant women after intervention in both study and control areas, respectively. Intervention: Iron supplementation and deworming were provided to all pregnant women in the study area from the fourth month of their pregnancy. An intensive information, education and communication was carried out with facts on anaemia and diet modi®cation to each pregnant woman, using a one-to-one approach in the community, and a group method in the mobile clinics. This was carried out for a period of 18 months. Results: A signi®cant decrease in the prevalence of anaemia was found, from 56.1% to 25.07% (P`0.001), 73.4% to 49.2% (P`0.001) and 68.8% to 56.8% (P`0.01) among women in the ®rst, second and third trimesters, respectively, in the intervention area. Signi®cant (P`0.001) increases in the mean haemoglobin of 0.85 gadl (95% CI 10.18 ± 10.84, 11.09 ± 11.63), 0.59 gadl (95% CI 9.98 ± 10.34, 10.55 ± 10.95) and 0.36 gadl (95% CI 9.93 ± 10.33, 10.25 ± 10.73) were also observed in each of the groups. Conclusion: A comprehensive community-based intervention with iron supplementation, helminthic treatment and increase in knowledge using IEC through effective strategies can improve the haematological status of pregnant women in each trimester.

Prevalence and Factors Associated with Anemia Pregnancy in a Group of Moroccan Pregnant Women

“…In this study anemia of the third quarter was the most predominant, contrary to a study that said that this is the second quarter that withdrawals from the woman reserves are the most important and therefore the hemoglobin level is lower [20]. The increase in the prevalence of anemia in the evolution of gestational age, demonstrated in this study is also noted by other authors [11] [21] [22], it is consistent with the increase physiological needs during pregnancy.…”

Prenatal iron supplementation in rural Vietnam

“…However, the increase in Hb concentration in the first trimester of pregnancy with iron supplementation was not observed. The Hb concentration of pregnant women in India was increased significantly by 0.84 g/dl in the first trimester 18 months after conducting a community-based anaemia reduction programme 95% confidence interval 11.0-11.63, 9.93-11.11) (Abel et al, 2000). This is due to the iron absorption rate that is different from degree of anaemia (Sloan et al, 2002).…”

“…All the tests were two-sided, and a significant level of 5% was regarded as significant. To calculate the required sample size, the prevalence of anaemia (10.0 g/dl) among pregnant women was estimated to be 35% (Khoi, 2001) and the relative decrease of anaemia prevalence used in the calculation was 25% (Abel et al, 2000). On the basis of this assumption, we estimated that a sample of 739 was required (95% power, Po0.01).…”

Effectiveness of a redesigned iron supplementation delivery system for pregnant women in Negros Occidental, Philippines

“…Reduction in anaemia prevalence after supplementing with Fe was also seen among pregnant women in India (25) , in rural Bangladesh (26) and in adolescent pregnant women in their first pregnancy in Wisconsin, USA (27) .…”