Exploring Unknown Predictors of Maternal Anemia Among Tribal Lactating Mothers, Andhra Pradesh, India: A Prospective Cohort Study

Abstract

Introduction Anemia is a serious public health issue in India, especially among women, adolescent girls, and young children. Tribal people reside mostly in remote underserved regions with little or no basic civic amenities which makes them a highly vulnerable group of Indians. The study aimed to identify unknown risk factors for anemia among tribal lactating mothers. Methodology It was a mixed method prospective cohort study for 10 months carried out among 340 scheduled tribes (ST) mothers in 10 clusters in Guntur district, Andhra Pradesh, India. Data collection using a questionnaire, 24 hours dietary recall, anthropometric measurement, and hemoglobin estimation was done. Weekly local recipe talk in the mother’s kitchen, informal group discussions, was conducted for 12 weeks after baseline data collection. The audio and video tapes of the weekly local recipe talk in the mothers kitchen were transcribed verbatim and then translated into English. The individual responses were grouped as barriers related to acceptability, availability, accessibility, use and utilization, appropriateness, and nutrition environment. Results A total of 340 mothers were enrolled initially of which 315 mothers were studied in an end-line survey with an attrition rate of 7.3%. Over 80% mothers belonged to Yerukula, Yenadis, Lambadi/Sugali tribes, respectively. A total of 345 weekly local mother kitchen recipe talks were conducted in 10 clusters. In the present study, only few mothers mentioned food accessibility and availability issues. Surprisingly, lack of skill to cook the commonly consumed local food item among Indian mothers were recorded. Lack of time for cooking, lack of knowledge of nutritious benefits of food, and use of ready to eat food were other important key findings. Conclusion The study documents initiation of transition of the tribal lactating mothers towards urbanization. The lack of knowledge of cooking, coupled with lifestyles of urban areas exposes the early aged, poor, low literate mothers to the trap of anemia.

Anaemia among lactating and non-lactating women in low-income and middle-income countries: a comparative cross-sectional study

“…Several studies have revealed that anaemia prevalence is not uniform among lactating and non-lactating mothers 21 22. Lactating mothers are considered a more vulnerable group than non-lactating mothers as they are physiologically and nutritionally at a higher risk of iron deficiency and could acquire anaemia during their pregnancy 23 24.…”

Alarming levels of inadequate intake of B group vitamins in tribal lactating women from South India

“…We could find only a few studies that had assessed the dietary intake of micro-nutrients after pregnancy 8 – 10 and among them only one had assessed the adequacy of multiple B-group vitamins in Lactating mothers. 7 Study done by Aparicio et al in Spain among lactating mothers showed that around 60% of participants had adequate intake of all the B group vitamins except Folic acid (39%). 8 This might be because Spain being a developed country and the participants don’t belong to any vulnerable group.…”

“…Five clusters were randomly selected in the urban and rural areas each from the above list. 7 The project has been approved by All India Institute of Medical Sciences Mangalagiri ethics committee [AIIMS/MG/IEC/2021-22/105].…”

Prevalence of Undernutrition Among Tribal Lactating Mothers in Andhra Pradesh, India

“…Indigenous foods are still integral to their sustenance, with a predominantly plant-based diet marked by notable anti-nutritional factors that hinder nutrient absorption and bioavailability. Due to financial constraints, even non-vegetarian tribal populations find it arduous to include animal products in their diets, despite the fact that animal-source foods are consumed in limited quantities [ 5 ].…”