Umashankar S and Nandimath: Interventional study to improve the haemoglobin level using moringa olifera powder on anaemic children in selected district of Karnataka


Introduction

Anemia develops when there are not enough healthy red blood cells in the body. Anemia can be a temporary condition or a consequence of other health condition, or it can be a chronic problem.1 According to NFHS 3, children between the ages of 6 and 59 months, majority i.e. 70 percent are anaemic. This includes 26 percent who are mildly anaemic, 40 percent who are moderately anaemic and 4 percent who suffer from severe anaemia. Boys and girls are equally likely to have anaemia. Children of mothers who have anaemia are much more likely to be anaemic.2

People with anemia may feel tired, fatigue, or experience shortness of breath which can cause problems carrying out routine activities. It can cause reduced work capacity in adult and impact motor and mental development in children and adolescents. There is a strong evidence that iron deficiency can affect cognition in adolescents.3 Anaemia is a serious concern for the young children as it affects the cognitive performance, development (cognitive and behavioural), coordination, language development and scholastic achievement. Anaemia also increases the morbidity of infectious diseases.

Although anaemia levels vary according to background characteristics, anaemia among children is widespread in every group and every state in India. More than half of children are anaemic even if their mother has 12 or more years of education or even if they are in their highest wealth quintile.2

The constitution of India, especially in article 47 has given the responsibility to the state for raising the level of nutrition and standard of living of its people and to improve the public health. Various interventions have been undertaken during last 50 years such as green revolution, PDS, ICDS, food for work, mid day meal nutrition education and research etc. India was able to achieve self sufficiency in food grains since 1970 but the nutritional deficiencies remain with the same burden and nutritional anemia being one of the major concern. Various programs that have direct and indirect impact to the nutritional problems have been implemented by Govt. of India. National nutritional anemia control program is one such program which is currently under RCH launched in 1970 to improve the status of nutritional anemia. But this program has not made remarkable impact on the nutritional status. Hence it becomes quite evident hat alternative strategies should be tried to improve the nutritional anemia and reduce the morbidity associated with it, such as use of locally available, traditional food to increase the bioavailability of iron, improve the nutritional behavior through nutritional education.

Moringa oleifera is considered as an extraordinary tree and leaves of the Moringa tree are an excellent source of vitamin A, vitamin B vitamin C and other minerals. The leaves are also an outstanding source of calcium, protein, potassium and iron. Carbohydrates, fats and phosphorous content are low making this one of the finest plant foods to be found.

The Nutritive value of dried Moring oleifera leaves is as follows.4

Table 1

Nutrient content (mean +/- std dev) of dried Moringa oleifera leaves

Nutrient reference

Nutrient amount in 100 g (300 mL or 1.25 cups)

Energy (Kcal, MJ)

304 +/- 87 kcal, 1.3 +/- 0.36 MJ

Moisture (mg)

7.4 +/- 2.89

Protein (g)

24 +/- 5.8

Carbohydrates (g)

36 +/- 9.2

Fat (g)

6 +/- 2.5

Fiber, crude (g)

9 +/- 7.45

Fiber, total dietary (g)

20.6 – 28.6

Oxalate (g)

2.6 +/- 1.25

Tannins (g)

1.2 – 1.4

Ca (mg)

1897 +/- 748.4

P (mg)

297 +/- 149.0

Na (mg)

220 +/- 180.0

K (mg)

1467 +/- 636.7

Mg (mg)

473 +/- 429.4

Fe (mg)

32.5 +/- 10.78

Zn (mg)

2.4 +/- 1.12

Cu (mg)

0.9 +/- 0.48

Thiamin (mg)

2.6

Riboflavin (mg)

1.29 – 20.5

Niacin (mg)

8.2

Vitamin B-6 (mg)

2.4

Folate (µg)

540

Vitamin A (µg RAE)B

3639 +/- 1979.8

Vitamin C (mg)

172 +/- 37.7

Vitamin E (mg)

56 – 113

Various studies have proven the effectiveness of drumstick leaf powder / Moring oleifera leaves as a supplement for iron deficiency anaemia. A study conducted by Vanisha S Nambiar on Effect of drumstick leaves supplementation on haematological indices revealed 28.6% reduction of anemia in Group A, by followed by 5% in group B and 4.7% in group C post supplementation of Moring oleifera leaves powder.5 Similarly a study was conducted Salwa M, Saleh MD and Abdel salam on effectiveness of moringa oleifera in combating mild and moderate malnutrition in pediatric age group. Everyday 10gm of ready prepared moringa powder was administered for the samples with fruit juice in two divided dose before the meals for 40days. Growth was monitored before and after intake of the intervention. It shown that after intervention, cases gained more weight than controls.6 Another study conducted by Ngozi M Nuam on “Moringa oleifera leaf improves iron status of infants 6-12 months” in Nigeria where forty infants were included in the study for four-week intervention. Infants in the Test Group received maize traditional complementary food (MTCF) with Moringa oleifera leaf while the Control Group had only MTCF. Mean Hb increased from 10.65 to 12.98 g dl−1 in the infants of test group.7

With these evidences the present study was proposed with an aim to assess the role of Moringa Olifera powder in improving haemoglobin level among the anaemic children.

