Indian Journal of Community Medicine Vol. 31, No.
3, July - September, 2006
Impact of Iron, Folate & Vitamin C Supplementation on The Prevalence of Iron
Deficiency Anemia In Non-pregnant Females of Peri Urban Areas of Aligarh
S Mehnaz, S. Afzal, S. Khalil, Z. Khan
Introduction
Nearly 1.5 billion people all over the world are affected by
iron deficiency anaemia (IDA). In India also, depending on
age and sex, prevalence of IDA has been reported to range
from 38-72 per cent, majority of them being women and
children. The IDA prevalence rate beyond the age of six years
is higher in girls. This could be due to certain factors such as
menstruation, gender discrimination in intra-household food
allocation and early marriage leading to early pregnancy.
Estimates suggest that about 25-50 per cent girls become
anaemic by the time they reach menarche. Thus, in these
adolescent girls, pregnancy only serves to aggravate their
pre-existing anemia.
Though supplementation with iron and folic acid remains the
cornerstone in treatment and prevention of anemia, addition
of vitamin C has its other added advantages. Iron deficiency
anemia is prevalent throughout the world because of the
inefficient absorption of nonheme iron, which forms the
bulk of the iron in the diet. Absorption of this type of iron is
impaired by substances in food, which reduce its availability.
Ascorbic acid reverses the effect of dietary inhibitors and is
one of the most powerful known promoters of nonheme iron
absorption2.
In view of the above facts, the present study was carried out
to ascertain the impact of iron supplementation alone and with
vitamin C on the prevalence of iron deficiency anemia among
the non-pregnant females of the age group 15-55 yrs.
Material and Methods
The study was conducted in ‘Qila ka nagla’ a periurban field
study area registered under `Urban Health Training Center’
(UHTC), Department of Community Medicine. Jawaharlal
Nehru Medical College. Aligarh Muslim University. Aligarh. All
the 515 households in this area are registered under UHTC.
From these households all the non-pregnant females of the
age group of 15-55 yrs formed the reference population,
of whom 177 females were randomly selected, (sample
size calculated with 10% error, with 95% confidence limits)
taking the prevalence rate of iron deficiency anemia among
adolescent and non-pregnant females to be 70%1.
They were interviewed using a prestructured performa.
Physical examination, haemoglobin estimation by Sahli’s
Deptt. of Community Medicine, Jawaharlal Nehru Medical
College, Aligarh.
Received 10.06.2004
201
haemoglobinometer and standard blood smear examination
were also done.
Two non-anaemic (Hb%>12m%) were excluded Rest were
divided into experimental (87) and control group (88) by
randomization using random number table. The experimental
group was further divided into two sub-groups 1 and 2. Sub-
group 1(44) were supplemented with iron (200mg) and folic
acid (0.5mg)/ day and sub-group 2 (43) were supplemented
with iron (200mg), folic acid (0.5mg) and vitamin C (l00mg)
/day for a period of 100 days. No supplements were given
to the control group.
Both the control & experimental groups were followed for a
period of 100 days and haemoglobin measurements done
at the start of the study, at 30 days and at 100 days of
supplementation. Drop out rate was 7.34%.
Exact description of the information was delivered to the
subjects of the study e.g. the objective and purpose of the
study, any long term or short-term risks or discomforts,
duration of procedures, duration of the study etc, and then
oral consent was taken from them.
Results
Sixty-eight subjects (38.85 %) were in the age group of 15-25
yrs, sixty six (37.7 %) in 26-35 yrs, 25 (14.28 %) in 36-45 yrs
& 16 (9.14 %) in 45-55 yrs. Most (83%) females of the study
population belonged to social class III & IV.
A very high overall prevalence of iron deficiency anaemia
(98.87 %) was found in the study population. The gradation
in anemia was- mild in 14.8% (26) cases, moderate in 72%
(126) cases and severe in 13% (23) cases. The general
blood picture was predominated by microcytic hypochromic
type while a few had normocytic hypochromic type of blood
picture.
After interventions, at 100 days, the proportion of mild anemia
(Hb% 10-11.9gm%)3 increased from 14.8 % (26) to 29.14 %
(51), while that of moderate (Hb% 7-10gm%)3 and severe
anemia (Hb%<7gm%)3 decreased from 72% (126) to 36%
(63) and 13% (23) to 10.28% (18) respectively (Table I). Forty
three (24.57%) cases attained normal range of haemoglobin
after the interventions.
The iron /folate supplementation given daily in sub group
1 brought about significant change (p<0.0.5) in the mean
haemoglobin level both at 30 days and 100 days, the
improvement being 0.94g/dl and 2.72g/dl respectively. In
sub group 2 vitamin C supplementation along with iron/folate
supplementation also brought about significant improvement
Impact of Iron, Folate & Vitamin C Supplementation
 Indian Journal of Community Medicine Vol. 31, No. 3, July - September, 2006

