Impact of IFA among pregnant women and School going children

Anaemia during pregnancy and school going age is the most prominent problem. About 50 percent of women have a haemoglobin level of less than 10g/dl during the third trimester of the pregnancy. During childhood also anaemia is a major problem. This situation is critical for both. After analyzing the problem the present study was conducted to find out impact of IFA consumption on pregnant mothers and school going children. The data gathered from 200 pregnant mothers and 200 school going children of five large slums of Bhopal. Out of these 200 samples in both, pregnant mothers and school going children, 100 respondents are in experimental group and 100 are in control group. The results of the data and observation were analysed and salient features are presented here.

By analyzing data gathered from pregnant mothers regarding age of the women all the pregnant mothers studied were in the age of 18-35 years. Majority women studied under both the groups were in between 18-25 years (69 percent in experimental group and 79 percent in control group). More than half of the India’s population belongs to Other Backward Class category. But in this study nearly half of the pregnant mothers (47 percent in experimental group and 41 percent in control group) belong to Scheduled Caste category followed by OBC (22 percent in experimental and 37 percent in control group). 34 percent pregnant mothers of experimental group were educated upto Higher Secondary followed by 30 percent had education upto Primary level while in control group majority 31.0% pregnant mothers were educated upto Primary level followed by 27 percent those were illiterate. More than two third of the pregnant mothers in control group (68 percent) were from the labour class family.  Among experimental group nearly three fourth (72 percent) families of the pregnant mothers were having same occupation. Nearly on fifth (19-19 percent) families of both the groups adopted small-small private service as their occupation. 1-1 percent pregnant mothers of both the group belongs to the unemployed family. Thus it is obvious that status of their nutrition will also deprived of. In experimental and control group, both, three fifth (60-60 percent) pregnant mothers belong to the family having monthly income in between Rs. 1001 to 2000. In experimental group one third (33 percent) and in control group 35 percent families of the pregnant mothers had monthly income less than 1000 Rs.   

During the study it was found that almost half of the pregnant mothers were in 2^nd trimester (43 in experimental and 45 in control group) whereas in control group around half (45 percent) and in experimental group more than half (54 percent) pregnant mothers were in third trimester. Among experimental group 99 percent pregnant mothers were either in second or third trimester of pregnancy the reason for this may be due to that first trimester will end till consumption of 100 tablets of iron although there was 1 pregnant mothers of experimental group in first trimester but she consumed less than 100 IFA tablets.

Any abnormal condition can be diagnosed primarily by observing clinical signs before diagnosing scientifically to tell that the condition is not completely normal but to find out the status of abnormality is not possible by observing clinical signs alone. During this study clinical signs and for scientific diagnosis of anaemia level of haemoglobin of pregnant mothers were measured. By observing clinical signs it was observed that prevalence of clinical signs among pregnant mothers of control group were more than compared to pregnant mothers of experimental group. Tiredness at the slightest excursion is one of the primary sign of anaemia and in both the group majority of pregnant mothers (61 percent in experimental group and 55 percent in control group) affirmed that feel this sign. Pale nails were the sign observed less than feeling of early fatigue. According to a women magazine “Grihshobha” Yellow or blue nails are the signs of anaemia. 27 percent pregnant mothers of experimental group and 39 percent pregnant mothers of control group had pale nails than normal. Spoon shaped nails were observed during severe anaemia and 18 percent pregnant mothers of experimental group and 31 percent pregnant mothers of control group had spoon shaped nails. Although none of the pregnant mother was found severely anaemic but few pregnant mothers of control group had 7.8 g/dl haemoglobin i.e., moderate anaemia. Clinical signs will help in early diagnosis of anaemia and how anaemia leave effect on pregnant mother and her baby likewise weight and height will also show status of malnutrition in pregnant mother. It is well known that we cannot expect birth of a healthy baby by a malnurioushed mother. Educated woman can provide better care and nutrition to herself and whole family. In this study also it was found that in control group pregnant mothers as the education of women was higher the mean haemoglobin level was also high. In experimental group also except few cases the same situation was observed. Availability of money leads family to purchase nutritious food but due to ignorance even member of well-earned family can deprive off some nutrients. In this study as the monthly income of pregnant mothers of experimental group goes higher the mean haemoglobin level of pregnant mothers was lower. The same situation was observed in the case of pregnant mothers of control group also.          

