Intervention Study among adolescents, pregnant and lactating mothers
to reduce prevalence
of Anaemia- contributory factor of maternal morbidity and mortality
Under the ‘Good
Health Program’ Sukarya in collaboration with Population
Foundation of India (PFI), New Delhi has undertaken the Anaemia
Intervention Project.
Goal of the
Project To
reduce the prevalence of Iron Deficiency 'Anaemia' among adolescent
girls in the age group of 13-19 years, pregnant and lactating mothers
in Gurgaon district of Haryana. Anaemia is a contributory
factor of maternal morbidity and mortality.
Objectives
of the Project
To measure
the prevalence of Anaemia in the target group.
To understand
the knowledge, attitude and practices in consuming iron-rich
food and health seeking behaviour.
To create
awareness on Anaemia, methods of prevention and treatment.
To prevent
and treat Anaemia among the target group.
Target Area 10
villages in 2 circles of ICDS Project area namely Jharsa and
Nathupur in Gurgaon District, Haryana with a population
of approximately - 30,000. The villages include Ghata, Tighra,
Samaspur, Wazirabad, Kanhai, Silokhra, Sainikhera, Gwalpahari, Walaiwas
and Bandhwari.
Target Group Adolescent
girls (13-18 years), pregnant women and lactating mothers from the
target selected villages.
Project Period May
2006 - April 2009 (3 years)
Activities for the Project undertaken in 2006-07 are as follows:
A. Baseline
Survey and Blood Test by Cyanmethemoglobin method A
Baseline Survey was conducted in the month of July 2006. The survey
was undertaken to assess the prevalence and knowledge of Anaemia
among women and adolescents in 7 Project villages. The total numbers
of target respondents which included pregnant women, lactating mothers
and unmarried adolescent girls were 300. The respondents were selected
by stratified random-sampling method. The survey was conducted by
an external organization called Formative Research and Development
Services (FRDS), Delhi. Sukarya was entrusted with the task
of collecting the blood samples for the Baseline Survey. The results
of the Baseline Survey were analyzed and the status of Anaemia among
the target group was established. Haemoglobin testing was done by
Cyanmethemoglobin method which helped us to measure the prevalence
of Anaemia in the Project villages. Haemoglobin testing of blood
samples during the baseline survey was undertaken by Flash Laboratory
and Physiotherapy, Gurgaon.
B. Recruiting
community mobilisers Community
mobilisers are the local adolescent girls or women from the Project
villages who are interested in the development activities of the
village. The main criteria for the selection of the community mobilisers
are:
Enthusiastic
and active people
Age group
(15- 40 years)
Basic Education
(5th Class)
Should belong
to the community
Should have
goodwill in the community
Should have
an inclination towards volunteering/ social causes
Commitment
of time
There are currently 20 community mobilisers in 10 villages. The
community mobilisers are actively working in the field and are primarily
engaged in household visits, formation of groups and mobilizing
pregnant and lactating women to visit the village level health workers
for regular checkups and consumption of Iron & Folic Tablets
(IFA). The community mobilisers
are given regular trainings on communication techniques, leadership
building, community participation and technical knowledge of Anaemia.
C. Women
and adolescent groups Under
the Project, 25 women’s and adolescents groups have been formed
in all the 10 villages. The group provides a platform for women
and adolescents to collectively discuss issues around Anaemia and
more importantly encourage their peers to adopt healthy practices
and follow medical intervention, (taking IFA tablets) for preventing
Anaemia. Regular meetings are conducted in these groups. The groups
have established a specific day of meeting and every group has its
own name and the group maintains its own record.
D. One to
One meeting with target group One
to one meeting is conducted regularly through household visits with
special focus on pregnant, lactating mothers and adolescents. This
process of individual meeting is an effective method of creating
an understanding about the entire objective of the Project and general
awareness about Anaemia.
E. Counselling
of Anaemic patients Anaemic
patients have been identified during the health camps and during
the baseline survey. Counselling is provided to the Anaemic patients
regularly. These patients are motivated to take IFA tablets and
consult the doctor in the primary health centre. Serious patients
are also referred to the hospitals.
F. IEC material
development for awareness building Since
awareness is a key activity of the Project, developing IEC materials
is crucial. The Project staff has developed innovative IEC materials,
such as graphic posters, leaflets, Project banners, slogans and
flexes charts to generate awareness and the illiterate to understand.
