USAID Micronutrient & Child Blindness Project, New Delhi, India.
Indian J Med Res. 2009 Nov;130(5):584-9.
BACKGROUND & OBJECTIVE: In June 2000, Adolescent Anaemia Control Programme was initiated as a pilot programme in Vadodara district of Gujarat covering over 69000 girls in over 426 schools. Programme strategy was to provide once weekly fixed day (Wednesday) supervised iron folic acid (IFA) supplements to all adolescent girls in Grade 8-12. Currently, programme covers 10 lakh schoolgirls and 2.6 lakh out of school girls with a compliance rate of over 90 per cent as reported by education department. This study was undertaken to institutionalize once a week IFA supplementation in the schools for adolescent girls with built in compliance monitoring in one district and scale up the programme from its learning to all the districts as feasible. METHODS: Baseline survey for three areas of Vadodara district, tribal, rural and urban from 10 schools each was conducted to collect data for anaemia prevalence. Education Inspectors were assigned responsibility to supervise and motivate teachers to try out innovative ideas to promote the programme. Simultaneously anganwadi workers of urban Vadodara were motivated to initiate IFA supplementation for out of schoolgirls on similar strategy. After approximately 17 months of intervention, impact study was conducted in the same 30 schools in November 2001 to obtain levels of anaemia and some of the paired data from the students who were part of the baseline study. Study also included knowledge and practices of the adolescent girls with reference to their dietary habits and package of intervention included nutrition education through schools by providing information and education material prepared by the government. RESULTS: Baseline study had shown around 75 per cent anaemia prevalence, which was similar in all the three areas. Level of serum ferritin was also low. Impact evaluation showed reduction in anaemia prevalence by 21.5 per cent that is, from 74.7 per cent to 53.2 per cent (P<x0.05). Further improvement in Hb was recorded among 80 per cent girls. Pre- and post-intervention also showed improvement in serum ferritin value. Programme is now scaled up to cover 10 lakh schoolgirls and 2.6 lakh out of school girls in the State. Out of schoolgirls is only small fraction of total out of schoolgirls in the state. Data on dietary and nutritional related knowledge and practices did not show significant changes among schoolgirls. Retention of messages specified in IEC material was not satisfactory. INTERPRETATION & CONCLUSION: Supervised, once a week IFA supplementation to adolescent girls through institutions specially, schools was found to be an effective intervention to reduce anaemia and was scalable within the system. The experience to educate the girls on dietary behaviour has not been satisfactory and covering all out of school girls is still a challenge to the success of anaemia control.
背景与目的:2000 年 6 月,在古吉拉特邦的瓦多达拉区启动了青少年贫血控制试点项目,覆盖了 426 多所学校的 69000 多名女孩。该项目的策略是为 8-12 年级的所有少女每周提供一次固定日(星期三)的铁叶酸(IFA)补充剂。目前,该项目覆盖了 100 万名女学生和 26 万名校外女孩,教育部门报告的依从率超过 90%。本研究旨在为少女在学校每周一次补充 IFA 建立制度,同时在一个地区建立合规性监测,并将该项目从学习阶段扩大到所有地区。
方法:对瓦多达拉区的三个地区(部落、农村和城市)的 10 所学校进行基线调查,收集贫血患病率数据。教育督察被分配了监督和激励教师尝试创新想法以推广该项目的责任。同时,也激励瓦多达拉市区的安加瓦迪工人按照类似的策略为校外少女提供 IFA 补充剂。在干预大约 17 个月后,于 2001 年 11 月在同一 30 所学校进行了影响研究,以获得贫血水平和部分基线研究学生的配对数据。研究还包括了青少年女孩的知识和实践,参考了她们的饮食习惯,以及通过提供政府编写的信息和教育材料,在学校进行营养教育的干预措施包。
结果:基线研究显示,贫血患病率约为 75%,在所有三个地区相似。血清铁蛋白水平也较低。影响评估显示,贫血患病率下降了 21.5%,从 74.7%降至 53.2%(P<0.05)。80%的女孩的血红蛋白进一步得到改善。干预前后血清铁蛋白值也有所提高。该项目现已扩大到覆盖该邦的 100 万名女学生和 26 万名校外女学生。校外女孩仅占该邦校外女孩总数的一小部分。少女的饮食和营养相关知识和实践方面的数据没有显示出显著变化。信息、教育和交流材料中指定信息的保留率并不令人满意。
解释与结论:通过专门的机构,特别是学校,为少女提供每周一次的监督 IFA 补充剂被发现是一种有效的减少贫血的干预措施,并且在系统内具有可扩展性。在教育女孩饮食行为方面的经验并不令人满意,要覆盖所有校外女孩仍然是贫血控制成功的挑战。
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