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


METHODS
Prospective longitudinal evaluation of DOHBIT.


METHODS
A remote rural hilly hamlet with 25 families.


METHODS
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.


METHODS
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.
Bharti
Sahul
S
Bharti Healthy India Movement (BHIM), Non-profit Community Health Foundation, Panyali, India. bhavneetb@yahoo.com
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000188:drug therapy*; D019587:Dietary Supplements; D023801:Directly Observed Therapy; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage*; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019035:Rural Health Services
D005296:Ferrous Compounds; C020748:ferrous sulfate; D005492:Folic Acid