Hindi posters have been developed for the literate. They are regularly
distributed amongst the target group in various forums like Project
meetings, schools, health camps and during household visits. Posters
and banners are displayed in strategic locations in all the 10 Project
villages.
G. Street
Play Street
theatre has proved to be an extremely useful medium for disseminating
information and knowledge to an essentially illiterate and uninformed
audience. Keeping this in mind, street plays were performed in 10
Project villages in the month of November and December, 2006. The
street play was performed by an experienced theatre group from the
NGO, Deepalaya.
The group is 11 years old and has completed a three years course
in acting from National
School of Drama (NSD). The main objective of the street play was
to create awareness on Anaemia among the community with a special
focus on the target group i.e. the pregnant women, lactating mothers
and the adolescent girls. The street play covered vital points of
Anaemia – its reasons, symptoms, preventive and curative steps.
Special emphasis
was also given to the following:
Social difference
or the inherent gender bias between boy and a girl which affects
their food intake and nutrition.
Personal
health and hygiene issues like washing the fruits and vegetables
before cooking or precautions while eating raw to prevent infections
causing loss of blood.
Women highly
susceptible to Anaemia due to frequent pregnancy.
Intake of
IFA tablets during pregnancy and lactation as a critical preventive
measure
Eating iron
rich green-leafy vegetables along with Vitamin C like
amla, lemon, green mangoes etc.
H. Documentary Films on Anaemia During
the project meetings, documentary films on Anaemia were shown to
group members as part of awareness building. Besides this, Sukarya
is in the process of producing its own documentary film to shown
regularly in the project areas.
I. Nutrition
Demonstration Workshop The
basic objective of the Nutrition Demonstration Workshop is to address
and sensitize the community on malnutrition (especially common among
lactating mothers, expectant mothers, adolescent girls and children)
which results in Anaemia, Vitamin A deficiency and iodine deficiency
disorders. This is reflected in low-birth weight, infant- mortality
rate, child-mortality rate and maternal mortality rate. During the
workshop importance of balanced and nutritious diet is explained
to the women and other community members. Affordable Iron-rich recipes
are demonstrated. For instance the cooking of Green Roti and
Amla Chatni is frequently demonstrated (especially for winter
months). The ingredients for the Green Roti are relatively
inexpensive and easily available like Soyabean Aata, Chana Aata,
Palak and Bathua. Chatni is another simple and easy-to-make
recipe iron-rich made from Amla, Dhania, Ginger, Garlic and Salt.
20 nutrition workshops have been conducted in the 10 Project villages
so far. This is an ongoing activity which will be conducted during
the entire
Project period.
J. Doctor's
visit to the Project villages The
main objective is to check up and follow up with the target group
and referral of serious cases to the hospitals. The doctor makes
10 visits to the project villages in the quarter.
K.
Blood test by Sahli's method Haemoglobin testing by Sahli's method was adopted which is a
very cheap method to identify anaemic cases. The Sahli's method
is being conducted for the entire target group with the consent
of the medical doctor on a regular basis. Those found anaemic clinically
was given tablets for de-worming and iron supplementation for a
period of three months. Haemoglobin estimation was repeated among
those detected anaemic after three months of iron supplementation.
This process 3 months after they reach the normal haemoglobin level.
L.
Health Education Sessions in Schools Health
education sessions are conducted in the middle, high and secondary
government schools. There are 8 villages that have middle schools,
4 villages having high-schools and only 1 village has secondary
school. The main objectives of these sessions are to bring about
awareness of Anaemia among the adolescents and school teachers who
can in turn educate their students. The sessions also focus on nutrition,
personal health and hygiene. Health education sessions are conducted
by the Project manger and the field supervisors. in the village
middle and higher secondary schools.
M.
Distribution of IFA tablets & de -worming tablets The
distribution of Iron & Folic Tablets and de-worming tablets
is the key medical intervention for the prevention and reduction
in Anaemia. Primarily the distribution of IFA Tablets and de-worming
tablets is undertaken by the ANM and the Aanganwari workers.100
tablets are given to each pregnant and lactating women given .In
the first year of the project Sukarya has played a vital role in
communicating with the AWW and the ANM to distribute the tablets
to the pregnant and lactating mother on a regular basis. Regular
meetings were done with PHC, Wazirabad. Sukarya has made continuous
efforts in following up with the target group as well as Anemic
patients to ensure that tablet have consumed or not. The community
mobilisers played a very crucial role in procuring the tablets from
the village health workers and distributing it to the target group.
