Effect of Directly Observed Iron Therapy (DOIT) in Anaemia & Productivity – A Community Based Intervention Study in Dibrugarh, Assam

Title of the article: Prevalence of anaemia and associated factors amongst tea pluckers and the effect of directly observed iron therapy( DOIT) in Anaemia and Productivity in Dibrugarh District, Assam – An Action Research. Introduction There is convincing evidence that iron deficiency and anaemia causes impaired growth, developmental delay, decreased physical activity, behavioural abnormalities and impairs cognitive function. Anaemia is rampant amongst tea garden community. Therefore this study is undertaken to estimate magnitude of anaemia and associated factors among permanent workers of tea estates and to assess difference in productivity amongst working women (tea pluckers) after giving directly observed iron therapy. Materials and Method: A cross sectional study followed by quasi-experimental, interventions study. In baseline, 1168 permanent workers, included. 150 anaemic women from each tea estates selected randomly, where directly observed iron therapy (DOIT) given to one tea estate and conventional treatment to other one and assessed after three month of intervention. Productivity was compared. Results: Prevalence of anaemia was 88% and 45.7% were underweight. Majority practiced open air defecation (96.1%) and were illiterate (99.7%). Helminthiasis was common in 63.6%. Sickle cell anaemia was prevalent amongst 9.72%. DOIT improved haemoglobin level to 1.44 gm/dl from baseline after three month of intervention. (p<0.05) Conclusions: Directly observed iron therapy improved significantly the haemoglobin level and productivity. There is a need to address multifactoral causation of anaemia by integrated approach. Introduction: Anaemia is a global public health problem affecting both developing and developed countries and is an indicator of poor nutrition and health with major consequences for health, social and economic development of a population. Worldwide, at any given moment, more individuals have iron-deficiency anaemia than any other health problem.1 Nutritional anaemia is one of the major public health problems in India affecting almost 90% poor children, adolescent girls and women, considered as “female disease “causing red alert for Indian women2. Lower haemoglobin values and anaemia (< 12 g/ dl) were associated with both lower labour productivity and more days of sickness and absenteeism. Taller women with greater arm circumference were able to pluck more green leaves, earn higher wages and were absent less often 3. The major causes of Anaemia in India are low intake of Iron through the diet coupled with low bioavailability, high level of parasitic infestations and frequent infections 3.The workers of tea plantation industry migrated to Assam from states like Madhya Pradesh, Bihar, Orissa and Andhra Pradesh in the latter part of nineteenth to early twentieth century 4. These migrant workers involved in tea plucking, typically reside in the periphery of the tea estate in what is known as labour lines. Tea garden population represent 17% of Assam’s population and 27% of Dibrugarh District. Almost half of the girls were stunted and most of them were thin. Factors typical to underdeveloped society; contribute to the moderate to high prevalence of under nutrition among the girls working in these Tea Gardens 5. Almost 96% of pregnant mothers and 100% of adolescent girls are anaemic (mild to severe); similarly 55% of mothers and 46% of girls are with low BMI6. With this background in this field concerning tea garden workers indulged us to contemplate the present study with an objective to estimate the magnitude of anaemia among permanent workers of tea estates and to assess the difference in productivity amongst working population (tea pluckers) after giving directly observed iron therapy. Materials and Methods: Setting – Dibrugarh District, also known as tea Capital of Assam is selected as this is the most tea intensive District having highest number of tea estates. Two tea estates were selected from a list of 169 tea estates of the District using computerised random number. Study design: A baseline, cross sectional study was carried out, in two tea estate populations of Dibrugarh District of Assam. Human subject recruitment was done after getting clearance from Institutional ethical committee. A predesigned, pretested format, covering demographic characteristics, socioeconomic status, general physical examination, laboratory investigation of blood for Haemoglobin (by cyanomethhaemoglobin method) and stool examination for helminthic ova along with dietary survey using 24 hour recall method was used. This was followed by a quasi-experimental, intervention study. In the Intervention tea estate, directly observed iron therapy was given using iron-folic acid (IFA) tablets six days in a week by a drug provider ( supervisor), who supervised the consumption of tablets by direct observation and also did recording of tea leaves plucked from the registered, to 150 anaemic women by giving 100 mg of Govt supplied tablets and in the control tea estate the selected population of 150 anaemic women were informed about their anaemic status and advice to take conventional treatment from tea garden outpatient department. Both the group were sensitized for