Effectiveness Of Educational and Nutritional Intervention Towards Iron Deficiency Anemia with an Iron Rich Chocolate [Vea Choc] Among the Female Volunteers of Reproductive Age Group (18-45 Years Old) in a Nutraceutical Industry -
A Kap Study

Prabhakar. S*

Corresponding Author: Prabhakar. S, Department of Research and Development, Aspirar Sphere Private Limited Bangalore-560040.

CopyRight: © 2021 Prabhakar. S. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: July 07, 2021

Published date: August 01, 2021

Abstract

Objective: The present study is aimed to access the effectiveness of educational and nutritional intervention towards iron deficiency anemia with an iron-rich chocolate [vea choc] among the female volunteers of a nutraceutical industry and this study also and assess the study subjects hemoglobin level before and after the nutritional intervention with an iron-rich chocolate [vea choc] and to assess the knowledge, attitude and practice of the study subjects towards iron deficiency anemia.

Methodology: It was an observational interventional study conducted in Aspirar sphere private limited, Bangalore. The data collection tool was a personal interview. The data collection instrument was a self-developed questionnaire after extensive literature research. KAP questionnaire was developed according to our cultural setup and Hb (g/dl) was measured before and after nutritional interventional.

Result: 19.3% had mild, 51.3% had moderate, and 13.3% had severe anemia. Only 16% of volunteers had normal Hb levels. 54% had good knowledge about anemia with Pearson correlation (r) = 0.092, P=0.263. 79% had a positive attitude towards self-awareness of anemia as a disease but correlation (r) was found to be in inverse relation (-0.005), P=0.95. A highly significant positive correlation was found between dietary practices and Hb levels; where 53% had shown desired dietary practices with r= 0.174, P= 0.033 and nutritional intervention showed a positive outcome, which is practically significant and an average percentage of Hb (g/dl) increased per study population post nutritional intervention was 0.425g/dl and 0.5g/dl of Hb was increased in 37.3% study population, 0.4mg/dl of Hb was increased in 50.7% of the study population and 0.3g/dl of Hb was increased in 12% of the study population.

Conclusion: Increasing trend of iron deficiency anemia among females of the reproductive age group was seen and the representative sample study is strongly suggested that Iron deficiency anemia was mostly related to the non-compliance lifestyle towards a balanced diet.

Introduction

Anemia is a global public health problem affecting developing countries with serious consequences upon human health, social and economic development. It is found at all stages in the life cycle, more prevalent among females of the reproductive age group (15-49 years) and young children.[26] anemia is considered to be the most common nutritional deficiency worldwide and in 95% of the cases it is associated with poor diet intake; despite the fact that iron is the second most abundant metal in the earth’s crust. Anemia is more common in infants, children 3-6 years of age and adolescents 11-17 years of age living in developing countries; constituting a serious public health issue.[27] WHO has defined anemia as hemoglobin (HB) concentration below 12g/dl in women.

According to WHO, over 30% of the world’s population are anemic; thus, focusing upon the importance of anemia as a public health issue in developed and developing countries. 4.3-20% of the population in the developed world where and 30-48% in developing countries are affected by Iron deficiency anemia. According to a WHO report, globally it is estimated that roughly 43% of children, 38% of pregnant females, 29% of non-pregnant women, and 29% of all women of reproductive age are diagnosed to have anemia.[28] mild to moderate iron deficiency has adverse functional consequences upon the health of an individual; impaired cognitive functions, behavior and physical growth among infants to school age children, physical capacity, work performance and immunity of all age groups are significantly affected by low levels of iron.[29]

Low concentrations of hemoglobin are referred to as anemia that reduces the oxygen-carrying capacity of the blood, which adversely affects cognitive function, impaired cerebral vascular regulation, neurological injury and motor development, ischemia of heart, brain, etc. and also causes fatigue.[26,27] In addition it is also observed that anemia is a major cause of mortality and morbidity in pregnant women and also associated with perinatal mortality and low size/weight at birth. According to WHO, hemoglobin level below 11gm/dl in pregnant women constitutes anemia and hemoglobin below 7gm/dl is considered severe anemia.[28] Maternal and neonatal deaths are a major cause of mortality in developing countries. Together with cause between 2.5 million and 3.4 million deaths worldwide respectively.[27]

A survey report reveals that about 2.6 billion people mostly women and children are suffering from anemia globally. When it comes to the Indian context, anemia in children and women is at alarming levels, especially in rural areas. The government of India has taken policy decisions and introduced schemes to improve the health of rural people and to reduce the anemia in them particularly. In spite of policy commitment and programs to combat anemia in children and women, it is observed that much improvement is not seen. Instead, the second and third NATIONAL FAMILY HEALTH SURVEY reveals that during 1999-2006 anemia prevalence increased from 74-79% in children aged between 6-36 months and 52-56% in women aged between 15-49 years. It was surprising to note that the prevalence of anemic conditions increasing in spite of rapid economic growth.[29]

