F&N Bulletin Vol 23 No 1b - United Nations University

Iron-deficiency anemia in young working women
increase of 163 kcal from pre- to postsurvey in unit 1
was due mostly to the consumption of iddli for lunch
at the workplace. In unit 2 the increase was 192 kcal.
In summary, the food-based intervention and the IEC
in units 1 and 2 appear to have increased food energy
intake significantly.
Protein. The mean protein intake at presurvey was
about 70 g, mainly from cereals and pulses, as compared
with the RDA of 50 g. At postsurvey there were
significant increases in protein intake of 6 g in unit 1,
7 g in unit 2, and 5 g in unit 3.
Iron. This study was primarily focused on a workplace
lunch plus an IEC strategy based on removal of
dietary inhibitors of iron in unit 1 and the addition of a
dietary iron enhancer in unit 2. The mean dietary iron
availability at baseline was 27 mg, as compared with
the RDA of 30 mg. However, very little of it appears to
have been available. In units 3 and 4 there were small
and nonsignificant increases of 1 g of dietary iron at
postsurvey.
There appears to have been some impact of our IEC
messages on consumption of vegetables and fruits.
However, by inference, the much greater or more
frequent consumption of iddlis at the workplace and
at home appears to have been the main reason for the
significant increase in the mean hemoglobin values of
the women in unit 1. In unit 2 (given gooseberry juice),
the major reason for enhancement of the hemoglobin
values at postsurvey appears to have been the regular,
although intermittent, consumption of gooseberry
juice at the workplace. Vitamin C-rich gooseberry is a
powerful enhancer of iron absorption [12]. The Indian
gooseberry is one of the richest sources of vitamin C
(63 mg/100 g edible portion) in India [9].
Calcium. The mean intake of calcium was 534 mg
at presurvey, as compared with the RDA of 400 mg. In
99
unit 1 there was significant increase in dietary intake
of calcium from 511 mg at presurvey to 539 mg at
postsurvey. No increase was observed in the other
three units. Calcium is known to be an inhibitor of
iron bioavailability [13].
Vitamin A. India is one of the more vitamin A-deficient
countries in the world [14]. Our dietary and
nutrient intake data confirm that even young women
who are not from the poorest group may be deficient
in vitamin A. The mean intake of vitamin A or its
precursor β-carotene was only 267 µg, as compared
with the RDA of 600 µg. The intake of vitamin A
increased significantly in units 1 and 2, due mostly to
a higher consumption of tomatoes, a rich source of
β-carotene (590 µg/100 g edible portion). Ripe tomato
is also a good source of folic acid (30 µg/100 g by highperformance
liquid chromatography) and vitamin C
(27 mg/100 g) [9].
Vitamin C. The mean intake of vitamin C was 29
mg at presurvey, as compared with the RDA of 40
mg. It increased significantly in unit 1 from 24 mg
at presurvey to 31 mg at postsurvey. This reflects a
change in behavior, perhaps due to a combination of
the food intervention and the IEC. The greatest and
most significant enhancement of vitamin C was seen
in unit 2, mostly consumption of gooseberry juice at
the workplace.
Impact on knowledge responses
As shown in table 5, the presurvey spontaneous recall
responses and general knowledge of anemia or irondeficiency
anemia were extremely poor, ranging from
9% in unit 3 to 23% in unit 4. Highly significant
increases of greater than 87% in correct responses
were noted in units 1, 2, and 3 at the postsurvey. Even
TABLE 5. Knowledge of anemia (% of women displaying knowledge) before and after intervention
Unit 2: Unit 3: medicinal Unit 4:
Unit 1: iddli gooseberry supplements negative control
(n = 72) juice (n = 80) (n = 70) (n = 80)
Indicator Before After Before After Before After Before After
Knowledge
Have heard of anemia 10 99*** 14 94*** 9 87*** 23 35***
Stating cause of anemia correctly
Weak blood 15 57*** 21 64*** 11 66*** 11 30***
Deficiency in diet 1 65*** 18 71*** 19 66*** 12 26***
Can’t say 83 6*** 61 18*** 70 5*** 89 53***
Which food makes the blood strong?
Fruits 15 22*** 11 66*** 14 19*** 11 36***
Vegetables 32 54*** 26 58*** 37 53*** 16 39***
Meat 17 75*** 28 65*** 47 86*** 13 39***
Milk 10 47*** 13 33*** 11 14*** 18 43***
Others 8 15*** 8 10*NS 0 0 13 38***
*** p < .001; NS, not significant.