Prevalence of Anaemia among Adolescent Girls on Weekly Iron and Folic Acid Supplementation (WIFS) and Non WIFS Group in Rural Schools of Mangalore, Karnataka; a Comparative Study

Background: Weekly Iron and Folic Acid Supplementation (WIFS) Programme is an initiative to decrease the burden of anaemia among adolescents studying in Government schools. Objective: To assess the difference in prevalence of anaemia among Government school-going adolescents girls on WIFS as compared to private school girls not on WIFS. Methods: Cross-sectional study was conducted among adolescent girls, 7th to 10th standard in Government schools (on WIFS) and private schools (not on WIFS). The sample size in each group was 104, selected by multi-stage sampling. Data was collected using semi-structured questionnaire, clinical examination and haemoglobin estimation. Chi-square test and Unpaired t test used to compare the categorical and continuous variables respectively. Results: The prevalence of anaemia among the school children in government schools was 51% and in the private schools it was 64.4%. The mean haemoglobin was 11.77 � 1.41 and 11.34 � 1.49 in government and private school girls, respectively, which was statistically significant (p=0.013). Conclusions: The prevalence of anaemia among the government school girls was lesser as compared to the private schools girls, suggesting the role of WIFS in the reduction of prevalence of anemia. WIFS programme may be extended to private schools as well.

The acceptability of weekly iron-folic acid supplementation and its influencing factors among adolescent school girls in Yogyakarta city: a mixmethods study

@#Introduction: Indonesia has initiated the weekly iron-folic acid supplementation programme (WIFS) among adolescent school girls since 2016. However, its acceptability needs to be investigated. This study aimed to assess the acceptability of WIFS and its influencing factors. Methods: A mixed-methods study was conducted in six schools in Yogyakarta from January-April 2018. Totally, 211 participants aged 12-18 years were involved in the cross-sectional survey, followed by four focus group discussions (FGDs) and in-depth interviews (IDIs). Body mass index-for-age, haemoglobin, serum ferritin, habitual intake, and acceptability (defined as selfreported iron folic acid tablet consumption) were assessed. Results: This study reported that 22.3% and 12.4% of the participants were categorised as iron deficient and anaemic, respectively. Almost 90% of participants had received the tablet, but only 62.0% of them reported consuming it. Logistic regression test indicated that the participants were more likely to take the tablet if it tasted good [OR (95%CI): 4.66 (1.90-11.43)]. Meanwhile, motivation for tablet consumption declined when respondents perceived the odour of tablet was unpleasant, reported forgetfulness, lacked peer support, and experienced side effects, with OR (95%CI) of 0.23 (0.07- 0.77), 0.35 (0.13-0.95), 0.30 (0.08-0.58), and 0.04 (0.04-0.39), respectively. The results from FGD and IDIs strengthened the findings that the experience of nausea, organoleptic properties of iron-folic acid tablet, forgetfulness, and mother’s support play important roles in students’ acceptability. Conclusion: This study found moderate acceptability towards the WIFS programme. The inhibiting and reinforcing factors of WIFS acceptability in this study could be considered as inputs for programme improvements in the future.

A Study of Nutritional Health Problems of Adolescent Girls in Rural Area of Nagpur District: A School Based Cross Sectional Study

Introduction: "Adolescence" literally means "to emerge"or "to attain identity" and is essentially the period of rapidphysical and psychological development. The World HealthOrganization (WHO) defines “adolescent” as an individualbetween 10 to 19 years of age. About 19.7% of Indianpopulation is adolescents. Nutritional health problems areone of the important health problem faced by adolescents.Prevalence of anemia in adolescents (15-19 years) girls is54%. Underweight is seen among 46.4% adolescent girls.Hence this study was conducted to find out nutritional healthproblems of adolescent girls in a rural area of Nagpur district.Menstrual hygiene was also studied.Material and methods: A cross sectional study was carriedout in one of the randomly selected school in a rural area ofNagpur. Calculated sample size was 145, though the studywas carried out on 150 adolescent girls in August 2019 usinga pre-designed and pre- tested questionnaire.Results: Mean age of study participants was 14.87± 2.77years. Prevalence of anemia was found to be 80%. Prevalenceof undernutrition was 36%. None of the student receivedweekly iron and folic acid tablets in last three months. Only28% study subjects received information of menstrual hygieneprior to menarche.Conclusion: Prevalence of anemia and undernutrition wasfound to be high in a school of rural area of Nagpur district.WIFS program should be strengthened through inter-sectoralcollaboration among health and education sectors

