Effect of Directly Observed Oral Iron Supplementation During Pregnancy on Iron Status in a Rural Population in Haryana: a Randomized Controlled Trial

Background: A community-based randomized controlled trial (RCT) in rural north India aimed to evaluate the impact of directly observed oral iron supplementation on iron status among pregnant women. This community-based randomized controlled trial aimed to assess the reduction in anemia prevalence, improvement in iron status, and compliance to oral iron-folic acid (IFA) supplementation.

Methods: Block randomization allocated 400 pregnant women into intervention and control groups. In the intervention group, women received supervised weekly doses of IFA, with instructions to take the remaining tablets as prescribed throughout the week. The control group received unsupervised IFA supplementation.

Results: Results revealed a 6% additional reduction in anemia prevalence in the intervention group compared to the control, a significant improvement considering the minimal annual reduction of anemia prevalence among pregnant women in India. Moreover, the intervention group demonstrated higher improvements in hemoglobin levels compared to the control. Compliance rates were notably higher in the intervention group (69.1%) than in the control group (60.4%), with forgetfulness and side effects being common contributors to noncompliance in the control group.

Conclusion: The study’s strengths include the RCT design to eliminate confounders and ensure equal distribution, minimized interobserver variation due to data collection by a single interviewer and its applicability to similar rural settings. However, limitations include the lack of assessment of participants’ socioeconomic status and dietary iron intake in both groups. Ahamed’s study underscores the effectiveness of directly observed oral iron supplementation in significantly reducing anemia prevalence and improving hemoglobin levels among pregnant women in rural north India. The findings highlight the importance of supervised supplementation in enhancing compliance rates, thereby addressing anemia—a persistent public health challenge in the region.