A Study to know the compliance rale of IFA tablets in respect of collection and consumption was carried out in three districts of Himachal Pradesh covering 90 clusters. Out of total women interviewed with childless than one year, only 94.8% had collected IFA tablets. 41.9% and 10% women had consumed these tablets for 60 and 100 days respectively. Majority of women did not consume these tablets with the reason that medicine is taken on ly during illness and as such they don't require these tablets. Intrusive Information, Education and Communication activities are stressed in the paper

Ahluwalia, S K

Bhardwaj, A K

Vaidya, N K

English

A Study to know the compliance rale of IFA tablets in respect of collection and consumption was carried out in three districts of Himachal Pradesh covering 90 clusters. Out of total women interviewed with childless than one year, only 94.8% had collected IFA tablets. 41.9% and 10% women had consumed these tablets for 60 and 100 days respectively. Majority of women did not consume these tablets with the reason that medicine is taken on ly during illness and as such they don\u27t require these tablets. Intrusive Information, Education and Communication activities are stressed in the paper

Indian Journal of Community Health

Indian Journal oj Community Health, 1995,VolB, NO.2 -3: 31.33PREVENTING ANAEMIA IN PREGNANCY - NEEDFOR INTENSIVE I.E.C. ACTIVITIESA.K. Bhardwaj*, S.K. Ahluwalia**, N.K. Vaidya***A Study to know the compliance rate of IFA tablets in respect of collection and consumption was carried out in three districts of Himachal Pradeshcovering 90 clusters. Out of total women interviewed with child less than one year. only 94.8% had collected iFA tablets. 41.9% and /0% women hadconsumed these tabletsfor 60 and 100 days respectively. Majority of women did not consume these tablets with the reason that medicine is taken onlyduring illness and as such they don't require these tablets. Intrusive Information. Education and Communication activities are stressed in the paper.I,!'.1INTRODUCTIONNutritional Anaemia is a serious public health problemwhich specially affects women in reproductive agegroup and the young children. About 87.5% of ourpregnant mothers suffer from this malady and 13.1%among these have hemoglobin levels below 7 gas/dland 37.6% between 7-9 gms/d1. Anaemia in pregnancyaccounts for 20% maternal deaths. It also has reachingeffects in terms of maternal morbidity, IUGR, low birthweight, impaired learning in children and impairedwork performance. Preventive measures for this type.of anaemia are directed against Iron imbalence in thebody which is the predominant cause of such anaemiasthroughout the World. Iron supplementation duringpregnancy has been inforce in India since 4th Five yearplan but the results are not encouraging due to frequentdropouts and low compliance rate. The present study isan attempt to know the collection and comsumptionpatterns of Iron and Folic Acid (IFA) tablets amongpreganant women, and the reasons for dropouts.MATERIAL AND METHODSThe study was conducted by the faculty of CommunityMedicine, IG Medical College, Shimla, HP as a part ofImmunization coverage assessment survey of childrenand pregnant women. in three districts" of theState-shimla, "Solan and Bilaspur. Survey wasconducted in 30 cluster villages in each district. AllEpidemilogist, State Health and Family WelfareTraining Institute, Parimahal. Shimla - 171009.Prof and Head, Community Medicine. IndiraGandhi Medical College. Shimla.DME cum Principal.1GMC. Shimla.31those women with child less than one year wereinterviewed regarding the collection and comsumptionofIFA tablets during last pregnancy. All those womenwho had actually consumed tablets (not merelycollected) were taken into consideration. Consumption'more than two months was taken as satisfactory andless than that as partial consumption. The reasons fornon or partial consur~ption were elicited.RESULTSIn all 667 women were interviewed in 90 villages. Outof these respondents, only 632(94.8%) had collectedIFA tablets from health Institutions.Duration of time for which tablets were actuallyconsumed has shown in table-I. It is evident from thistable that the consumption went down from 92.7 to10% during the course of pregnancy. Only 41.9% hadconsumed these tablets for two months.Consumption was directly related to the educationalstatus of the women (Table-II) and it was highlysignificant (P than .005).Reasons for partial or non-consumption has depicted in"table-III. Out of a total of 667 women, only 187 hascontinued for more than 2 months and 480 women hadeither not collected tablets or had terminated inbetween. Taking tablets without any illness was themain reason for low compliance followed by time.'constraints, fear of side reations and irregular supply: ".DISCUSSIONThe results of this study indicate that 94.8% womenhad collected IFA tablets from health institutionswhich is very high as compared to 72% reported inNational Family Health Survey of 1992 from Himachalpradesh. All India percentage(50.05%) was still less.Variation