The objectives of the study were: To assess the haemoglobin level of children in the age group of 5-14years and to assess the improvement in the level of haemoglobin among the anaemic children with the intervention of Moringa Olifera powder. The objective of the study was also to create an awareness about the impact of Moringa Olifera powder on anaemia and to train the community in preparing Moringa Olifera powder

Materials and Methods

312 school children were selected for screening the Haemoglobin level and to recruit the study participants into control and experimental group. Out of 312 students 124 school children fulfilled the inclusion criteria. 66 children were recruited to control group and interventional group respectively. Estimation of haemoglobin level was done using digital hemoglobin meter using capillary blood. Estimation of haemoglobin percentage was done for the children in the control and interventional group before and three months after the intervention. Children with haemoglobin level- 110-119g/l ie with mild anaemia, 80-109 g/l – and with moderate anaemia were included for the study. Children with pre-existing medical conditions were excluded. Administering the Powder: The children in the interventional group were administered with 3gms per day (1/2 a tea spoon) of Moringa Olifera powder along with their food for 3 months. Control group was advised to continue with the regular meal. Training and capacity building – Awareness program was conducted to educate the families in the village about the impact of Moringa Olifera powder. The families were also thought on how to prepare the Moringa Olifera powder at home.

Results

The following are the results of the data collected from a total of 124 study participants. 66 students were recruited for interventional and control group respectively. Out of the 66 study participants in the interventional group 8 students dropped during the study. Hence the total participants in the interventional group were 58.

Out of the total 124 study participants 57 were males and 67 were females.

Demographic characteristics of the study participants

Out of 58 children in the interventional group 33 (56.9%) were females and 25 (43.1%) were males and out of 66 children in the control group 34 (51.5%) were females and 32(48.5%) were males (Table 2). Out of 124 study participants 74 (59.7%) children were Hindu’s, 49(39.5%) were Muslims and 1 (.8%) child was Christian (Table 3). Out of 58 children in the interventional group, 28 children (48.3%) were in the age group of 11-15 years and 30(51.7%) were in the age group of 5-10 years. Similarly out of 66 children in the control group 30 children (45.57%) were in the age group of 5-10 years and 36(54.5%) were in the age group of 11-15 years. (Table 4)

Table 2

Distribution of the participants according to sex

Group

Sex

Frequency

Percent

Interventional group

Males

25

43.1

Females

33

56.9

Total

58

100.0

Control group

Males

32

48.5

Females

34

51.5

Total

66

100.0

Table 3

Distribution of the participants according to religion

Religion

Frequency

Percent

Hindu

74

59.7

Muslim

49

39.5

Christian

1

.8

Total

124

100.0

Table 4

Distribution of respondents according to age group

Frequency

Percent

Interventional group

5 to 10 Years

30

51.7

11 to 15 Years

28

48.3

Total

58

100.0

Control Group

5 to 10 Years

30

45.5

11 to 15 Years

36

54.5

Total

66

100.0

Personal hygiene of the study participants

All the study children brushed their teeth daily. Out of 124 children 123 (99.2%) children washed their hands before and after eating food. Out of 124 children 82 (66.1%) children did not take bath daily and 42 children had bath daily (Table 5).

Table 5

Distribution of the study participants according to brushing

Brushing teeth daily

Frequency

Percentage

Yes

124

100

No

0

0

Total

124

100

Washing hands

Frequency

Percentage

Yes

123

99.2

No

1

.8

Total

124

100.0

Daily Bathing

Frequency

Percentage

Yes

42

33.9

No

82

66.1

Total

124

100.0

Attainment of menarche

Out of 67 girls only 4 of them had attained menarche.(Table 6)

Table 6

Distribution of girls according to the attainment of menarche

Menarche

Frequency

Percent

No

63

94.1

Yes

4

5.9

Total

67

100.0

General physical appearance of the study participants

Out of 124 children only one (.8%) child had pallor and all the children had normal appearing nails. Sclera of 38 (30.6%) students was pale and 86 (69.4%) children had clear sclera. 5 (4.0%) children had cracked lips and 119 (96.0%) had normal lips. Only 4 (3.2%) children had coated tongue. (Table 7)

