Factors Influencing Receipt of Iron Supplementation by Young Children and their Mothers in Rural India: Local and National Cross-Sectional Studies

Abstract

BackgroundIn India, 55% of women and 69.5% of preschool children are anaemic despite national policies recommending routine iron supplementation. Understanding factors associated with receipt of iron in the field could help optimise implementation of anaemia control policies. Thus, we undertook 1) a cross-sectional study to evaluate iron supplementation to children (and mothers) in rural Karnataka, India, and 2) an analysis of all-India rural data from the National Family Health Study 2005-6 (NFHS-3).MethodsAll children aged 12-23 months and their mothers served by 6 of 8 randomly selected sub-centres managed by 2 rural Primary Health Centres of rural Karnataka were eligible for the Karnataka Study, conducted between August and October 2008. Socioeconomic and demographic data, access to health services and iron receipt were recorded. Secondly, NFHS-3 rural data were analysed. For both studies, logistic regression was used to evaluate factors associated with receipt of iron.ResultsThe Karnataka Study recruited 405 children and 377 of their mothers. 41.5% of children had received iron, and 11.5% received iron through the public system. By multiple logistic regression, factors associated with children's receipt of iron included: wealth (Odds Ratio (OR) 2.63 [95% CI 1.11, 6.24] for top vs bottom wealth quintile), male sex (OR 2.45 [1.47, 4.10]), mother receiving postnatal iron (OR 2.31 [1.25, 4.28]), mother having undergone antenatal blood test (OR 2.10 [1.09, 4.03]); Muslim religion (OR 0.02 [0.00, 0.27]), attendance at Anganwadi centre (OR 0.23 [0.11, 0.49]), fully vaccinated (OR 0.33 [0.15, 0.75]), or children of mothers with more antenatal health visits (8-9 visits OR 0.25 [0.11, 0.55]) were less likely to receive iron. Nationally, 3.7% of rural children were receiving iron; this was associated with wealth (OR 1.12 [1.02, 1.23] per quintile), maternal education (compared with no education: completed secondary education OR 2.15 [1.17, 3.97], maternal antenatal iron (2.24 [1.56, 3.22]), and child attending an Anganwadi (OR 1.47 [1.20, 1.80]).ConclusionIn rural India, public distribution of iron to children is inadequate and disparities exist. Measures to optimize receipt of government supplied iron to all children regardless of wealth and ethnic background could help alleviate anaemia in this population.

Vitamin-B12 and folate deficiency, major contributing factors for anemia: A population based study

“…The association of vit-B12 and folate deficiency with anemia in the studied population from the eastern part of India becomes important because despite the state initiative to supplement iron to the population at large during the last 40 years (since 1970) a significant decline in the incidence of anemia has not been seen, especially among children and pregnant women. 3 Even if allowance is made for operational inadequacies in the implementation of this programme, 10 there is valid reason to believe that there are major factors, other than, or along with, iron that cause anemia at such large scale in Indian population. We contend, high frequency of vit-B12 deficiency all through the cross section of population in India is one of the reasons of ineffectiveness of iron supplementation in reducing the rate of anemia.…”

Rapid Assessment for Coexistence of Vitamin B12 and Iron Deficiency Anemia among Adolescent Males and Females in Northern Himalayan State of India

“…But, despite the significant efforts by the country the significant reduction in anemia is yet to be observed. A marked difference in IFA consumption due to considerable disparities in socioeconomic factors and health care delivery system was observed [24]. …”

Iron Deficiency Anemia (IDA), their Prevalence, and Awareness among Girls of Reproductive Age of Distt Mandi Himachal Pradesh, India

“…But, despite the significant efforts by the country the significant reduction in anemia is yet to be observed. A marked difference in IFA consumption due to considerable disparities in socioeconomic factors and health care delivery system was observed (31).…”