Introduction
Despite several decades of programming, anaemia continues to be a
critical public health problem in India, affecting 59% adolescent girls
and 31% boys aged 15-19 years.1 This is an increase
from the 2015-16 estimates and has raised concerns regarding
the effectiveness of anaemia prevention programs.2, 3In India, the prevalence of anaemia is highest in the early years,
decreases until about 11 years of age and then increases again during
adolescence, particularly in girls due to the start of menstruation and
as a consequence of early marriage and teenage
pregnancy.4-8 Nutritional anaemia due to lack of iron,
folate, or vitamin B12 is the most prevalent form in this age
group6 and has long term negative implications on
growth and development, school performance and work
productivity.8-12 Anaemia during adolescent pregnancy
is associated with poor pregnancy outcomes such premature births, low
birth weight, and perinatal and maternal mortality.8,
13, 14
The Government of India has highlighted the importance of improving the
nutrition of adolescents by modifying schemes originally aimed at the
welfare of pregnant women and children. The Scheme for Adolescent Girls
(SAG), the Kishori Shakti Yojana , RMNCH+A initiative, Sneha
Clinics, the National Iron Plus Initiative, the Anaemia Mukt
Bharat (AMB, Anaemia free India) initiative and POSHAN Abhiyaan,
all include special features for empowering and improving the health and
nutrition of adolescents. The revamped AMB initiative, aimed to break
the intergenerational cycle of anaemia, focuses on six groups likely to
benefit, six institutional mechanisms and six
interventions.15, 16 Several of these interventions
such as weekly iron and folic acid (IFA) supplementation, anaemia
testing and treatment, deworming and education, specifically target
adolescent boys and girls.15
Regardless of these interventions, findings from our recent study in
rural Karnataka and others studies as well, revealed gaps in community
awareness of adolescent anaemia and its prevention, poor dietary
behaviour, low compliance with regular IFA consumption and lack of
adequate nutrition education in schools.17-21 Students
and teachers described a vigilance-oriented approach i.e., supervised
swallowing of IFA tablets, without any meaningful communication on what
they were receiving, and why.22 In addition to
addressing supply side barriers and careful programming, studies have
continually highlighted a need to implement interventions to address
demand-side barriers by improving awareness and changing behaviours
surrounding diet and iron consumption.4, 16, 19, 23-27To this end, we conducted research to understand the extent to which
adolescent awareness of and attitudes about anaemia can change through
short, targeted nutritional messages delivered by teachers at school.