Battling iron deficiency anemia in rural Bangladesh
By Maherin Ahmed
Comilla, Bangladesh, 17 July 2014: It is a usual day in Burichong Upazila (sub-district) of Moynamoti Union under Comilla district. The early sultry summer weather means profuse sweating and a rush to the ponds by children, swarms of insects flying all around and many expectant mothers going to the Shinduriapara community clinic.
Changing Behaviour: Curbing anemia
Rozina Akhtar, community health care provider, is carrying medicine boxes from the local health complex. She has been working here for the last three years, available six days a week for her visitors. Rozina provides basic health care services including antenatal care.
“I suggest to all pregnant women to drink plenty of water, and I strictly monitor if they take iron tablets regularly, which are provided free by the government,” she says. At the same time, pregnant women are advised to take a varied diet including foods which are rich in iron, other micronutrients and protein, some additional energy foods during pregnancy. Pregnant women are also encouraged to rest for some time each day and to try to avoid stressful situations.
Razia Begum, (25), has a three-year-old child and is six months pregnant with her second child. Razia is now well aware of the benefits of iron tablets which was not the case during her first pregnancy. “When I was pregnant with my son for the first time, I felt weak all the time. I did not eat properly and my son was very small and weak when he was born. I felt pain all over my hands and feet and felt weak and tired during that time. This time around, I followed advice on a better diet and took iron tablets from the day I learnt that I was pregnant. Apa (Rozina Akhtar) has suggested that I take one every day. Now I feel energetic, and have no pain in my body,” she confirms.
Another expectant mother of nearby Shameshpur village echoed the same sentiment as Razia. Rozina is now eight-month pregnant for the third time. Her first baby is five year’s old. Her second child, a daughter was born just 10 months later, and died seven days after her birth.
“She was so small and light, I could not save her. I did not know about iron tablets then. This time, I am taking the red tablet everyday,” Rozina says, adding that this time she feels more energetic compared to her previous pregnancies -- eating vegetables and fish, taking both calcium and iron supplements regularly. She is hopeful that she will give birth to a healthy child.
Rozina’s next-door neighbour Shumi, also pregnant for the third time, adds that they all know about the benefits of iron tablets and a good diet now, and it’s good for both the mother and child, thanks to their family health care provider, Farida Yasmin.
Providing selfless care
Farida has been working as a family welfare assistant for the last 22 years. On a regular basis, she visits all the homes in the village, and keeps an eye on homes with newly married couples, adolescent women, and pregnant mothers.
Farida says that many people in the villages are impoverished. They cannot afford nutritious food. Hence, she strongly advocates iron tablet intake. “I explain to both new to-be-mothers and their mother-in-laws that now couples have a children or two, not eight or nine like the earlier days. Hence, it is very important to take good care of the few children they will have so that they are well nourished, and this Shakti tablet (energy tablet, referring to iron supplements) will help maintain good health. Since it is provided for free by the government, why would you not take it?”
Other than carrying out one-on-one home visit for counseling like Farida, and clinic services like Rozina, family health care providers also conduct regular courtyard meetings with the rural women.
Nigar Parveen, who practices once a month in satellite clinics, also discusses lifestyle issues with the villagers. “Not only do I suggest to pregnant women to take iron tablets, but also tell them to continue intake three months after delivery,” she says.
Nigar Parveen also adds that previously iron tablets would often melt, and this was unappealing to most women, hence they did not take them. But now, the tablets are supplied in strip packages. This also helps to monitor intake.
Targeting pregnant women
In 2007, Bangladesh rolled out its national anemia control strategy that provided daily iron supplements comprising 60mgFe and .4mg Folic acid throughout pregnancy for up to three months of lactation.
In 2012, most pregnant women (60 per cent) received iron supplements anytime during pregnancy, only 23 per cent received supplements during their first antenatal care (ANC) visit, and less that 14 per cent consumed at least 100 tablets.
At the end of 2012, the Ministry of Health and Family Welfare with the support of UNICEF jointly implemented an anemia reduction programme. UNICEF identified gaps and supported performance on each intervention with increasing availability and monitoring intake. In one year, availability of Iron tablets increased from 39 per cent to 67 per cent. Consumption of adequate supplements by pregnant women increased from 13 per cent to 31 per cent across 19 Upazilas in 11 districts. The Government is now scaling up this intervention across all 64 districts of Bangladesh.