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

2. 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

3. 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)

4. 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
(Christian Medical College, 2016)

5. 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

6. 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

7. 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

8. 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

9. Educational Program

10. 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.

11. 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)

12. 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

13. 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

14. 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

15. References
Christian Medical College. (2016). Facts and figures: 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:
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: