The KAP 2 Study: Preliminary Results from a Pragmatic Cluster Randomized Trial of a Community Education Intervention to Support Childhood Anemia Control in India

Abstract Introduction: Childhood anemia is a public health concern, particularly in India and in Africa, countries that account for 80% of the global burden. Usual treatment of childhood anemia in India consists of monthly distribution of Iron and Folic acid (IFA) tablets according to National Iron + Initiative guidelines. This approach is hampered in part by lack of anemia awareness, dietary practices, and poor adherence to IFA in the target population. To support anemia control efforts, we developed a novel community-centered education and counseling intervention optimized for delivery by village lay health workers (LHWs) to mothers of anemic children. The intervention consisted of five monthly sessions covering: a] anemia awareness education b] adherence counseling and assessment, c] dietary modification to improve iron intake, and d] hygiene and sanitation. Methods: We evaluated the effectiveness of this intervention in a pragmatic cluster randomized controlled trial. Sixty villages selected at random from the study area in Karnataka, South India were randomly allocated to either intervention + usual anemia treatment (n=30) or usual anemia treatment alone (n=30). A cluster (randomization unit) was defined as a village from the study area together with its Anganwadi Daycare Center (ADC), and the corresponding LHW in charge of the ADC. LHWs in the intervention group were specifically trained to administer the intervention to mothers of anemic children in addition to usual anemia care. Hemoglobin at baseline and endpoint was used to define anemia (Hb Results: From 55 finally included villages (intervention=28; control=27), a total of 1144 children were screened. The overall anemia prevalence was 47% (n=534; intervention=303; control=231). Baseline characteristics of the anemic children are presented in Table 1. Hypoferremia (ferritin 5 mg/L; n=55) all sTfR/log Ferritin values were >1.03 (median=2.7; 1.85, 4.20) suggesting functional IDA. Overall loss to follow up in the trial was low (3%) but was greater in the usual treatment group (n=12 vs. 5). According to an intention to treat analysis, children receiving the intervention had a significantly higher anemia cure rate compared with children receiving usual treatment (55.7% vs. 41.4%; p Conclusion: At the end of 6 months, the intervention combined with usual anemia treatment was more effective in curing anemia than usual treatment alone. This trial suggests that community education may positively interact with usual anemia treatment practices to achieve better childhood anemia control in India. Download : Download high-res image (323KB) Download : Download full-size image Disclosures No relevant conflicts of interest to declare.