Folic Acid Supplementation in Chinese Peri-conceptional Population: Results from the SPCC Study / 生物医学与环境科学（英文）

Objective@#To determine the prevalence and determinants of folic acid (FA) supplementation in Chinese couples planning for pregnancy and in women during early pregnancy.@*Methods@#This was a cross-sectional study based on the Shanghai PreConception Cohort (SPCC) study. Data on FA supplementation and socio-demographic features were collected using questionnaires. Couples visiting clinics for pre-pregnancy examination and pregnant women at < 14 gestational weeks were recruited in Shanghai, China, between March 2016 and September 2018.@*Results@#Among the pregnancy planners, 42.4% (4,710/11,099) women and 17.1% (1,377/8,045) men used FA supplements, while 93.4% (14,585/15,615) of the pregnant women used FA supplements. FA supplement use was higher in female pregnancy planners who were older ( : 1.13, 95% : 1.08-1.18), had higher education ( : 1.71, 95% : 1.53-1.92), and were residing in urban districts ( : 1.06, 95% : 1.01-1.11) of FA supplementation; female pregnancy planners with alcohol consumption ( : 0.95, 95% : 0.90-0.99) had lower odds of FA supplementation. In early pregnancy, women with higher educational level ( : 1.04, 95% : 1.03-1.06), who underwent pre-pregnancy examination ( : 1.02, 95% : 1.01-1.03) had higher odds of using an FA supplement; older aged ( : 0.99, 95% : 0.98-0.99), and multigravida ( : 0.97, 95% : 0.96-0.98) had lower odds of FA supplementation.@*Conclusion@#Although the majority of pregnant women took FA supplements, more than half of the women planning for pregnancy did not. Urgent strategies are needed to improve pre-conception FA supplementation.

Analysis of comorbidities among pregnant woman attending rural Medical College Hospital

Background: In pregnancy Anaemia and Depression is an important factor associated with an increased risk of maternal, fetal and neonatal mortality, poor pregnancy outcomes, and impaired cognitive development. To assess prevalence and factors associated with anemia and Depression among pregnant women attending antenatal clinic.Methods: A Facility based cross-sectional study was conducted on 284 pregnant women to at Rural Medical college hospital from June to August 2018. Data on sociodemographic and clinical characteristics of the study participants were collected using a Pretested structured questionnaire by interview and review of medical records. Binary Logistic regression analysis had been used to check for association between dependent and independent variables in all cases. P-value less than 0.05 was considered statistically significant.Results: The prevalence of anemia was found to be11.6% (95 %CI; 7.8%-14.8%) and Depression was 8.6% Pregnant women in the second and third trimester [AOR (95% CI), 8.31 (1.24-55.45), and P=0.029] were more likely to be anemic when compared to pregnant women in their first trimester. Pregnant women who did not receive iron/folic acid supplementation [AOR (95%CI),4.03(1.49 10.92), and P=0.01] were more likely to be anemic when compared to pregnant to women who did take supplementations.Conclusions: In this study the prevalence of anemia and Depression in pregnancy was low compared to the findings of others. Gestational age (trimester) and iron/folic acid supplementation were statistically associated with anemia.

Operational issues and lessons learned during National Iron Plus Initiative documentation in Eastern India

Anaemia is a condition in which red blood cells have fewer haemoglobin molecules than normal, or fewer red blood cells overall, and thus less ability to carry oxygen to tissues in the body. Nutritional anaemia is a major public health problem in India and is primarily due to iron deficiency. Symptoms of iron deficiency anaemia are primarily non specific and become apparent when there is severe anaemia. The National Iron Plus Initiative (NIPI) is the most ambitious and comprehensive anaemia control programme in the world. The process documentation team conducted 170 interviews in March, April and May 2016 among officials and frontline workers at state, district, block, sector/cluster and field levels and among NIPI beneficiaries in Odisha. To achieve variation in responses and to get full set of information on how NIPI was being implemented, process documentation and survey data were collected in four districts of Odisha– Keonjhar, Jagatsinghpur, Bhadrak and Kalahandi. This review will give an overview about the operational issues encountered during the National Iron Plus Initiative documentation in Odisha.

