title: Factors influencing receipt of iron supplementation by young children and their mothers in rural India: local and national cross-sectional studies.
abstract: BACKGROUND
  In India, 55% of women and 69.5% of preschool children are anaemic despite national policies recommending routine iron supplementation. Understanding factors associated with receipt of iron in the field could help optimise implementation of anaemia control policies. Thus, we undertook 1) a cross-sectional study to evaluate iron supplementation to children (and mothers) in rural Karnataka, India, and 2) an analysis of all-India rural data from the National Family Health Study 2005-6 (NFHS-3).
  
  
  METHODS
  All children aged 12-23 months and their mothers served by 6 of 8 randomly selected sub-centres managed by 2 rural Primary Health Centres of rural Karnataka were eligible for the Karnataka Study, conducted between August and October 2008. Socioeconomic and demographic data, access to health services and iron receipt were recorded. Secondly, NFHS-3 rural data were analysed. For both studies, logistic regression was used to evaluate factors associated with receipt of iron.
  
  
  RESULTS
  The Karnataka Study recruited 405 children and 377 of their mothers. 41.5% of children had received iron, and 11.5% received iron through the public system. By multiple logistic regression, factors associated with children's receipt of iron included: wealth (Odds Ratio (OR) 2.63 [95% CI 1.11, 6.24] for top vs bottom wealth quintile), male sex (OR 2.45 [1.47, 4.10]), mother receiving postnatal iron (OR 2.31 [1.25, 4.28]), mother having undergone antenatal blood test (OR 2.10 [1.09, 4.03]); Muslim religion (OR 0.02 [0.00, 0.27]), attendance at Anganwadi centre (OR 0.23 [0.11, 0.49]), fully vaccinated (OR 0.33 [0.15, 0.75]), or children of mothers with more antenatal health visits (8-9 visits OR 0.25 [0.11, 0.55]) were less likely to receive iron. Nationally, 3.7% of rural children were receiving iron; this was associated with wealth (OR 1.12 [1.02, 1.23] per quintile), maternal education (compared with no education: completed secondary education OR 2.15 [1.17, 3.97], maternal antenatal iron (2.24 [1.56, 3.22]), and child attending an Anganwadi (OR 1.47 [1.20, 1.80]).
  
  
  CONCLUSIONS
  In rural India, public distribution of iron to children is inadequate and disparities exist. Measures to optimize receipt of government supplied iron to all children regardless of wealth and ethnic background could help alleviate anaemia in this population.
authors.affiliation: The Nossal Institute for Global Health, Faculty of Medicine, Dentistry andHealth Sciences, The University of Melbourne, Carlton, Victoria, Australia.
authors.forename: Sant-Rayn
authors.initials: SR
authors.lastname: Pasricha
authors.forename: Beverley-Ann
authors.initials: BA
authors.lastname: Biggs
authors.forename: N S
authors.initials: NS
authors.lastname: Prashanth
authors.forename: H
authors.initials: H
authors.lastname: Sudarshan
authors.forename: Rob
authors.initials: R
authors.lastname: Moodie
authors.forename: Jim
authors.initials: J
authors.lastname: Black
authors.forename: Arun
authors.initials: A
authors.lastname: Shet
mesh_terms: D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D019587:Dietary Supplements; D005260:Female; D006302:Health Services Research; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D058085:Iron Compounds / Q000008:administration & dosage*; D019266:Iron, Dietary / Q000097:blood; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D058085:Iron Compounds; D019266:Iron, Dietary