During the pregnancy a woman should gain 9-11 Kg. in her weight. The gain in the weight is as: first trimester- no weight gain, second trimester-1-1.5 Kg weight gain per month and third trimester- 2-2.5 Kg. weight gain per month. It was found that mean of the current weight of a pregnant mother according to the month of pregnancy was less than normal (45 Kg.+weight gain according to pregnancy month) than also the mean weight of the pregnant mothers of experimental women had more weight compared to pregnant mothers of control group. Although there was no significant difference in the height of the pregnant mothers and almost all the pregnant mothers were more than 150 cms.

Normally other factors are also responsible for weight of a woman like, their food, food habits, environment, etc. Like wise their height may be dependent on heredity, nutritional status, nutritional status of her mother at the time of her birth, etc. when we think about the environment, then we easily think that an Indian slum is how much unhygienic? Like that all the five slums selected for this study had plenty of garbage; mosquitoes; stagnant water pits; flowing water on roads; small, dark, seepage rooms and excreta of children here and there on the roads. Foodstuffs fried in cheap oil and stale/open fruits and vegetables were easily available and the women and children were fond of these. We could not imagine keeping healthy in such circumstances. But when we talk of the weight of the pregnant mothers if we provide balanced diet to the pregnant mothers then in these situation proper digestion and absorption of nutrients was difficult. In this study it comes out that diet of almost all pregnant mothers was deprived of nutrients then quantity of nutrients recommended by ICMR. ICMR recommended 10 gms of extra protein to a normal pregnant mother that means 55 grams of protein daily. But in this study it was found that mean consumption of protein by both (experimental and control group was 29 to 37.8 gms pre day. According to a study conducted by ICMR (1974) mean protein intake by pregnant mothers was on 40 gms instead of 55 gms. per day. Highest consumption of protein in experimental group was by the pregnant mothers educated upto higher secondary followed by the pregnant mothers having education more than higher secondary. In control group pregnant mothers having education more than higher secondary had consumed more protein compared to others. In both the groups consumption of protein rises with the increase in monthly income of the family. 

        

In addition to protein, consumption of calorie also affects weight and height. After increasing height could not be reduced but height will depend upon quantity of protein and calorie consumed during childhood. In this study it was found that according to ICMR recommendations a moderate active normal woman should consume 2500 Kcal (2200+300) energy. But it as found that in both the study groups there was very low energy consumed (1169 Kcal in experimental group and 975 in control group) than the standard recommended.

According to a study conducted by ICMR in 1974 it was found that pregnant mothers consumed only 1400 Kcal instead of 2500 Kcal. Nutrition Foundation of India has also conducted a study and it comes out that dietary intake of majority pregnant mothers was lee than recommended. The study was conducted in Assam, Orissa and Madhya Pradesh and the mean consumption of calorie among pregnant mothers in Madhya Pradesh was 1404 Kcal. only.

Iron intake is essential for synthesis of haemoglobin. During pregnancy a woman is recommended to consume 40 mg iron per day. But it was found that in both, experimental and control group the mean consumption of iron was almost half (22.6 mg and 20.7 mg respectively. Pregnant mothers of experimental group had also consumed iron as IFA tablets which was not included here. There was not much difference in dietary iron consumption in both the groups, but by observing haemoglobin level of pregnant mothers it was found that all the pregnant mothers of experimental group had haemoglobin level in normal range (10.8-14.0 dl/g) whereas pregnant mothers of control group had mild and moderate level of anaemia also. According to a study conducted by ICMR in 1974 consumption of iron by pregnant mothers was less than half (18 mg). Another study conducted in Assam, Orissa and Madhya Pradesh also reported that the consumption of iron among pregnant mothers in Madhya Pradesh was nearly half (19.4 mg). It was observed from the analysis of data that as the income of the family rises the mean consumption of iron also increased in both the groups. However, mean consumption of iron by the pregnant mothers of the families having monthly income more than 5000 Rs. was lower than other income groups. Highest consumption of iron in both the groups was by the pregnant mothers educated upto higher secondary followed by the pregnant mothers having education more than higher secondary.

Only intake of recommended quantity of iron in diet or as IFA tablet is not helpful in synthesis of haemoglobin, but its complete absorption is also an important factor. Absorption of iron depends on several factors like drinking of tea before and after half an hour of meals, and it was noticed that majority women had habit of drinking tea after getting lunch or many pregnant mothers take IFA tablets with tea. In these conditions counseling is necessary. Vitamin C also plays an important factor in absorption of iron and in this study it was found that pregnant mothers of experimental group consumed 73.7 mg where as pregnant mothers of control group consumed 41.9 mg. vitamin C against ICMR recommendation of 50 mg. per day.

