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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 2  |  Issue : 1  |  Page : 9-12

Differentials in iron folic acid supplementation among pregnant women in a rural area of North-West, India


1 Department of Community Medicine, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh, India
2 Government Medical College, Jammu, Jammu and Kashmir, India

Date of Web Publication17-Apr-2013

Correspondence Address:
Sunil K Raina
Department of Community Medicine, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.110562

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  Abstract 

Research Question: What determines the trend in coverage of iron folic acid (IFA) supplementation among pregnant women? Objectives: To assess the role of various socio-demographic factors in determining IFA supplementation among pregnant women in RS Pura block of district Jammu. Materials and Methods: A stratified two-stage design with villages as the primary sampling unit and mothers with children less than 1 year of age as secondary sampling unit. Villages were divided into different clusters on the basis of population and sampling units were selected by a simple random technique. Results and Conclusion: Coverage for IFA supplements is still not complete in RS Pura block and the programme needs to focus on informing pregnant women about the advantage of IFA.

Keywords: Iron folic acid, supplementation, trends


How to cite this article:
Raina SK, Mengi V, Singh G. Differentials in iron folic acid supplementation among pregnant women in a rural area of North-West, India. Int J Health Allied Sci 2013;2:9-12

How to cite this URL:
Raina SK, Mengi V, Singh G. Differentials in iron folic acid supplementation among pregnant women in a rural area of North-West, India. Int J Health Allied Sci [serial online] 2013 [cited 2019 Aug 22];2:9-12. Available from: http://www.ijhas.in/text.asp?2013/2/1/9/110562


  Introduction Top


Anemia is a serious public health problem in India, affecting all segments of the population (50-70%), especially infants and young children, adolescent boys and girls, women of child bearing age, and pregnant women. [1] Recent surveys conducted by National Nutrition Monitoring Bureau (NNMB) and National Family Health Survey (NFHS-3) show high prevalence of anemia (24.3%) even in men aged more than 20 years. [2],[3] Estimates say that globally, 56 million pregnant women (41.8% of the total) are affected with anemia, again mostly due to iron deficiency. [4] The prevalence of anemia for married women in India has increased from 52% in NFHS-2 to 56% in NFHS-3. [3]

Iron supplementation is strongly recommended for all pregnant women in developing countries. [5],[6],[7] The provision of iron folic acid (IFA) tablets to pregnant women to prevent nutritional anemia forms an integral part of the safe motherhood services offered as part of the Reproductive and Child Health Program in India. The program's recommendation is that women should consume 100 tablets of IFA during pregnancy.

But despite supplementation programs being in operation for decades, there has been no perceptible decrease in the prevalence of anemia. [1] Its prevalence is similar in both urban and rural areas: However, gender differences exist from the age of 15 years, as females become more vulnerable to this malady. [1] This somehow raises a question on whether the mere existence of a program ensures intake of iron supplementation.

Keeping this fact in view we planned to conduct a study to determine trends in IFA supplementation.

Mothers with children of less than 1 year (12 completed months) of age were picked to collect information on whether the mother received IFA tablets or syrup during last pregnancy. IFA syrup was included in the question along with IFA tablets since IFA syrup is sometimes prescribed in the private sector and may even be prescribed in the public sector when and where tablets are not available.


  Materials and Methods Top


The study was conducted in block RS Pura of district Jammu. The block is located in the southwest of Jammu city adjacent to the Indo-Pak border with a total area of 273 km 2 and average density of 658/km 2 . There are 176 villages and one town (11 wards) in the block with an estimated population of 179,636. [8] The majority of population comprises Hindus. The study population comprised 375 mothers of children less than 1 year (12 completed months) of age. The methodology comprised a stratified two-stage design which is in accordance with the, Institute of Research in Medical Statistics Delhi methodology. The methodology used in rural and urban areas is as follows.

Rural area

In the design of the study, the stratification was according to the population size of the village. The village was the primary sampling unit and mothers the secondary sampling unit. One hundred and seventy-six villages of block RS Pura were stratified according to their population into four different strata as given below:

Stratification

  1. Stratum 1: Small villages - villages with population of less than 500.
  2. Stratum 2: Moderately small village - villages with population of 500-999.
  3. Stratum 3: Medium size villages - villages with population of 1000-1999.
  4. Stratum 4: Large size villages - villages with population equal to or greater than 2000.


Five villages were selected from each stratum by simple random technique. Thus, the total number of villages taken was 20.

Selection of mothers

From each village, 15 mothers having children less than 1 year (12 completed months) of age at the time of study were picked-up independent of each other. Thus, the overall sample consisted of 300 mothers in the rural area.

The village selected was mapped and a house-to-house survey was conducted. Information on having received IFA during last pregnancy was collected from all eligible mothers (mothers of children less than 12 completed months of age) and recorded on a structured questionnaire. Any eligible mother refusing to participate in study was excluded.

Urban area

RS Pura town of block RS Pura was taken as the urban area for this study. Of the 13 wards, five wards were selected randomly. The selected wards were identified with the help of an identification number. Fifteen mothers with children of less than 1 year (12 completed months) of age were picked from each ward, independent of each other. Thus, the total number of mothers picked up from the urban area was 75.

The number of mothers was fixed at 75 keeping in view the rural-urban ratio of 80-20 in Jammu and Kashmir state. The selection procedure adopted for mothers from the wards was similar to the one adopted for the villages in the rural area. The desired information on each selected mother was collected with the help of the same questionnaire as used for the rural areas and in a similar manner.

Definition for IFA coverage

Any eligible female was said to have been covered for IFA supplementation, if she had consumed any part of the dose, she had procured for consumption.