Table 7

Distribution of respondent’s base on general physical appearance

Skin conditions

Frequency

Percent

Normal

123

99.2

Pallor

1

.8

Total

124

100.0

Nails

Frequency

Percent

Normal

124

100.0

Total

124

100.0

Sclera

Frequency

Percent

Clear

86

69.4

Pale

38

30.6

Total

124

100.0

Condition of lips

Frequency

Percent

Normal

119

96.0

Cracked

5

4.0

Total

124

100.0

Condition of the tongue

Frequency

Percent

Normal

120

96.8

Coated

4

3.2

Total

124

100.0

Haemoglobin level of the study participants

Out 58 children in the interventional group 38(65.5%) children had moderate anemia and 20(34.5%) had mild anemia. Similarly out 66 students in the control group 52(78.8%) children had moderate anemia and 14(21.2%) children had mild anemia. (Table 8)

Table 8

Distribution of respondent’s based on haemoglobin level

Group

Frequency

Percent

Experiment Group

Moderate

38

65.5

Mild

20

34.5

Total

58

100.0

Control Group

Moderate

52

78.8

Mild

14

21.2

Total

66

100.0

Table 9

Distribution of respondent’s based on mean haemoglobin level before and after intervention

Mean Haemoglobin level

Group

Before intervention

After intervention

Interventional Group

Mean

10.322

10.967

Std. Deviation

1.1469

1.1065

Minimum

8.0

8.4

Maximum

11.9

13.0

Control group

Mean

9.950

9.873

Median

9.800

9.800

Mode

9.6

10.6

Std. Deviation

1.0453

.9982

Minimum

8.2

8.0

Maximum

11.9

11.8

Table 10

Distribution of participants according to their haemoglobin level before and after intervention

Before intervention

After intervention

Group

Frequency

Percent

Frequency

Percent

Experiment Group

Moderate

38

65.5

23

39.7

Mild

20

34.5

22

37.9

Normal

00

00

13

22.4

Total

58

100.0

58

100.0

Control Group

Moderate

52

78.8

54

81.8

Mild

14

21.2

12

18.2

Total

66

100.0

66

100.0

Table 11

T-test

Paired t Test

Group

Mean

Std. Deviation

Std. Error Mean

Interventional group

Hemoglobin level before intervention

10.322

58

1.1469

.1506

Hemoglobin level after intervention

10.967

58

1.1065

.1453

Control Group

Hemoglobin level before intervention

9.950

66

1.0453

.1287

Hemoglobin level after interventio

9.873

66

.9982

.1229

Table 12

Paired samples correlations

Group

Correlation

Sig.

Experiment Group

Hemoglobin level before intervention & Hemoglobin level after intervention

58

.922

.000

Control Group

Hemoglobin level before intervention & Hemoglobin level after intervention

66

.941

.000

The mean Heamoglobon level of the children in the interventional group before the intervention was 10.332 which increased to 10.967 after the intervention. Similarly the mean Heamoglobin level of children in the control group before the intervention was 9.950 which remained 9.873 after the intervention.

The increase in the mean heamoglobin level in the interventional group was significant with the p value of 0.045 (Table 9).

After the intervention the children with moderate anemia decreased from 38(65.5%) to 23(39.7%) and 13 (22.4%) children turned normal in the experimental group and in the control group the children with moderate anemia increased from 52(78.8%) to 55(81.8%). (Table 10 ). Paired t Test was applied to check the significance of the effectiveness of the intervention. The mean changes in the hemoglobin level in the intervention and control group were significant with p value of 0.00. (Table 10, Table 11 )

Discussion

Moringa oleifera is considered as an extraordinary tree with exceptionally high nutritional value. Moringa oleifera leaves powder can be used in treating the malnutrition in a local and cost-effective manner.

The present study reported that, Out 58 children in the interventional group 38(65.5%) children had moderate anemia and 20(34.5%) children had mild anemia. Similarly out 66 students in the control group 52(78.8%) children had moderate anemia and 14(21.2%) children had mild anemia. Similar study was conducted by Ferreira MU, et al8 on Anaemia and iron deficiency in school children, showed that 19.7% of the overall population had iron deficiency anaemia.8 A study conducted by Hashizume M et al9 showed that 27% of the school children were anemic.10 Study conducted by Baral KP, et al showed that the overall prevalence of iron deficiency anemia among adolescent population was 70.0%.9