Folatos y embarazo, conceptos actuales: ¿Es necesaria una suplementación con Acido Fólico? / Folate and pregnancy, current concepts: It is required folic acid supplementation?

El aporte de folatos durante el embarazo es esencial para un desarrollo fetal y placentario adecuados y para la salud del individuo a largo plazo. Su deficiencia puede inducir alteraciones y patologías fetales como bajo peso al nacer, recién nacidos de pre término y defectos del tubo neural (DTN). Por ello, varios países han decidido implementar políticas públicas de fortificación de alimentos con ácido fólico (AF). Chile inició la fortificación de la harina de trigo con AF en el año 2000, logrando reducir en un 43% la prevalencia de DTN. Sin embargo, además de la elevada ingesta de pan de nuestra población (principal alimento fortificado con AF), muchas mujeres embarazadas consumen suplementos de AF, lo que podría estar superando las concentraciones máximas de AF recomendadas. Adicionalmente, si la dieta materna es reducida en vitamina B12 (vit B12), se alteraría la razón óptima folatos/vit B12 lo que modificaría la metilación de genes específicos y otras vías metabólicas pudiendo afectar el desarrollo fetal y la salud de los recién nacidos a largo plazo. Creemos que, transcurridos 17 años del inicio de la fortificación de la harina de trigo con AF, es necesario evaluar los posibles efectos secundarios de un alto consumo de AF, no solo durante el embarazo, sino también en la población general. Presentamos antecedentes acerca del mecanismo de acción de folatos y vit B12 a nivel celular, y conceptos actuales sobre las posibles consecuencias de un aporte materno elevado de AF sobre la descendencia.

Folate intake during pregnancy is essential for an adequate fetal and placental development and for the long time health of the individual. Its deficiency may induce fetal pathologies, including neural tube disease (NTD). Therefore, several countries implemented public policies to fortify foods with folic acid (FA). Chile started the fortification of wheat flour with FA in the year 2000, decreasing a 43% the prevalence of NTD. However, despite the high consumption of bread (the main fortified food with FA) by our population, a high number of pregnant women consume FA supplements, thus, over passing the maximal recommended FA intake. Additionally, if the diet is reduced in vitamin B12, the optimal ratio folates/vit B12 may be altered, thus inducing changes in the methylation of specific genes and other metabolic pathways, affecting fetal development and the long-term health of the neonates. We think that, after 16 years of the initiation of the fortification of wheat flour with FA, it is necessary to evaluate the possible side effects of a high intake of FA in the pregnant population and their offspring. This article shows antecedents about mechanisms of folates and vit B12 at cellular level, and their possible consequences of an elevated FA maternal intake on the offspring.

Association between congenital heart disease and folic acid supplementation during periconceptional period among women of childbearing age in Shaanxi / 西安交通大学学报(医学版)

Objective To explore the association between folic acid supplementation during periconcerptional period and congenital heart disease in newborns to provide scientific evidence for making intervening measures.Methods Using stratified random cluster sampling,a total of 30 counties were sampled from Shaanxi Province.A questionnaire survey was conducted among childbearing-aged women pregnant between January 2010 and November 2013.All of the included women had definite pregnancy outcomes and had signed the consent form.Logistic regression was performed to investigate the association between folic acid supplementation during pregnancy and congenital heart disease in newborns.Results In total,28 354 questionnaires were available for analysis.The overall prevalence of congenital heart disease among live-birth neonates in the present study was 7.3‰.The percentage of childbearing-age women who had taken folic acid supplementation during pregnancy was 64.4％,while only 17.2％ of them took folic acid according to the specification.Taking folic acid regularly during pregnancy was associated with a lower risk of congenital heart disease among the newborns (OR 0.502,95％ CI:0.279 0.902).The multiple-factor analysis results also showed that taking folic acid regularly during periconcerptional period could reduce the risk of congenital heart disease (adjusted OR=0.512,P=0.046) when we controlled the family background factors,mother factors and exposure risk factors during pregnancy.However,no association was found between irregularly taking folic acid during periconcerptional period and the risk of congenital heart disease.Conclusion Taking folic acid according to the specification during periconcerptional period (taking folic acid during 3 months before pregnancy to 3 months after pregnancy with a daily dose of 0.4mg for more than 90 days) may prevent congenital heart disease of newborns.

