The document summarizes a study on child anemia feasibility in rural Uttar Pradesh, India. It discusses: 1) High rates of child anemia in the region based on previous studies. Frontline workers lacked capacity and anemia programs had low coverage. 2) A comprehensive package to address anemia through nutrition, IFA supplementation, deworming, and infection control was implemented. Frontline workers were trained. 3) A follow-up study found large reductions in anemia prevalence among children in the intervention area compared to the control area, showing the package was feasible to deliver through existing systems with capacity building. However, challenges in full coverage and compliance remained.

1. Child Anemia Feasibility Study: Approaches and Lessons Learnt S R Nagar – Uttar Pradesh Presentation at XIII Annual Conference of Indian Association of Preventive & Social Medicine UP & Uttarakhand Chapter Dehradun – Uttarakhand 31st October, 2010 Prof Prakash V Kotecha Country Representative, A2Z, the USAID Micronutrient Project, New Delhi, India Ex Professor and Head, PSM Dept, Medical College, Baroda, Gujarat pkotecha@aed.org/pvkotecha@gmail.com

5. Anemia in Children Anemia failed to decrease…and at present highest ever Dr. Prakash V. Kotecha

8. Dr. Prakash V. Kotecha Source: http://pariwarkalyan.up.nic.in/mch-intro.htm 17/09/2010

10. NFHS III (2005-06) India Data Age in Months Dr. Prakash V. Kotecha

11. Anemia by Age Group Dr. Prakash V. Kotecha

12. Child Anemia Feasibility Study Why UP? Source: DLHS III (2007-08) Much Larger Sample Size 90,000+ HH UP

14. Study area Dr. Prakash V. Kotecha

15. Study area Dr. Prakash V. Kotecha District State S. R. Nagar, UP Block Gyanpur Total population 2,65,678 No. of Sub-centers 32 No. of ANM 29 No. of AWC 187 Children 6-23 14000 Control block Handia, Allahabad district

18. Scenario at the Start of the Feasibility Study in Gyanpur Block Dr. Prakash V. Kotecha

19. Anemia Prevalence at the starting of the Feasibility Study (6-23 m) Dr. Prakash V. Kotecha Source: NFHS III & A2Z study 2007-08

20. Helminthes Study Children in UP N=472 (Gyanpur Block) Source: Awasthi et al, 2008 Dr. Prakash V. Kotecha

21. IFA Consumption at the starting time 2008 Baseline study Dr. Prakash V. Kotecha Source: A2Z study 2007-08

24. Anemia Status of Health workers N=288

25. Dr. Prakash V. Kotecha

26. Dr. Prakash V. Kotecha IEC Material in form of calendar

39. On going Monitoring LQAS Dr. Prakash V. Kotecha FOCUS LQAS I (Sept. 08) LQAS II (Feb. 09) LQAS III (Aug. 09) Advice on Anemia 46 34 75 IFA syrup Received 66 45 73 Benefits Explained 44 33 65 IFA consumed in last 7 days 59 15 50 Complementary Feeding Advice 28 51 Complementary Feeding Practice 14 11 Anemia Prevalence 95 87 86

40. RESULTS OF THE END LINE STUDY Dr. Prakash V. Kotecha

41. End Line Study Children Dr. Prakash V. Kotecha District Block Number of mothers of children aged 6-23 months (total sectors) Sant Ravi Das Nagar Gyanpur 304 Allahabad Handia 331 Total 635

42. Religion & Caste of children studied Dr. Prakash V. Kotecha Characteristics Project Block (Gyanpur) Comparison Block (Handia) Religion Endline Baseline Endline Baseline Hindu 93.4 93.8 93.4 94.2 Muslim 6.3 6.2 6.3 5.8 Scheduled caste 24.3 30.8 24.3 22.6 Scheduled tribe 2.6 0.0 2.6 1.3 Other backward caste 44.7 41.6 44.7 55.5 Total N 304 305 331 310

43. Standard of living & Literacy Dr. Prakash V. Kotecha Standard of living Percent Households Project Block (Gyanpur) Comparison Block (Handia) Low 80.6 25.7 Medium 14.8 33.5 High 4.6 40.8 Illiteracy Illiterate 54.3 37.8 Total N 304 331

44. ANC Coverage of Mothers Dr. Prakash V. Kotecha

45. IFA Received by Mothers of children 6-23 months during their pregnancy Dr. Prakash V. Kotecha

46. IFA Consumption by Mothers Dr. Prakash V. Kotecha

47. Anemia among children IFA Consumption by Mothers Dr. Prakash V. Kotecha

48. IFA Syrup Received by Children 6-23 months Dr. Prakash V. Kotecha

49. IFA Syrup Knowledge among mothers of children who received syrup Dr. Prakash V. Kotecha

51. IFA Syrup Consumption in last 7 days Dr. Prakash V. Kotecha

52. Deworming Medicine Received by the Children Dr. Prakash V. Kotecha 87% children & 73% of mothers consumed the medicine

53. Benefits explained by ASHA Dr. Prakash V. Kotecha “ Child becomes weak and pale due to lack of blood in the body. It is advisable to take iron rich diet and other iron preparation to prevent anemia. Iron increases blood and help fight infection.”

54. Complementary Feeding Dr. Prakash V. Kotecha

55. Hygiene Practices observed Dr. Prakash V. Kotecha

57. Anemia Prevalence Difference 13% Reduction of Anemia 2% Reduction of Anemia 84% Increase in non anemic children

58. Level of Malnutrition Dr. Prakash V. Kotecha

60. Dr. Prakash V. Kotecha

62. Age profile of mothers Dr. Prakash V. Kotecha