  Results Top


[Table 1] shows the overall coverage level of IFA tables in block RS Pura including both rural and urban areas. The coverage for receiving IFA was higher in urban area (81%) as compared with the rural area (54%). The difference was found to be statistically significant ( P < 0.05) The coverage of IFA tablets was found to be higher (71%) in non-schedule caste (SC)/non-schedule tribe (ST) as compared with SC/ST (44.5%) in rural area [Table 2]. The difference was found to be statistically significant ( P < 0.05). The coverage levels in urban areas according to social group were showed less difference as compared with urban areas, with SC/ST having slightly higher coverage at 85% against non-SC/ST (74%). The difference, however, was not found to be significant.
Table 1: Coverage of iron and folic acid tablets among pregnant women

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Table 2: Coverage of iron and folic acid tablets received according to caste/religion

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Literacy seems to be a major influence on receiving IFA; with higher the level of literacy the coverage level was higher. The coverage levels seem to improve with the improvement in literacy levels of both partners (husband and wife). The trend remains similar in both rural as well as urban areas.

The difference in rural area for both mothers as well as fathers literacy was found to be statistically, significant ( P < 0.005) [Table 3] and [Table 4].
Table 3: Coverage of iron and folic acid tablets received according literacy of husband

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Table 4: Coverage of iron and folic acid tablets received according literacy of mother

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  Discussion Top


Preponderant evidence indicates iron deficiency as the main cause of anemia in all age groups. [3] Even higher income groups are victims of widespread anemia. Iron deficiency is seen to coexist with other causes of anemia in India. Overall, mothers in RS Pura received IFA for around 60% of births. According to NFHS-3, 65% of mothers received IFA supplements for their most recent birth. [3]

Even if an iron density of 10.8 mg/1000 kcal (as recommended) is assumed for all socio-economic groups and age/gender categories, very few Indians would satisfy Recommended daily allowances (RDAs) for iron and energy with the present patterns of food consumption. [9] This makes supplementation imperative and more so in pregnancy.

IFA coverage is well below average for older women, women with fourth or higher-order births, women with no education, Muslim women, and women in households in the lowest wealth quintile. [3] Overall, only 23% of women consumed IFA for at least 90 days. This percentage is universally low among all groups of women except women who have completed 12 years of education or more (56%) and women in households in the highest wealth quintile (49%). [3] According to our study, IFA coverage is much lower in rural areas (54%) than in urban areas (81%). Mothers belonging to SC/ST's show lower coverage in rural areas but almost similar coverage in urban areas. Here, again literacy seems to play an important role in coverage with literates having a better coverage.

According to a study conducted in Haryana by Sunder Lal, BMS Vashist, MS Punia, the coverage levels of IFA among pregnant mothers in ten functional subcentres picked up for the study, was distressingly low (5.8%). [10]

Not all mothers who received IFA consumed the recommended three-month supply of tablets or syrup. These data do definitely point to incomplete coverage for IFA supplements in RS Pura block and the program needs to focus on informing pregnant women about the advantage of IFA. But the fact that not all mothers who receive IFA consume that is also worrisome. Research should focus on trying to understand why many women do not consume all the IFA they receive and try to find ways to overcome the resistance to IFA. Ensuring availability of IFA to all may be the key as the correct dissemination of information on supplementation.

 
  References Top

1.Indian Council of Medical Research (ICMR). Nutrient Requirements and Recommended Dietary Allowances for Indians. A Report of the Expert Group of the Indian Council of Medical Research 2010. Hyderabad, India: National Institute of Nutrition; 2010. p. 157.  Back to cited text no. 1
    
2.Diet and nutritional status of population and prevalence of hypertension among adults in rural areas. Hyderabad: National Institute of Nutrition; 2006. National Nutrition Monitoring Bureau, National Institute of Nutrition. NNMB Technical Report No 24.  Back to cited text no. 2
    
3.Available from: http://www.nfhsindia.org. [Last accessed on 2012 Oct 10].  Back to cited text no. 3
    
4.de Benoist B, McLean E, Egli I, Cogswell M, editors. Worldwide Prevalence of Anaemia 1993-2005. WHO Global Database on Anaemia. Available from: www.who.int/nutrition/publication. [Last accessed on 2012 Oct 10].  Back to cited text no. 4
    
5.Sharma JB, Soni D, Murthy NS, Malhotra M. Effect of dietary habits on prevalence of anemia in pregnant women of Delhi. J Obstet Gynaecol Res 2003;29:73-8.  Back to cited text no. 5
    
6.Sharma JB. The obstetric protocol. In: Sharma JB, editors. Medical Complications in Pregnancy. 1 st ed. Delhi, India: Jaypee Brothers; 1998. p. 78-98.  Back to cited text no. 6
    
7.Sharma JB. Nutritional anaemia during pregnancy in non-industrialized countries. In: Studd J, editor. Progress in Obstetrics and Gynaecology. Edinburgh: Churchill Livingstone; 2003. p. 103-22.  Back to cited text no. 7
    
8.Raina SK, Mengi V, Singh G. Determinants in initiation of breastfeeding among lactating women in block R.S. Pura of district Jammu (India). Ann Trop Med Public Health 2011;4:71-3.  Back to cited text no. 8
    
9.Indian Council of Medical Research (ICMR). Nutrient Requirements and Recommended Dietary Allowances for Indians. A Report of the Expert Group of the Indian Council of Medical Research 2010. Hyderabad, India: National Institute of Nutrition; 2010. p. 167.  Back to cited text no. 9
    
10.Lal S, Kapoor S, Vashisht BM, Punia MS. Coverage and quality of maternal and child health services at sub centre level. Indian J Community Med 2000;26:16-20.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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Introduction
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