Fellow’s research: Parental education and counselling by community health workers improve anaemia cure rates in children

01 Aug 2019

Fellow’s research: Parental education and counselling by community health workers improve anaemia cure rates in children


Prof Arun Shet, Senior Fellow (Alumnus)

St. Johns Research Institute, Bengaluru

Current host institution: National Institutes of Health

In our recent publication, we show for the first time that combining parental education and counselling delivered by community health workers with routine iron supplementation treatment improves the cure rate of anaemia in young children from rural India.

Anaemia—a condition wherein the number of red blood cells or their oxygen-carrying capacity is below optimal for normal activities—is a global health problem that affects half the world’s population. South Asia and sub-Saharan Africa have the highest burden of anaemia. Approximately half the cases of anaemia are due to iron deficiency and those particularly at risk are children aged 0–5 years, women of child-bearing age, and pregnant women. Anaemia can affect maternal and child mortality and physical performance in adults. Anaemia caused by iron deficiency hampers brain development in children and has important social and economic costs. According to a National Family Health survey conducted in 2015–2016, 60% of children aged 6–59 months in India were diagnosed with anaemia. Thus, there are approximately 96 million cases of childhood anaemia in India alone.

Treatment strategies for anaemia include oral intake of the prescribed iron dose. The distribution of iron supplements occurs under administrative support of the National Anaemia Control Program. In rural communities, community health workers implement this activity. However, no public health intervention in India has previously evaluated the role of community health workers in improving the uptake of anaemia treatment. In order to address this gap, researchers from local and international academic institutions partnered with governmental and non-governmental actors and developed a community-based intervention delivered through community health workers to support the national anaemia control efforts.

To study how helpful the intervention was, a clinical trial was conducted in Chamarajnagar, Karnataka, India, from November 2014 and July 2015 and a 6-month follow-up that ended in January 2016. Over 1200 children aged 12–59 months from 55 randomly selected villages were screened; 534 of them were found to be anaemic and grouped into two groups: the intervention group and the usual treatment group. All children with anaemia in both groups received iron treatment. However, in the intervention group, parents of anaemic children were educated/counselled monthly about anaemia, its causes, and the importance of adherence to treatment. At the end of a 6-month follow up, children with anaemia whose parents and caregivers received counselling and education were found more likely to have taken their iron pills and to have been cured of anaemia.

This study shows that maternal/caregiver education and counselling delivered by community health workers enhances the effectiveness of medicinal iron prescribed for anaemia treatment. The results of this clinical trial are possibly relevant to other similar regions in India and worldwide where childhood anaemia is a major problem; therefore, policy makers may consider augmenting population-level anaemia control efforts. 


Effect of a community health worker delivered parental education and counselling intervention on anaemia cure rates in rural Indian children: a pragmatic cluster randomized clinical trial. Arun S. Shet, Merrick Zwarenstein, Abha Rao, Paul Jebaraj, Karthika Arumugam, Salla Atkins, Maya Mascarenhas, Neil Klar, Maria Rosaria Galanti. JAMA Pediatrics. July 2019.

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