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Objective: Intervention with iron supplementation, deworming, and information, education and communication (IEC) to improve the haematological status among each of the three trimesters of pregnant women in a rural community. Design: A community-based study was carried out using a two-group pre ± post experimental design in a rural community. Setting: Two rural blocks in Vellore district were selected for the study. KV Kuppam block with a population of 120,000 and the adjacent Gudiyatham block with a population of 132,000 served as study and control areas for the study. Subjects: Using a multistage sampling, initially 50% of the panchayats, the local village administrative units, were randomly selected and all pregnant women were the subjects. In the pre-intervention survey 458 and 387 pregnant women had haemoglobin tested and the post-intervention survey covered 403 and 425 pregnant women in the study and control areas, respectively. Similarly serum ferritin was tested in a randomly selected subsample with 254 and 191 pregnant women before intervention and in 216 and 223 pregnant women after intervention in both study and control areas, respectively. Intervention: Iron supplementation and deworming were provided to all pregnant women in the study area from the fourth month of their pregnancy. An intensive information, education and communication was carried out with facts on anaemia and diet modi®cation to each pregnant woman, using a one-to-one approach in the community, and a group method in the mobile clinics. This was carried out for a period of 18 months. Results: A signi®cant decrease in the prevalence of anaemia was found, from 56.1% to 25.07% (P`0.001), 73.4% to 49.2% (P`0.001) and 68.8% to 56.8% (P`0.01) among women in the ®rst, second and third trimesters, respectively, in the intervention area. Signi®cant (P`0.001) increases in the mean haemoglobin of 0.85 gadl (95% CI 10.18 ± 10.84, 11.09 ± 11.63), 0.59 gadl (95% CI 9.98 ± 10.34, 10.55 ± 10.95) and 0.36 gadl (95% CI 9.93 ± 10.33, 10.25 ± 10.73) were also observed in each of the groups. Conclusion: A comprehensive community-based intervention with iron supplementation, helminthic treatment and increase in knowledge using IEC through effective strategies can improve the haematological status of pregnant women in each trimester.

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A multistage sampling technique was used to select 845 pregnant women from two blocks in Vellore district. Haematological measurement of haemoglobin (Hb) was done on all women and serum ferritin (SF) on a subsample of 445. The prevalence of anaemia (Hb <11 g/dl) was 56.6%, 70.2% and 69.5%, respectively among the first, second and third trimester women. The mean Hb of 10.7 g/dl was significantly higher among the first trimester than among the second and third trimester women, which was less than the recommended value of 11 g/dl. Iron deficiency (SF <12 microg/L) was significantly (P< 0.05) more among the third trimester women than among the first. The high prevalence of anaemia in each trimester in pregnancy indicates the need for iron supplementation as early as possible starting from the fourth month of pregnancy.

Summary A cross-sectional comparative study on the levels of knowledge and attitude on leprosy among teachers and students was carried out in a rural area of Vellore district in Tamil Nadu, India. A total of 30 teachers and 120 students participated in the study. It was found that knowledge about leprosy among teachers was inadequate. Only 23·4% of teachers stated that germs caused leprosy, while 23·4% mentioned immoral conduct, 20·0% marrying a leprosy patient, 6·6% insects and 26·6% did not know the causes of leprosy. While 80·0% of teachers knew that anaesthetic hypopigmented patches were a sign of leprosy, enlarged painful nerves were not mentioned by a single teacher, although this sign was identified by 17·5% of students. Teachers had a more positive attitude towards leprosy than students and this was statistically significant (p < 0'001). This paper discusses the need for continuous education, especially for teachers and through them the students, using different media so as to ensure sustained knowledge for behavioural change in the community.