Folic acid is also essential in addition with vitamin C for synthesis of haemoglobin.

According to ICMR recommendations during pregnancy a pregnant mothers should take 150-300 µg/day. But in this study the mean consumption of folic acid was 41.9 µg in control group and 43.6 µg in experimental group. Some better situation was found in another study where mean consumption of Folic acid by pregnant mothers of Madhya Pradesh was 59.8  µg per day. 

Other than dietary intake it was also tried to find out by pregnant mothers of both the groups that how much quantity of iron and protein rich sources, helpful in haemoglobin synthesis, were they buying and in how much days they consumed these products. It was also inquired that what was the number of family members. After getting these data it was analysed that what was the pattern of consumption of these items (per day per person). By analysis the data it was found that families of pregnant mothers of experimental group were consuming more protein and iron rich sources compared to control group. In experimental group 12.9 gm per day per person jaggery and groundnuts (both) were consumed while in control group consumption of these stuffs was 8.6 gm and 10.1 gm respectively. Spinach is another rich source of iron and also available every where, its consumption was also very low in both the groups i.e, 26.2 gm in families of pregnant mothers in experimental group and in control group it was 19.0 gm per day per person. . Another source of protein is groundnut. In experimental group mean consumption of groundnuts was 12.9 gms. and among control group its consumption was 10.13 gms per day per person. Rice flakes are easily available in Bhopal and its cooking is also very easy and less time consuming. 100 gms. of rice flakes contains 20.0 mg. (50% of recommended) of iron. It is also easy for a woman to eat 100 gm of rice flakes per day. Although families of pregnant mothers of both (experimental and control group) were consuming rice flake more than jaggery, groundnuts, egg, fish, and meat and in experimental group families of pregnant mothers consuming 18.3 gms. and in control group its consumption was 15.7 gms only. Cumin seeds are also a rich source of iron and 100 gm of cumin seeds have 31.0 gm of iron although one can not eat 100 gm or even 50 gm of cumin seeds per day. But it can be suggested that every pregnant mother should consume cumin seeds in more quantity. Pregnant mothers of experimental group were consuming double quantity of cumin seeds than of control group (4 gm and 2 gm per day respectively). Watermelon is available in summer only but it was easily available in slums although its condition was very unhygienic (spoil and stale, open and cut into pieces). But if 100 gms of hygienic watermelon was consumed than a person can get 10.8 gm iron. Normally an individual can eat around 300-400 gms. watermelon easily and it will fulfill demand of iron for whole day but in this study it was found that mean consumption of watermelon by pregnant mothers of experimental group was 33.8 gm and in control group 20.5 gm. per day per person. 

Animal food products (egg, meat and fish) are also good sources of protein and their protein are meant to be good protein. The consumption of these item were analysed only for the families those are taking non vegetarian food. It comes out that 62 families of pregnant mothers of experimental group and 61 families of pregnant mothers of control group were consuming eggs. Out of these none were taking even half egg per day. All the groups were consuming eggs around one tenth. According to ICMR it was recommended that a pregnant mother (moderate worker) should consume 30 gm. (half egg) per day. It was also suggested by ICMR that a pregnant mothers (moderate worker) should consume 30 gms of meat or fish per day. The consumption of meat by the families of pregnant mothers of experimental group was 12.0 gms. whereas among control group its mean consumption was 6.2 gms. Mean consumption of fish among experimental group was 6.5 gms. and among control group it was only 1.8 gms. per day per person.

 

By analysis nutrients availability from diet it could be concluded that pregnant mothers of both (experimental and control) the groups had consumed very less quantity of nutrients than requirement thus to find out impact of consumption of IFA, which was helpful for reducing anaemia and increasing in synthesis of haemoglobin, pregnant mothers of experimental group were only interviewed. 

From this study it was found that 45 percent pregnant mothers had consumed 75 or more tablets of IFA. 22 percent pregnant mothers consumed 25-50 IFA tablets whereas one third (33 percent) pregnant mothers consumed 51-75 IFA. although this was the situation at the time of data collection and after it data collection also they continued IFA consumption. One pregnant mother had consumed 150 tablets of IFA. According to NFHS III only 23 percent pregnant mothers were consumed IFA tablets for more than 90 days. In Madhya Pradesh only 12 percent pregnant mothers took IFA for atleast 90 days. According to DLHS II conducted in 2006 in Bhopal district 38.9% pregnant mothers consumed one tablet of IFA per day while 24.1% pregnant mothers consumed two or more IFA tablets per day. According to an appraisal published by NIPCCD New, Delhi “Three Decades of ICDS” after analysis of data it was found that relation to consumption of IFA tablets by pregnant mothers showed that 68.9% pregnant mothers consumed tablets regularly, 13.5% women kept the tablets in their possession but did not consume it because they did not like its taste while 17.6% enjoyed its use sometimes “as and when” they felt like swallowing it. “Bulletin” by Department of Public Health and Family Welfare M.P. it was reported that in Bhopal District 70.4 percent pregnant mothers had received IFA tablets. After all these efforts the status of anaemia is tremendous. 