From the present study it can be seen that there was an improvement in the hemoglobin level of the study participants in the interventional group after the consumption of the Moringa oleifera powder. The present study revealed that after the intervention the children with moderate anemia decreased from 38(65.5%) to 23(39.7%) and 13 (22.4%) children turned normal in the experimental group and in the control group the children with moderate anemia increased from 52(78.8%) to 55(81.8%). Similar study was conducted by Nambiar et, al1 on Drumstick powder among 60 children results indicated that the recipes prepared with the Drumstick were highly acceptable to the ICDS authorities. Vanisha S Nambiar study revealed that supplementation of drumstick leaves reduced the anaemia by 28.6%.5 Study conducted by Salwa M, Saleh MD on effectiveness of moringa oleifera where 60 samples were taken in the age group of 4-12 and 10gms of powder was given daily for 40 days showed that cases gained weight than the controls.6 Study conducted by Ram Chand dhakar, on Moringa used to describing the potential benefits of the moringa utilized in treating the malnutrition in a local and cost-effective manner.9

There was significant marginal improvement in the heamoglobin level in the interventional group with the supplementation of 3 gms (1/2 tea spoon) of Moringa oleifera powder for the duration of 3 months. The minimal improvement in the hemoglobin level can be attributed to the shorter duration of intervention i.e for 3 months. Hence such studies need to be scaled up for a longer duration (6 months as a therapeutic duration) for complete assessment of improvement in the hemoglobin level.

The families of the study participants were educated about the impact of the of Moringa oleifera powder in improving the Haemoglobin level. The study has also demonstrated the need for education and awareness of locally available drumstick leaves to combat anemia.The families of the study participants were also trained to locally make the Moringa oleifera powder at their household level. They were given training on how to select the Moringa oleifera leaves, how to dry and preserve and how to use the powder. This aspect of the study has not only helped in capacity building but also has emphasized on the sustainability of the project.

Conclusions

There a statistically significant marginal improvement in haemoglobin level in the interventional group after three months. Moringa oleifera is a very common medicinal plant which is locally available. The present study has proved the efficacy of Moringa oleifera powder in improving the Haemoglobin level. This can be considered as a cost effective intervention in combating anemia among children. The study has also demonstrated the need for education and awareness of locally available drumstick leaves to combat anemia. The study has not only helped in capacity building but also has emphasized on the sustainability of the project by training the families in preparing the Moringa oleifera powder at household level.

Source of Funding

Grant –In –Aid for Advanced Research Projects for the year 2016-17 by Rajiv Gandhi University of Health Sciences, Karnataka.

Conflict of Interest

The authors declare that they have no conflict of interests.

Acknowledgement

Authors are grateful to all participants who participated in this study.

References

1 

National Family Health Survey (NFHS-3) Report. Mumbai: International Institute for Population Sciences (IIPS) 2005;06

2 

Guidelines for the control of iron deficiency anemia Ministry of Health and Family Welfare Government of Indiahttp://www.unicef.org/india/10._National_Iron_Plus_Initiative_Guidelines_for_Control_of_IDA.pdf

3 

Anemia basics National Anemia Action councilhttp://www.anaemia.org/patients/taq

4 

RC Dhakar BK Pooniya M Gupta SD Maurya N Bairwa Sanwarmal Moringa : The herbal gold to combat malnutritionChronicles of Young Scientists2011231192510.4103/2229-5186.90887

5 

VS Nambiar Effect of drumstick leaves supplementation on haematological indiceshttp://www.ijpba.info/ijpba/index.php/ijpba/article/view/94

6 

S Saleh HA Salam , Effectiveness of Moringa oleifera in combating mild and moderate malnutrition in pediatric age groupNew York Sci J2014736979

7 

NM Nuam Moringa oleifera leaf improves iron status of infants 6-12 months in NigeriaInt J Food Saf Nutr Public Health2009215864

8 

MU Ferreira M da Silva-Nunes CN Bertolino RS Malafronte PT Muniz MA Cardoso Anemia and Iron Deficiency in School Children, Adolescents, and Adults: A Community-Based Study in Rural AmazoniaAm J Public Health200797237910.2105/ajph.2005.078121

9 

RC Dhakar BK Pooniya M Gupta SD Maurya N Bairwa Sanwarmal Moringa : The herbal gold to combat malnutritionChronicles Young Sci20112311910.4103/2229-5186.90887

10 

KP Baral SR Onta Prevalence of anemia amongst adolescents in Nepal: a community based study in rural and urban areas of Morang DistrictNepal Med Coll J200911317982



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Article History

Received : 20-02-2021

Accepted : 30-03-2021

Available online : 10-04-2021


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https://doi.org/10.18231/j.ijfcm.2021.008


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