Feasibility of "directly observed home-based twice-daily iron therapy" (DOHBIT) for management of anemia in rural patients: a pilot study.

ABSTRACT

BACKGROUND: Iron deficiency anemia (IDA) is a significant public health challenge in resource-poor settings, despite strong evidence for efficacy of iron supplementation. We hypothesized, modeled on the successful initiatives in disorders like tuberculosis or HIV, that directly observed therapy is an effective and practical strategy for control of IDA in such settings. OBJECTIVE: To overcome practical constraints and optimize compliance and effectiveness of iron supplementation by "Directly Observed Home-Based twice daily Iron Therapy" (DOHBIT) through village youth volunteers. DESIGN: Prospective longitudinal evaluation of DOHBIT. SETTING: A remote rural hilly hamlet with 25 families. METHODS AND MATERIAL: 100 mg elemental iron was administered twice daily under direct supervision to 33 anemic patients at home for 90 days. Outcome measures included hemoglobin rise, weight gain and side-effects. STATISTICS Pre- and post-intervention weight and hemoglobin values were compared using paired t-test. RESULTS: 29 patients completed 3-months twice-daily iron therapy without interruption (compliance 87%). There was significant increase in mean weight (43.3 +/- 6.8 kg vs. 45.1+/- 6.9 kg; P < 0.0001) as well mean hemoglobin concentration (9.5 +/- 0.9 gm% vs. 11.7 +/- 0.7 gm%; P < 0.0001) and prevalence of anemia decreased by 40% from recruitment through the 3-months therapy. In terms of side effects, occasional constipation was stated by 3 patients, transient heartburn by two and diarrhea by none. Vomiting prompted withdrawal of iron therapy in one patient. CONCLUSIONS: Providing iron supplementation as directly observed home based therapy is feasible and successful in decreasing the prevalence of anemia in resource-poor settings.