According to a baseline study conducted by ORG (Operations Research Group) in Uttar Pradesh three fourth pregnant mothers did not consumed IFA tablets during their last pregnancy. There were only 2 percent pregnant mothers those consumed 100 or more IFA tablets. After enquiring number of IFA tablets consumed by the pregnant mothers, it was also enquired that whether they feel only good, only bad (side) or both or none effect after consuming IFA tablets. Only one percent pregnant mother reported that she did not feel any good or bad effect after IFA consumption while 2 percent pregnant mothers reported for feeling of side effects. 69 percent pregnant mothers reported good as well as side effects both. While 28 percent pregnant mothers feel good signs due to IFA consumption.

97 percent pregnant mothers those reported good or good as well as side effects of IFA consumption were first enquired about positive (good) effects of IFA consumption in detail, it was found that 69 percent pregnant mothers replied that their haemoglobin level had increased. 54 percent pregnant mothers reported that they gain weight due to IFA consumption. 67 percent pregnant mothers told that their appetite had increased. 40 percent pregnant mothers had good sleep and 43% pregnant mothers reported that their morbidity had reduced. 48 percent pregnant mothers had feel increase in activeness after IFA consumption.

71 percent pregnant mothers responded regarding bad (side) effects or both good and bad effects of IFA consumption were inquired for the bad sign felt by them. 24 percent pregnant mothers reported for constipation while 13 percent had complaint for diarrhoea. Majority 73.2 percent pregnant mothers reported that the colour of their stool turned black, although it was the only chemical changes because of extra iron excretion and shows no other harm to women’s health or daily routine. Thus there is a need to provide them awareness regarding this issue, so the IFA consumption may not be interrupted due to this factor. Nearly one-fourth (25.4 percent) pregnant mothers reported for vomiting, 36.6 percent complaint for nausea and 12.7 percent pregnant mothers were complaint for gizziness   after consuming IFA tablets. These signs can be over come by consuming IFA tablets with meals and they will subsidize within 6-7 days. If these matters will discuss with pregnant mothers before starting consumption then the misconception about this side effects can be overcome.

It also comes out from the study that level of haemoglobin will increase as the number of consumed IFA tablets increases thus it is necessary to complete the full course of IFA so the anaemia and its bad effects can be stopped and pregnant mother could give birth to a healthy baby.

According to an appraisal published by NIPCCD New, Delhi “Three Decades of ICDS” also a special drive needs to be initiated by both ICDS and Health functionaries to cover all pregnant mothers to take IFA. Non-consumption of these tablets has enormous repercussion on the health of the child at pre, neo and postnatal period.

For this study 200 school going children (100 for experimental group and 100 for control group), upto 5^th class, were also selected from 5 slums of Bhopal. 20 school going children for experimental group and 20 school going children for control group were selected from each slum. These children were studying either in govt. primary schools or in private primary schools running in same slums.

In experimental group 38 boys and 62 girls and in control group 47 boys and 53 girls were selected for this study. In experimental group majority of school going children (63) were in between 9-12 years, whereas in control group highest (48) children were in between 6-9 years. 46.0 percent school going children in experimental group and 74.0 percent school going children in control group were from service class families either Govt. or private servant. In experimental group 32.0 percent school going children and in control group 16.0 percent school going children belongs to labour class family. In both the groups only 1-1 school going child belongs to farmer family. According to census of India 2001 major population of the country belongs to OBC category. But as pregnant mothers majority of school going children (46 percent in experimental group and 42 percent in control group) belongs to SC category followed by OBC (31 percent experimental group and 30 percent control group). 22 percent school going children of experimental group and 18 percent school going children of control group were from general category and 1 child of experimental group and 10 school going children were of Scheduled tribe also.  In this study almost 89 percent school going children of experimental group and 94 percent of control group belongs to Hindu religion followed by 10 percent and 3 percent respectively to Muslim religion. Only 1 school going child of experimental group and 1 of control group belongs to Boudh religion. In control group 1 school going child also belong to Jain religion.