Folic acid supplementation reduces oxidative stress and hepatic toxicity in rats treated chronically with ethanol

Folate deficiency and hyperhomocysteinemia are found in most patients with alcoholic liver disease. Oxidative stress is one of the most important mechanisms contributing to homocysteine (Hcy)-induced tissue injury. However it has not been examined whether exogenous administration of folic acid attenuates oxidative stress and hepatic toxicity. The aim of this study was to investigate the in vivo effect of folic acid supplementation on oxidative stress and hepatic toxicity induced by chronic ethanol consumption. Wistar rats (n = 32) were divided into four groups and fed 0%, 12%, 36% ethanol, or 36% ethanol plus folic acid (10 mg folic acid/L) diets. After 5 weeks, chronic consumption of the 36% ethanol diet significantly increased plasma alanine transaminase (ALT) (P < 0.05) and aspartate transaminase (AST) (P < 0.05), triglycerides (TG) (P < 0.05), Hcy (P < 0.001), and low density lipoprotein conjugated dienes (CD) (P < 0.05) but decreased total radical-trapping antioxidant potential (TRAP) (P < 0.001). These changes were prevented partially by folic acid supplementation. The 12% ethanol diet had no apparent effect on most parameters. Plasma Hcy concentration was well correlated with plasma ALT (r = 0.612**), AST (r = 0.652*), CD (r = 0.495*), and TRAP (r = -0.486*). The results indicate that moderately elevated Hcy is associated with increased oxidative stress and liver injury in alcohol-fed rats, and suggests that folic acid supplementation appears to attenuate hepatic toxicity induced by chronic ethanol consumption possibly by decreasing oxidative stress.

Effects of dietary supplementation of high-dose folic acid on biomarkers of methylating reaction in vitamin B12-deficient rats

Folate is generally considered as a safe water-soluble vitamin for supplementation. However, we do not have enough information to confirm the potential effects and safety of folate supplementation and the interaction with vitamin B12 deficiency. It has been hypothesized that a greater methyl group supply could lead to compensation for vitamin B12 deficiency. On this basis, the present study was conducted to examine the effects of high-dose folic acid (FA) supplementation on biomarkers involved in the methionine cycle in vitamin B12-deficient rats. Sprague-Dawley rats were fed diets containing either 0 or 100 microg (daily dietary requirement) vitamin B12/kg diet with either 2 mg (daily dietary requirement) or 100 mg FA/kg diet for six weeks. Vitamin B12-deficiency resulted in increased plasma homocysteine (p<0.01), which was normalized by dietary supplementation of high-dose FA (p<0.01). However, FA supplementation and vitamin B12 deficiency did not alter hepatic and brain S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) concentrations and hepatic DNA methylation. These results indicated that supplementation of high-dose FA improved homocysteinemia in vitamin B12-deficiency but did not change SAM and SAH, the main biomarkers of methylating reaction.

Effect of Folic Acid Supplementation on Serum Homocysteine and B Vitamins in Infertile Women

Elevated homocysteine concentration is known to be related to placental abruption, spontaneous abortion, and many adverse pregnancy outcomes. The purpose of this study was to investigate the effects of folic acid supplementation (1000 microgram per day) and 5, 10 methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism genotype on serum homocysteine and B vitamin levels in 50 infertile women (aged 31.2 +/- 3.2 years). Blood sampling was performed at baseline and at the end of folic acid supplementation period. In infertile women, serum folate and vitamin B12 concentrations were significantly higher in post-supplementation than those in pre-supplementation. Serum homocysteine concentration was significantly lower in post-supplementation than that in pre-supplementation. However, serum homocysteine levels were still higher in the T/T genotype than those in the C/C or C/T even after folic acid supplementation. Serum homocysteine was inversely related to serum folate in T/T homozygotes at baseline and at the end of folic acid supplementation. These results suggest that folic acid supplementation is needed for infertile women to improve their vitamin status and also to reduce the risk of hyperhomocysteinemia. These effects were different according to their MTHFR C677T genotypes. Therefore, further studies are necessary to determine the optimal level of supplementation of folic acid by MTHFR genotypes.