Abstract
BackgroundIndia suffers from a double burden of malnutrition and anaemia. The Karnataka anaemia project indicated that a counselling intervention delivered by community health workers improved anaemia cure rates.ObjectiveTo evaluate the effect of maternal counselling on nutritional aspects of anaemia prevention.MethodsSecondary analysis of a cluster randomised controlled trial (55 simultaneously randomised villages using random number generator in Chamrajnagar district, Northern India). In the intervention group mothers of anaemic children received five monthly counselling sessions plus usual care (iron and folic acid supplements), while mothers of anaemic children in the control group received usual care alone. Daily intake of nutrients related to anaemia prevention, i.e. iron (mg) and vitamin C (mg), was estimated using the 24-h dietary recall method at baseline and 6 months follow-up. Linear and logistic mixed regression models were used to assess between-groups difference in changes in nutrients intake from baseline to end of follow-up. Data collectors and analysts were blinded to the group assignment.ResultsParticipants were 534 (intervention n = 303; usual treatment n = 231) anaemic children, aged 1 to 5 years and their caregivers, of whom 521(intervention n = 299 from 28 villages; usual treatment n = 222 from 27 villages) were retained at 6 months follow-up and included in the analysis. This study provides inconclusive evidence of improvement in the intake of nutrients that prevent anaemia from baseline to follow-up among the intervention compared to the control group; increase in iron intake was 0.24 mg/day (95% CI -0.67; 1.15) and increase in vitamin C intake was 4.61 mg/day (95% CI -0.69, 9.91). Although encouraging, it is notable that the overall intake of nutrients that prevent anaemia remained well below the national recommended daily allowance.ConclusionThis study provides inconclusive evidence of the effect of parental counselling on nutritional aspects of anaemia prevention. The results highlight the need to devise multi-component anaemia-prevention interventions that include facilitators of the availability of nutritious food and should be evaluated in studies that are adequately powered to detect nutritional changes.Trial registrationInternational Standard Randomized Controlled Trial Number ISRCTN68413407, prospectively registered on 17/12/2013.
Highlights
India suffers from a double burden of malnutrition and anaemia
This study provides inconclusive evidence of the effect of parental counselling on nutritional aspects of anaemia prevention
This study aims to determine the participant level effects of the health worker delivered counselling on community child nutrition in Karnataka, India. Study design This is a secondary analysis of a pragmatic cluster Randomised Controlled Trial (RCT) that was conducted to evaluate the effectiveness of the intervention described above [10]
Summary
India suffers from a double burden of malnutrition and anaemia. The global statistics for undernutrition remain alarming with 150 million children stunted and 50 million children wasted in 2018 [1]. Undernutrition still accounts for 45% of the under-five mortality worldwide [1]. The global nutrition report highlights the need to intensify efforts to meet the second sustainable development goal (SDG) of ending all forms of malnutrition by 2030 [1]. Tackling undernutrition in India is of paramount importance, as the country accounts for two thirds of the prevalence of undernutrition globally [2]. Undernutrition is associated with poor diet among Indian children; national surveys estimate that less than 40% of the children consume an adequate diet [3, 4]. Only 36.6% of preschool children consumed at least 70% of the recommended daily allowance (RDA) for iron in 2016 [4]
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