By observing clinical signs among school going children it was found that, majority school going children reported that they feel fatigue earlier than other children. In experimental group 44 school going children (12 boys and 32 girls) and in control group 53 school going children (20 boys and 33 girls) told that they feel fatigue earlier than compared to their friends. Other clinical symptoms were observed more in girls than compared to boys. Among experimental group 9 school going children and in control group 21 school going children had pallor of pails. Among control group 7 boys and 11 girls had pale eyes where as in experimental group only 1 boy and 7 girls had pale eyes. Spoon shaped nails were found in 6 boys and 6 girls of control group where as this sign was observed in 2 boys and 5 girls of experimental group. In experimental group only 2 girls had pale tongue/lips while in control group 5 boys and 6 girls had pale tongue/lips. In addition to these two boys and two girls of control group had white spots on face and hand. In this group one boy and in experimental group one girl school going child was reported for etching on hands and feet also. To sum up, it may be concluded that among both the groups girls had more clinical signs of anaemia as compared to boys.

Not only clinical signs but weight of children can also be linked with malnutrition and anaemia is also a type of malnutrition. To assess growth of these children weight and height of these children were also recorded. Age wise mean weight of the experimental group and the control group boys was compared with the reference Indian standards for affluent school going children reported by Agrawal and Agrawal (2003). The mean weight of boys in the experimental group and the control group was almost similar in the 9-12 and 12-15 years age groups. But when the age-wise mean weight of boys of the experimental group and control group was compared with the mean weight of affluent Indian school children of the corresponding age and it was observed that the mean weight of sampled children was much lower. When the mean weight of girls was compared with the mean weight of sampled girls of experimental and control group in different age segments was almost similar. But the mean weight of girls in control group was much smaller when compared with the mean weight of affluent Indian children. The mean weight of girls was 19.9 kg at age 6-9 and 29.5 kg at age 12-15 years group. The corresponding mean weight of affluent Indian girls was 21.7 kg and 45.2 kg respectively.

The mean height of boys of the experimental group and the control group under study were almost similar in age group 9-12 and 12-15 years. Boys of experimental group in 6-9 years age group mean height of children was more than Indian affluent children (121.6 cm.). But in other two age groups the mean height was less than affluent Indian children. The mean height of the experimental group was more than the Control group girls in 6-9 years and 9-12 years. But compared to Indian affluent girls our girls were shorter in each age segment except in experimental group of 6-9 years. The difference in the mean height of our girls and Indian affluent girls was 8.3 cm at 6-9 years. By primary school leaving age (12-15 years) the difference increased by 43.2 cm. The anthropometrical data (height and weight) of children showed that school going children of the study areas were smaller in height and weight as compared to the affluent Indian children. The data further shows that our school going children start with a disadvantage (lower mean height and mean weight) when they enter school and the difference increases over the years.  This is despite the fact that feeding program for primary school children under the Mid day Meals program of the Department of Human Resource Development are in operation for the last several years. It may also be due to the dietary intake which is quite lower in terms of major nutrients like protein and calories. Protein and calorie intake shows direct impact on weight and height of a child.

Age of 6-15 years is vulnerable due to its growing phase as well as puberty of the child is also started at 11 years of age. Therefore children in this age group needs more nutrients. It was inquired from the children that on the previous day of data collection what food items they had eaten and in what quantity. However it is difficult to recall each and every item but, by probing even a toffee or a piece of sweet if eaten was recorded and nutritive value of these items were calculated accordingly. We did not get any research data of dietary consumption by the children of this age group to compare with thus the comparison of consumption of studied school going children was only performed with the ICMR recommended quantity. 

Mean haemoglobin level of boys of the experimental group and the control group were compared with standard values of Hb. level and the acceptable range (Nelson, Text book of Paediatrics). Mean Hb. of experimental group boys were found to be between 9.7 gm/dl to 13.3 gm/dl. The mean Hb. values were slightly lower than the standard values.  Although the mean Hb. values of our boys were within the normal range (11.0-16.0 gm/dl) they were near the lower value of the range. The Control group school going children had consistently lower mean Hb. for each age group school going children as compared to the Experimental group. The differences were statistically significant. Mean haemoglobin level of girls of the Experimental group and the Control group along with reference values shows that in all age groups mean Hb. level of girls of both for experimental and control group was lower than the standards, although they were within the acceptable range in experimental group.

