Adolescent girls' anaemia control programme, Gujarat, India
Background & objectives: 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<0.05). 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 & conclusions: 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.