At the nutritional level supplements such as iron, vitamin B12 (cyanocobalamin), folic acid and in some cases pyridoxine are often used to treat and cure anemic patients. Erythropoietin (Procrit), Ferrous Sulfate (generic), Iron dextran (INFeD), Folic acid (Folvite), Vitamin B12 (Generic) are some of the anti-anemic drugs indicated for all types of anemia. Though these drugs are more effective, their long-term usage includes severe side effects – increased death, serious cardiovascular and thromboembolic events and increased risk of tumor progression or recurrence, circulatory collapse and death.[30]

The period of adolescence and adulthood in the life cycle is a period of growth, second only to infancy; thus overall nutrient need is high in order to support optimum growth and development, and iron is the particular nutrient that is in high demand. The body needs more iron during the rapid growth phase or when frequent blood losses are there (menstruation); Thus adolescent girls and young adult women are at a greater risk of developing iron-deficiency anemia[6] previous researches found a lack of appropriate knowledge and attitude regarding healthy eating patterns thus leading to unhealthy eating practices.[7] continuous practice of unhealthy foods habits and patterns lead to serious effects upon nutritional status as well as the overall health status of an individual.[9] Nutritional education is the type of intervention that aims to address deranged nutritional status in individual status in individuals by motivating them to adopt behavioral change towards healthy nutritional practices. Improving the nutrition knowledge, attitude and practices of adolescents and youth are very important in order to develop a society that is conscious towards having a healthier population.[8] According to another study knowledge, attitude and practices regarding healthy nutritional status have become the mainstay to encounter the occurrence of nutrition-related health problems; and such studies are still very few in number in developing countries.[10]

Iron deficiency anemia is a major health problem in developing countries. Individuals with anemia have reduced physical work capacity, slower cognitive functions that adversely affect learning and scholastic performance in school girls entering adolescence. A cross-sectional study conducted in Iran upon young girls aged 14-20 years found the prevalence of anemia was 21.4%.[11] Another study reported prevalence of iron deficiency anemia as 40% in preschool children, 30% in menstruating girls and women, and 38% in pregnant women; in the absence of dietary fortification. These rates reflect the increased physiological need for dietary iron during specific life stages and according to gender.[12]

Another research found an overall prevalence of anemia was 8.3% among young girls as compared to 1.6% among boys, and Iron deficiency anemia was diagnosed in 59% of the anemic patients. Results suggested that the socio-economic status of the family, traditional eating habits of the region, fear of gaining weight, and irregular eating habits were contributing factors towards the development of iron deficiency anemia among girls.[13] Assessment of hemoglobin is one of the most reliable indicators of anemia and is widely used to screen anemic individuals and also to evaluate responses to interventions. Hemoglobin concentration is routinely measured using an automated Hematology analyzer.

KAP assessment tool is a suitable instrument to assess and evaluate the target group’s current knowledge, attitude, and practices towards a specific problem under investigation; and it gives effective feedback upon needs, problems, and possible barriers among the target group. In recent studies upon nutritional assessment, KAP evaluation has been commonly used.[15] KAP was also used to evaluate the knowledge in regards to dealing with the management of iron deficiency anemia among young girls in European countries.[16]

The problem statement developed for this study is : keeping in mind the current scenario in India regarding nutritional facts and figures and lack of comprehensive nutritional intervention, education and counseling; there is a strong feeling that poor dietary patterns are found among females of reproductive age group. Girls of younger age are too conscious of weight maintenance without good knowledge about healthy and balanced diet and its importance. Most of the time adolescent girls are into bad dietary practices that lead to the long-term effect upon health in the form of various deficiencies and morbidities. This needs to be corrected through a swell planned nutritional health education program at small as well mass scale; and for this purpose, on-ground status of iron deficiency anemia is required to be known.

The rationale of the present study is: identification of correlation between Hb levels and KAP will enable the investigators to assess the dietary habits of young females; thus, enabling us to formulate a well-planned nutritional guideline for the students. Results will also enable us to identify the need for further research in this area with a representative sample.