Mean values of Hb. level of girls of experimental group were found to be between 11.6 gm/dl to 12.8 gm/dl. The mean Hb. values were slightly lower than the reference values for children between 7–14 year age segments.  Although the mean Hb. values of our girls were within the normal range (11.0- 16.0 gm/dl) they were towards the lower value of the range. The control group school going children had consistently lower mean Hb. values for each age group school going children as compared to the experimental group. The differences were statistically significant.

In age group 6-9 years a boy needs 33 gm protein per day but in this age group mean consumption of protein among school going children of experimental group was only 19.3 gm where as in control group boys protein intake was 29.4 gm per day. During 9-12 years age group boyren ICMR recommended 41 gm protein per day. In experimental group school going children of this age group protein intake was only half of the recommended (20.9 gm per day) where as in control group it was little less (36.2 gm per day) than recommended. In age group 12-15 years although the number of children was less (only 13). For this age ICMR recommended 55 gm protein per day, but in experimental group less than half (24 gm. per day) protein was taken by the school going children whereas in control group consumption of protein was little more (41.0 gm per day) than experimental group. A girl under 6-9 years age needs 33 gm protein per day. Mean consumption of protein in experimental group of this age group was only 21.8 gm where as among control group girls protein intake was 25.6 gm per day. For girls of 9-12 years age group ICMR recommended 41 gm protein per day. In both the groups protein intake was slightly more than half (22.6 gm per day in experimental group and 26.6 gm. per day in control group) of the recommended quantity. In age group 12-15 years although the number of girls was less (only 14). In this age ICMR recommended 50 gm protein to be taken per day, but in experimental group less than half (20.2 gm. per day) of the recommended quantity of protein was taken by the girls whereas in control group it was little more (21.8 gm per day) than experimental group.

Among all the three age groups school going children of both (experimental and control) group did not consumed calories in recommended quantity. Among 6-9 years age 1800 cal. are recommended in daily diet of a boys. In experimental groups school going children consumed little more than one third (716 cal.) of the calories recommended. While in control group school going children of this age group has consumed more than half (1038 cal.) of the calories recommended for this age group. In 9-12 years of age group school going children in experimental group consumed 803 cal. whereas in control group consumption of calories was 1187 cal. school going children of age group 12-15 years of experimental group consumed 831 cal., while control group school going children had mean consumption of 1433 cal. Among girls of age group 6-9 years age 1800 cal. are recommended. In experimental groups girls consumed more than one third (730 cals.) of the calories recommended. In control group also the consumption of calories was less than half (852 cal.). In 9-12 years age group girls in experimental group consumed 818 cal. whereas in control group consumption of calories was 898 cal. In 12-15 years consumption of calories among school going children was the lowest in both experimental and control group was 716 cal. and 766 cals. respectively.  Protein and calorie intake had direct impact on the height and weight of the school going children while protein, iron, folic acid and Vitamin C are responsible for the level of haemoglobin in blood. As protein and calorie, consumption of iron among school going children was also less, but compared to protein intake iron intake was better.  

Among boys of age group 6-9 years of experimental group consumed 11.3 mg. iron while school going children of control group of same age group consumed 18.2 mgs of iron which is within the recommended (15-20 mg) quantity. In 9-12 years age group the consumption in experimental group was little less than (13.8 mg) lower limit of recommended quantity while school going children of control group had consumed 19.0 mg. iron (within recommended range). In 12-15 years of age group the consumption of iron was less than recommended in experimental group (14.6 mg.) and in control group it was more (26.5 mg) than recommended quantity. In girls of 6-9 years of experimental group had consumed 12.1 mg iron whereas in control group its consumption was 15.4 mg. Among 9-12 years of age school going children of experimental group had consumed 12.7 mg. iron while school going children of control group had consumed iron (16.3 mg.) within the recommended range. In age group of 12-15 years school going children of both experimental and control group had consumed less than half of the recommended (13.5 and 15.3 mg respectively).

Quantity of vitamin C is recommended by ICMR for 6-15 years of boys and girls is 30-50 mg. per day. Although absorption of vitamin c is affected by several factors, and it also helps in absorption of iron. But among experimental group children consumption of vitamin C was lower than recommended quantity. Children of 6-9 years of age group had consumed vitamin C within recommended range (42 mg). Boys in the same age group of all the five areas had consumed vitamin C more than (54 mg.) recommended quantity. Among 9-12 years age group in experimental group school going children had consumed 23 mg. vitamin C in their diet one day prior to data collection. In control group school going children of same age group had consumed 52 mg. of vitamin C which was more than recommended. School going children of 12-15 years of age in experimental group children had consumed 26 mg. vitamin C whereas in control group school going children of this age group had consumed just double (105 mg) vitamin C. In girls of experimental group, only 6-9 years age of children were consumed vitamin C within recommended range. While among control group children of 6-9 years and 9-12 years had consumed vitamin C within the recommended range (47 mg) and more than range (58 mg) respectively. In both the groups (experimental and control group) children of 12-15 years age were consuming vitamin C less than (17 mg. and 12 mg. respectively) recommended quantity.