within the state may be due to the fact thatonly 3 districts are included in the current study.Preventing Anaemia in PregnancyTable I.Showing the time period for which the tablets were censnmed.Time Period (Days) No. of Women Percentage*(n=632)< 15 586 92.7 -15-30 493 78.031-45 379 60.046-60 265 41.961-90 187 29.6100 (full course) 63 10.0* Cumultative PercentagesEducation of women directly influenced IFAconsumption(Table-II) which emphasises promotionoffemale litracy.mg from initial 60 mg. Will this facilitate in bringingdown the incidence. It is a million dollor question. Butthere are areas which still has not been looked into.Only 10% women completed full course of 100 days .Then how can we think of reducing the incidence ofanaemia? Unsatisfactory consumption rates has alsobeen reported in ICMR study--. They had evenrecommended to increase the duration of consumptionof IFA tablets during pregnancy for more than 100days.Analysing. reasons for partial consumption of IFAtablets it was noted that majority of respondcnts wercTable II.IF A tablets censumed in relation to the Educational Status ofthe Women.Educational No. of women Duration in DaysStatue <15 15-30 31-45 46-60 61-90 100 (full course)I1literate 289 260 195 129 81 35 ( j(90.0)@ (67.5) (44.6) (28.0) (12.1) (2.1 )Primary 170 157 139 101 59 38 12(92.4) (81.8) (59.4) (34.7) (22.4) (7.1 )Middle 93 90 81 72 55 50 16(96:8) (87.1) (77.4) (59.1). (53.8) (17.2)Matric 67 66 65 65 58 54 22(98.5) (97.0) (97.0) (86.6) (80.1) (32.8)Post Matric 13 13 12 12 12 10 7(100.0) (100.0) (92.3) (92.3) (76.9) (53.8)@ Figure ifn parenthesis denote percentagesIron anfFelic Acid .Illiterate vs Literate (consumption .>2months) - X2 77.9, P< .005Main aim of National Programme for the control and . Consumption of IFA tablets has never been monitoredprevention of nutritional anaemia is to decrease its sicerely.prevalence and incidence in pregnant and lactating.women. Peripheral health workers at subcentre or PHCare responsible for distribution of IFA tablets to thebeneficiaries. These tablets, being highly effective,should have brought the prevalence of anaemia inpregnancy down since the inception of the programmein the 4th Five year plan. But this has not happened asevidence by sustained prevalence rates over the years,4The strength of IFA tablets has been increased to 100lIidianJournalojCommunity Health, 1995,Vol 8,NO.2 -3: 31- 33Table III.Showing reasons for nbn consumption, partial consumption* OflFA tablets.Reasons NumberofWome Percentage(n= 480)1. Why to take tabletswithout illness. 194 40.42. Nee time to collect IFA tablets. 110 22.93. Irregular Supply. 55 11.54. Fearofmisoarriage. 55 11.55. Irregular HealthStaff. : 47 9.86. Fear of change in the complexion ofthe Child. 19 3.9I.It means that the tablets were taken for less than 2 months.not sure about the motive being distribution of thesetablets. Some of them disclosed that the packets are justhanded over to them and asked to take contentsregularly without explaining any thing. This reflectsthe quality of communication on the part of our healthfunctionaries who, it seems, are not motivated for thisprogramme. So workers, being an important link,should be good at communication. Inter PersonalCommunication (IPC) is the best form ofcommunication in present time and Mahila SwasthyaSangh the best platform. Still best place for IPC is thefield visit of the worker. Mass Media can play asecondary role. Contacts during pregnancy is also animportant opportunity for education beneficiariesregarding ill effects of anaemia and benefits of regularconsumption ofIFA tablets. Objective is to change thebehavior of beneficiaries--. regarding this importantnutritional programme. Community has also to beinvolved at all levels. Traditional Birth Attendant c'analso be entrusted with the responsibility of promotinguse of IFA tablets amon expectant mothers as theycome in contact with these women quite frequently.Active involvement of Mahila Mandals and MahilaSwasthya Sangh should also be secured. Mainobjective is to convey the message to the targetaudience by planningcommunication activities to bring about the desiredbehavioural change.Only then we can think of preventing anaemia duringpregnancy ..REFERENCES.1. Reddy Y, Rao NP, Sastry JG and Kasinath K.Nutrition trends in India. NIN Hyderbad, 1993; 36-37.2. Government of India. Policy of Control of NutritionalAnaemia: Ministry of Health and FW, Govt. of India,1991. .3. Indian Institute of Population Sciences. NationalFamily Health Survey, 1992.4. UNICEF. The Progress of Nations. UNICEF, 1994;115. Indian Council of Medical Research. Fieldsupplementation trial in pregnant women with 60 mg,120 mg and 180 mg of Iron and 500 mcg of FolicAcid. ICMR Task Force Study, ICMR, 'New Delhi,1992.6. UNICEF, 'How to Communicate effectively withgrass-root women. UNICEF, New Delhi, .1984.J. Staley J. In" People in Development.". PublishersSEARCH, Banglore, 1982.

Preventing anaemia in pregnancy - need for intensive IEC Activities

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Indian Journal of Community Health