Improving women's health: An assessment of community-based strategies to increase iron and mebendazole intake and reduce maternal anemia, in Orissa, India

Background. In India 50% to 60% of women are anemic in early pregnancy, and 60% to 75% are anemic in the last trimester. Iron supplementation and de-worming have demonstrated efficacy in reducing iron deficiency anemia, and are appealing for their low cost and potential for wide coverage. However less than 20% of pregnant women in India benefit from iron or mebendazole because they do not receive or consume the tablets.; Aim. This study tests the effectiveness of a strategy to increase iron and mebendazole intake and reduce the prevalence of anemia.; Methods. The study applied a pre-test post-test control-group design. An experimental strategy was implemented only in the project area through existing government or village resources, and included: (1) village-based pill supply, promotion, and monitoring; (2) early pregnancy registration; (3) family reminders; and (4) self-monitoring of pill intake. Program evaluation compared 4 independent samples generated from survey data at time 1 (non-project area n = 200, project area n = 215); and time 2 (non-project area n = 201 and project area n = 226). The samples were drawn from 170 villages of Harichandanpur Block in Keonjhar District of Orissa.; Results. Iron intake (>7500mg during pregnancy) increased significantly from 10.6% to 35.8% (p = 0.0005) in the project area, and from 7.6% to 8.0% in the non-project area (p = 0.88). Mebendazole intake increased dramatically and significantly in the project area from 4.6% to 54.4% (p = 0.0005); while the change in the non-project area was less dramatic, but statistically significant, from 1.5% to 10.4% (p = 0.0005). There was a significant decline in the prevalence of anemia (Hb < 11 g/dl) from 86.0% to 70.9% (p = 0.0005) in the project area, while the change in the non-project area was from 81.8% to 78.5% and not significant (p = 0.45). Adjusted odd ratios after controlling for background factors and time and area indicate that women in the area exposed to the experimental strategy were 60% less likely to be anemic (Hb < 11g/dl) compared to the other study groups (OR: 0.38; p = 0.01).; Conclusions. The results suggest that the prevalence of anemia (Hb < 11 g/dl) can be reduced with regular and accessible supply of iron and mebendazole, daily reminders, and self-monitoring of pill intake. Multivariate models also indicate that the control of infections, especially malaria and hookworm, are critical for reducing the prevalence of anemia.; The percentage and numbers of women currently affected by anemia is unacceptable given efficacious interventions, effective and simple strategies; and sound programs and policies to control anemia. At the very minimum, eligible women need to receive the supplies to practice the promoted behaviors associated with improved nutrition and health status. First and foremost, what is required is commitment and action to implement current programs and heart-felt motivation to improve the health status of women.