Folic acid is an essential component for synthesis of heamoglobin this study is also focused on the impact of iron and folic acid consumption. The quantity of supplementary folic acid (IFA tablet) was not included in this table. But disheartening fact is that none of the group (experimental as well as control) had even consumed quantity of folic acid upto lower side of the recommended range (50 µg). Consumption of Folic Acid was also higher among control group (32.9 µg) as compared to experimental group (22.0 µg). Among girls also the situation was poor. None of the age group (except age group 9-12 years of control group) in both the groups of experimental as well as control group had even consumed half of the recommended (25 µg) folic acid. All the age groups had consumption of folic acid in the range of 19.3 µg to 26.1 µg. when observing different age groups, it was found that the lowest consumption of folic acid was among the school going children of 12-15 years age group control group (19.3 µg).

According to a compendium of guidelines-2000, Integrated Child Development Services emphasis on nutritional and health status of adolescent girls scheme should be given. IFA supplementation along with deworming interventions and nutrition and health education may be provided. Research have indicated that the most common similarity exist in low levels of iron and folic acid in adolescent girls leading to nutritional anaemia.  

Rajiv Gandhi Mission on Community Health, Department of Health and Family Welfare had implemented a program of IFA supplementation of primary school children. Hundred tablets of Iron Folic Acid (each tablet containing 65 gm iron and 0.1 gm of folic acid) were administered to students of all primary level government supported schools. The school going children were also administered one tablet of albendazole (400 gm) at six months interval to treat intestinal heliminthic infection.

Iron intake is directly related with the haemoglobin synthesis and if the consumption of iron is less, level of heamoglobin will also be lower. But among experimental group level of haemoglobin may also be effected by IFA supplementation. It was observed that the level of haemoglobin increases with the increase in consumption of iron.

Among girls haemoglobin level is affected with iron intake as well as many other reasons like, menstruation or blood loss, etc. During the study it was found that in some groups iron consumption did not affect or even adversely affect level of haemoglobin.

After dietary intake supplementation of iron and folic acid was also enquired from the school going children of experimental group.

One tablet of IFA should be consumed daily and by many studies it was observed that the consumption of IFA was stopped due to many reasons. In this study also it was found that in 6-9 years one male school going child consumed only less than 25 IFA tablets. In 9-12 years 7 boys and 5 girls and in 12-15 years age group 2 boys and 3 girls had consumed less than 25 IFA tablets. On the contrary in 6-9 years 2 boys and 3 girls in 9-12 years age group 4 boys and 14 girls and in 12-15 years age group one girl had consumed more than 100 tablets i.e. 24 percent.

Bulletin of Department of Public Health and Family Welfare M.P. it was reported that in Bhopal District 80.3 percent children had received IFA tablets

Out of 100 school going children 90 percent reported that they feel good after consuming IFA tablets. 2 percent children feel good as well as bad signs also. 5 percent school going children reported that they did not feel any sign due to IFA consumption. 3 percent children reported that they feel side effects after IFA consumption.

Good impact of IFA as told by boys of the experimental group, they were also enquired about the symptoms they observed. Majority boys (14-14 each) had observed that their stamina was increased and they also had good sleep after IFA consumption. Thirteen boys each had reported that their concentration had increased and they feel decrease in morbidity. Increase in weight was reported by 3 school going children. 7 school going children had also reported that their haemoglobin (blood) had increased. Seven school going children also reported increase in their appetite. Where as 10-10 children each had reported increase in activeness and memory. Girls had more reported good impact of IFA as compared to boys of the experimental group. They were enquired about the good symptoms they observed after consumption of IFA. Majority female school going children (28) had observed that they became less susceptible to infections and thus it was found that their morbidity rate decreased. Twenty five girls reported that they feel increase in their concentration level.  22 girls had reported that they had good sleep after IFA consumption. Increase in weight was also reported by 14 girls. 14 girls had also reported that their haemoglobin (blood) had increased. Twenty one girls each had reported increase in their appetite as well as increase in memory.  20 girls had reported increase in stamina.