(p<0.0.5) at 30 days (1.6g/dl) and 100 days (4.36g/dl). In and young females. There was considerable improvement
the control group where no supplementation was given the in the haemoglobin status of the anaemic females on
mean increase in haemoglobin was 0.23g/dl at 30 days and supplementation with iron/folate alone or with vitamin C. It
0.10g%dl at 100 days, which was found to be insignificant was also observed that the rate of rise in Hb percentage was
(p>0.05). (Table II). more in the females who had their Hb percentage at a lower
range before supplementation. However, the mean increase
Table I: A Comparison of Prevalence of Anaemia Before and After
Interventions in Hb percentage was equal in all age groups.
After Interventions The dietary intake of Vitamin C along with iron rich sources
(N=132)
enhances the absorption of iron significantly 4,5 . The
B Normal Mild Moderate Severe Total
E
difference in the response of the subjects getting Vitamin C
F supplementation with Fe/folate as compared to those receiving
O only Fe/folate in the present study seems to confirm this.
R Mild 10 13 01 02 26
E (14.8%) Experimental studies on anaernic preschool children
I
consuming a purely vegetarian diet have shown that 100g
N Moderate 31 35 58 02 126 of crystalline ascorbic acid taken as a tablet along with lunch
T (72%) and dinner meals for two months brought about a significant
E improvement in the haemoglobin level that was higher than
R
V
the rise obtained with iron supplements in the same study
E Severe 02 03 04 14 23 (1.9g/dl Vs l.lg/dl)6.
N (13%)
T In another intervention study done on adolescent girls of poor
I community it was observed that even weekly supplementation
O Total 43 51 63 18 175 of vitamin C along with iron/folate had a significant higher
N (24.57%) (29.14%) (36%) (10.28%)
S increase in haemoglobin concentration (0.76g/dl), as
(N=175) compared to weekly iron/folate supplementation alone
*Before interventions out of 175 study subjects nobody was normal, all (0.71 g/dl) after three months of supplementation. Also daily
were anaemic. supplementation with iron /folate demonstrated an increase
The c2 test was applied and the p value obtained was found to be signifi- in haemoglobin by 0.99g/dl at the end of three months 1.
cant i.e. (p<0.05).
In yet another study it was observed that supplementation
Table II: The Increase in Mean Haemoglobin of the Study Population
at the Start of the Study and at 100 Days of 50mg of vitamin C along with iron/folate increased
Mean 0th Mean 30th Mean Mean Hb Mean
the iron absorption to 7.7% as compared to iron/folate
day Hb day Hb increase after (gm%) after increase supplementation alone where the iron absorption was 1.6%
(gm%) (gm%) 30 days 100 days after 100 only7.
(initial) (gm%) days
gm%) On observing a high prevalence rate of iron deficiency
Controls 8.33 8.40 0.23 8.43 0.10 anemia in this study, it may be concluded that adolescents
Cases 8.30 9.24 0.94 11.02 2.72 and non-pregnant females of the reproductive age group
(sub-group 1) should be included in the government’s R.C.H. programme of
Cases 8.70 10.30 1.6 13.06 4.36 provision of free iron/folate tablets, and giving vitamin C along
(sub- group 2) with it may be an added advantage. Emphasis should also
be made on the need to improve the diet through increased
(ANOVA TABLE) intake of fruits and vegetables rich in vitamin C (e.g. guava,
Source of Sum of Degree of Mean sum of Variance amla, oranges, tomatoes).
variation square (ss) freedom (df) square (M.S.S) Ratio’F’
Our study also demonstrate that the hard core cases (14
Treatments 573.35 2 286.67 F=286.67/0.02
of 23 severe anemia cases) remained in severe category
Error 3.86 173 0.02 F=143.43
even after intervention. Thus, factors other that nutritional
Total 577.21 175
deficiency might have been involved e.g. some underlying
The value of F is significant. The value of p is <0.05 (significant)
disease. Major shift (impact of intervention) was noted in
moderate cases where 66 (52%) improved. However, two
Discussion cases of mild & moderate anemia each lapsed into severe
The highest prevalence of iron deficiency anemia in the study anemia after intervention. This need further in depth study
was found in the age group of 15-25 yrs i.e. adolescents of such cases.

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 Indian Journal of Community Medicine Vol. 31, No. 3, July - September, 2006

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