 To overcome the adverse effects of allopathic drugs, a novel approach was required and the use of herbs/herbal products that possess medicinal value was brought to light. WHO (world health organization) estimated that 80% of people worldwide rely on herbal medicines for their primary health care needs. WHO also found that around 21, 000 plant species have the potential for being used as medicinal plants.[31]

There are several herbs that are proved to possess the Anti-anemic activity and attenuate the symptoms of anemia. Medicinal [plants can boost the absorption of nutrition, blood cell production, control their destruction and thereby maintain stable hemoglobin levels.[32] A comprehensive literature review shows that the anti-anemic effect would be the fact of the following active phytochemical constituents – alkaloids, ascorbic acid, calcium, flavonoids, iron, saponins, solasonine (glycoalkaloid), tannins, vitamin C, vitamin K and zinc.[33] A native practitioner formulated a polyherbal formulation in a chocolate form containing more than a dozen of herbs that possess the above phytochemical constituents and claimed that this formulation is very effective in reducing the anemic condition, especially in women and children. Due to the proprietary issues, the native practitioner using it was not revealing the names of the 18 plants, however, he has revealed the phytochemical constituents present in them.

Since, there are reports that above mentioned phytochemical constituents possess anti anemic effect and a polyherbal formulation of plants containing the above phytochemical constituents is claimed to have high efficiency in reducing the anemic conditions, It is hypothesized that a polyherbal formulation in the form of chocolate prepared by the native practitioner possesses anti- anemic activity. The present study is planned to evaluate the impact of iron-rich chocolate on the hemoglobin levels of their study population, to verify and validate this hypothesis.

There are several anti-anemic drugs that are currently in use to treat anemia. Though they are efficient in treating the disease their side effects limit their usage. A native practitioner took this as a challenge and formulated a novel treatment for the same. This review aims at the significance and the value of herbal medicine and its role in the treatment of anemia. Researchers have evolved with a novel approach and with an intention of eradicating anemia from the world of diseases and stop pregnant women and children from becoming a part of that world, have formulated several medications to treat anemia. Since chocolate is loved by everyone and hated by none, the native practitioner formulated a polyherbal medication in the form of chocolate.

The outcome of the study is useful and beneficial for the anemic patients in mitigating and relieving the patient from anemia. Since the polyherbal formulation is in the chocolate form its patient compatibility will be high. Therefore the present study is essential and justifiable.

Fact findings of anemia

• About 60% of females are anemic in India

• 50% of premature death happens due to anemia

• 23% of disability in India happens due to anemia

• About 2 billion are anemic in the world

• 50% of pregnant women are anemic

• 50% of children under the age of 2 are anemic

• 40% school-going children are anemic  

• 30 – 55% adolescents are anemic

• 35% of non-pregnant women are anemic

• Planning, pregnant and lactating women need an additional intake of iron

• In vegetarian, the absorption of iron is very low as 1 – 5%

• Non vegetarian has an absorption of 1 – 45%

• It is affected in all countries including developed countries

• Undeveloped and developing countries are worst affected

• 21 out of 36 states in India is facing the challenge and iron deficiency is the most common and widespread nutritional disorder in the world

• 4% of GDP is lost due to anemia in India

• Physical, mental and social disturbances happen in anemic individuals

• Anemia also causes depression

• Anemia causes impaired cognitive and physical performance, and increased maternal and child mortality

• In any health issue Hb level found to be the first villain and most of the doctors prefer to begin with Hb level investigation

• Globally 45% of child deaths are attributed to underweight, Thus the significance of government schemes to eradicate anemia and malnutrition is highly necessary

• Government is really striving hard to eradicate anemia and malnutrition across India

• National program of mid-day meal in schools (MDMS)

• MDM is a flagship program of the government of India in the eradication of anemia and malnutrition

• Mid-day meal (MDM) is served in drought-affected area also

• Indian government have also launched schemes like education guarantee scheme (EGS) / alternative and innovative education (AIE) and national children labor project (NCLP) for the welfare of children’s

• Integrated child development services (ICDS) scheme was launched on 2nd October 1975, and is one of the flagship programmes of the government of India and represents one of the world’s largest and unique programs for early childhood care and development

• Infant and young feeding guidelines are a set of well known and common recommendations for appropriate feeding of newborns and children under two years of age and these guidelines were framed to ensure appropriate nutrition, breastfeeding and importance of colostrum and thus avoiding malnutrition and anemia in infants

Background

• Anemia is a group of the disease characterized by a decrease in either hemoglobin or circulating red blood cells, which results in the reduced oxygen-carrying capacity of the blood.

• According to the World Health Organization (WHO) 1.6 billion people (1/4th of the world’s population) are anemic.

• Affected population are not just innocent bystanders; affects both length and quality of life (QOL).

• IDA occurs across all populations and is associated with:

1.Diminished quality of life (QOL)

2.Diminished physical and cognitive performance, and

3.Unfavorable clinical outcomes.

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