Three boys who consumed 51-75 IFA tablets did not observed any good symptom while 10 school going children who consumed IFA tablets upto 25 tablets only reported that they feel various good symptoms of IFA consumption. 18 boys who took IFA tablets more than 75 were reported majority of good symptoms after IFA consumption. Majority (71.4 percent) school going children reported increase in haemoglobin had consumed more than 100 IFA tablets. 42.9 percent children reported increase in appetite had consumed less than 25 IFA tablets only. None of the children consumed more than 100 IFA had reported increase in activeness. 57.2 percent children reported increase in stamina had consumed 76-100 IFA tablets. More than three fourth (76.9 percent) school going children reported decrease in morbidity had consumed more than 75 IFA tablets.   

Eight girls had consumed IFA tablets upto 25 tablets only, had reported several good effects they feel due to IFA consumption. 33 girls who took IFA tablets more than 75 were reported either one or other good symptoms after IFA consumption. Majority (35.7 percent) school going children reported increase in haemoglobin had consumed more than 100 IFA tablets. 42.9 percent children reported increase in appetite had consumed less than 25 IFA tablets only. 27.8 percent children consumed more than 100 IFA had reported increase in activeness. 60.0 percent children reported increase in stamina had consumed more than 75 IFA tablets. More than three fourth (78.6 percent) school going children reported increase in weight had consumed more than 75 IFA tablets.   

Dose of IFA tablets is of 100 tablets (one tablet every day) but rarely any one can complete its full dose. It was enquired by the school going children that whether they consumed full dose of IFA or stopped in middle. It was found that only 2 boys had stopped consuming IFA tablet due to their drop out from school.  

In all five girls had stopped consuming IFA tablets in middle. Majority of dropping cases (3) stopped consumption of IFA tablet in between the dose due to their drop out from school. One child stopped due to its side effect and one was unable to get it from school. Thus it is necessary to maintain supply of IFA and to make them aware about side effects.  

Rajiv Gandhi Mission for Community Health supplemented the Mid-day Meal program in government aided primary schools of Madhya Pradesh. Hundred tablets of IFA were given to each child (one tablet per day). Two tablets of albendazole, at six month’s interval were also administered to the children. It was evident that if worm are present in intestine, blood loss will take place. Therefore it is necessary to give one antihelminthic tablet before initiating IFA consumption. It was observed that out of 38 boys 28 children got albendazole also and among girls out of 62 children 51 had received albendazole tablets. 

Ten boys reported that they had suffer with problem of constipation and 6 boys had complaint regarding lack of appetite, 8 school going children reported that they had frequent stomach ache before consumption of Albendazole tablet.

26 girls reported for having stomach ache due to worm infestation and 20 school going children complaint regarding lack of appetite, 15-15 girls reported for constipation and lack of interest in playing/studying before consumption of Albendazole tablet.

After consuming Albendazole most of the boys had reported its good impact in reducing complications, which they feel before its consumption.

After consuming Albendazole most of the girls had reported its good impact in reducing complications which they reported before its consumption. 20 girls reported that they had stomach ache less frequently after consuming Albendazole tablet. 18-18 school going children reported relief in constipation and increased appetite.  

         

It was observed that experimental group school going children had slightly higher mean haemoglobin levels than control group school going children and the difference was statistically significant. Albendazole tablets remove intestinal parasitic infection thereby improving the nutritional level among children. twenty one school going children received IFA tablets alone while 79 school going children received IFA tablets as well as at least one dose of albendazole. Mean haemoglobin level among boys who had received only IFA tablets ranged between 11.9 gm/dl to 13.0 gm/dl. The corresponding mean Hb. level among boys who received IFA and at least one dose of albendazole was 11.1 gm/dl to 13.5 gm/dl. Examination of data for girls of the two groups showed that mean haemoglobin level among girls who had received only IFA tablets ranged between 11.7 gm/dl to 13.6 gm/dl. The corresponding mean Hb. level among girls who received IFA and at least one dose of albendazole was 11.1 gm/dl to 12.8 gm/dl. But examination of mean Hb. level of two groups of school going children in different age segments for both boys and girls, no definite trend was observed on the basis of which it could be concluded that administration of albendazole tablet had any positive effect on Hb. level of school going children.

It may be concluded that Iron and Folic Acid as well as Albendazole (Anti Heliminthic) Tablet has more good impact than side effects and these side effects may be over come by only small efforts. Thus it may be strongly recommended that every pregnant mothers and school going children should undergo supplementation of IFA and before initiating IFA Albendazole tablet should also be given so the worm infestation can be stopped and anaemia can be controlled.