IMPACT OF NUTRITION EDUCATION AND IRON-FOLATE SUPPLEMENTATION ON HEMOGLOBIN, IRON STATUS AND COGNITIVE PERFORMANCE OF ADOLESCENTS IN RURAL KELANTAN
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Date
2012
Authors
HAFZAN, YUSOFF
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan Universiti Sains Malaysia
Abstract
Introduction: Iron deficiency anemia is a significant public health challenge
mostly among resource-poor communities. Realizing that adolescents are among the
most vulnerable group to this type of anemia, we have developed a specifically designed
nutrition education package for adolescents.
Objectives: The aims of this study were to investigate the effectiveness of
nutrition education package alone, daily iron-folate supplementation, or combination of
both on hemoglobin, iron status (serum ferritin) and cognitive performance of schooling
adolescents in Tanah Merah, Kelantan.
Methodology: This study falls into two phases; Phase 1: Baseline study, and
Phase 2: Community Intervention Trial. Stratified, multistage cluster sampling
technique was used for sampling purpose and finally a total of 855 respondents
(age 16-17) were recruited and baseline measurements including hemoglobin, body
weight and height were taken. Two hundred and eighty eligible respondents were then
pursued to Phase 2. They were randomized (by school) into either intervention or
control groups namely; Supplement alone (S), Nutrition education alone (NE), Nutrition
education plus supplement (NE+S) and Control (C). The stages and the parameters
studied in Phase 2 were: i) Pre-intervention - hemoglobin (full blood count), serum
ferritin (AxSYM ferritin micro-particle enzyme immunoassay), knowledge and attitude
levels (multi-choice questionnaire), nutrients intake (24 hours dietary recall) and
cognitive performance (Standard Raven’s Progressive Matrices), followed by
ii) Intervention period, iii) Post-intervention 1 (at 3 months) - hemoglobin,
knowledge and attitude, and nutrients intake and finally, iv) Post-intervention 2 (at 6
months) - hemoglobin, serum ferritin, cognitive performance. Statistical significant
difference between 3 different interventions and control of each parameter were
analyzed.
Results: About 59.6% (n=855) of anemia prevalence was found in Phase 1 with
greatest number of respondents having mild to moderate anemia. In Phase 2, Split-plot
ANOVA showed significant main effect of intervention group [INTERVGP] in
improving hemoglobin [F (3, 276) = 116.33, p < 0.001] and serum ferritin
[F (1, 133) = 1076.29, p < 0.001] levels of respondents. No main effect of intervention
group was evidenced in altering cognitive performance, except significant interactions
between evaluation stage and intervention group (PHASE*INTERVGP)
[F (3, 276) = 5.82, p = 0.001]. The effectiveness of nutrition education package in
sustaining iron status was evidenced even after termination of supplementation.
Conclusion: The findings demonstrate that the Community Intervention Trial
carried out at school setting which incorporating combination of nutrition education and
iron-folate supplementation was feasible and effective in improving and sustaining
hemoglobin and iron status of adolescents, whereas its true effect on cognitive
performance need further confirmation.
Description
Keywords
Community Medicine