The Effectiveness of the IFA Supplementation in Reducing the Prevalence of Anemia During Pregnancy Among Women in Eastern Maharashtra, India

OBJECTIVES: Maternal anemia is a critical public health problem, especially in Low- and Middle-Income Countries (LMIC) like India. Anemia during pregnancy increases the risk of poor fetal outcomes, such as low birth weight. The Indian national Iron + Initiative includes iron & folic acid (IFA) supplementation for pregnant & lactating women. We sought out to assess the effectiveness of the IFA program in Nagpur, India. METHODS: We conducted a prospective cohort study of 200 pregnant women from four clusters in Nagpur (Eastern Maharashtra), India. Maternal hemoglobin was assessed using Hemocue and the finger prick method. Anemia was defined as hemoglobin < 110g/L. IFA receipt and consumption was assessed via questionnaire during the 1(st) and 3(rd) trimester of pregnancy. RESULTS: Hemocue/capillary assessment revealed prevalence of anemia in the third trimester of 69.52% (N = 187), as compared to 50.0% (N = 200) in the first trimester. In the first trimester, 44.5% of women reported consuming IFA the previous day, while 84.8% reported consuming it the previous day by the 3(rd) trimester. In the first trimester, 61% (n = 122) of women reported receiving IFA: 43% for free from a public health facility, 14% purchased it from a store/pharmacy, and 4% from other locations. By the 3(rd) trimester, 99.5% of women had received IFA: 75.4% for free from a facility, 11.8% from a pharmacy/store and 8.02% from other locations. CONCLUSIONS: We noted a markedly high prevalence of anemia in pregnancy that increased from the first to third trimester, characteristic of physiologic amenia, despite an increase IFA coverage and consumption. Other nutritional and non-nutritional interventions to reduce anemia in pregnancy need to be explored to prevent maternal anemia in Nagpur, India and possibly other LMIC contexts. FUNDING SOURCES: This study was funded by the Thrasher Research Fund grant.