Anemia in Childbearing Age Women in Rural India Christian Medical College in Vellore, Tamil Nadu, India Katie Bolin School of Nursing, N4 1

Objectives Understand distribution of common health problems at the national, state & local level Perform community health assessment Explore impact of health and illness on development of health care delivery, practices & systems Design public health nursing intervention strategy for a community behavior change Use outcome measures to evaluate effect of change

Health Challenges in India Communicable Disease Malaria, Tuberculosis, Diarrheal diseases, Acute Respiratory Infections Nutritional Problems Protein-energy malnutrition Nutritional Anemia Non-Communicable Disease Diabetes, CVD, Cancer, Stroke, Chronic Lung Disease Overpopulation and Environmental Sanitation Access to Health Care (G. Alexander, personal communication, January 3, 2017)

College of Nursing Community Health (CONCH) Nurse-run department at CMC Community clinics, awareness programs, educational services 11,476 rural patients 13,771 urban patients Conduct rural and urban home visits Total of 70,671 home visits in 2015-2016 (Christian Medical College, 2016)

Melminnal Demographics Population 1,957 Main religion Hindu Family Structure Joint Occupations among women Housewife Nurses or lab technicians Other Frequent Health Problems Hypertension, Diabetes, Obesity, other NCD Village of Melminnal: our target population Other occupations: shopkeepers, weavers, other crafts

Project Focus: Anemia in Melminnal Common problem among women of childbearing age The WHO estimates that 58% of pregnant Indian women are anemic (Seghal et al., 2016) Anemia is indirectly responsible for 20-40% of maternal deaths (Seghal et al., 2016) Common causes in India: Lack of iron rich foods in diet Helminth infections Anemia is related to increased levels of post-partum hemorrhage and other serious pregnancy complications Blood loss may be from heavy menstrual bleeding Hookworm infestation – d/t lack of footwear

Individual Interventions Anemia project through CONCH included women: Ages 15 to 45 Not currently pregnant Not currently menstruating Never been diagnosed with a bleeding disorder Pre-test of knowledge about anemia Hemoglobin level check Post-test

Community Interventions Educational program hosted at local temple Approved by the Panchayat leader Approximately 20 village members attended Education included Iron rich foods for sampling Poster presentation Anemia theme song

Educational Program

Main Conclusions After the educational program: 95% of women were able to identify the definition of anemia, as opposed to 52% before the intervention. 75% of women were able to identify several sources of iron rich food in their diets, as opposed to ~34% before the intervention. The educational program proved to be successful, based on the majority of the post- test data showing improvement of knowledge.

System Interventions Iron-folic acid supplements distributed by government and nonprofit services Take-home rations of food fortified with iron and other vitamins and minerals Helminth infection prevention: Poor water quality & sanitation increase risk for infections (parasitic intestinal worms), which can lead to anemia Need continued government commitment to improve water quality & availability Pregnant women should receive anthelmintic tablets prophylactically during their prenatal care (Ramakrishnan et al., 2012)

Future Implications We hope our project will: Create positive behavioral changes related to increased intake of iron-rich foods, which will help to increase Hb levels of women that are tested Be a foundation for future studies regarding anemia Improve maternal outcomes during and around the time of childbirth Encourage the villagers to actively participate in their health Enrich the community’s knowledge of anemia and its implications

Clinical Experiences Holding a newborn at the Rural Unit for Health and Social Affairs (RUHSA) hospital Getting to know the community members of Melminnal during our anemia project

Cultural Experiences Celebrating the local Hindu harvest festival, Taj Mahal in Agra, Uttar Pradesh Celebrating the local Hindu harvest festival, Pongal, with one of the village leaders and his family

References Christian Medical College. (2016). Facts and figures: 2015- 2016. Vellore, Tamil Nadu. Ramakrishnan, U., Lowe, A., Vir, S.,  Kumar, S., Mohanraj, R., Chaturvedi, A., Noznesky, E.A., Martorell, R., & Mason, J.B. (2012). Public health interventions, barriers, and opportunities for improving maternal nutrition in India. Food and Nutrition Bulletin, 33: 71-92. Sehgal R, Kriplani A, Vanamail P, Maiti L, Kandpal S, Kumar N. (2016). Assessment and comparison of pregnancy outcome among anaemic and non anaemic primigravida mothers. Indian J Public Health, 60: 188-94