Impact of Mobile Medical Units on Anaemia Prevalence and Treatment Adherence in Rural India

Introduction

The World Health Organization (WHO) classifies anaemia with a prevalence exceeding 5% as a health concern and surpassing 40% as  severe public health concern necessitating immediate programmatic actions for intervention.¹ The latest data from the National Family Health Survey-5 (NFHS-5) highlights alarming anaemia indicators in targeted regions, emphasizing the critical need for intervention strategies. High anaemia prevalence rates among children aged 6-59 months and non-pregnant women aged 15-49 years were observed in Jharkhand’s Ranchi and Khunti districts as well as in Uttar Pradesh’s Prayagraj and Bahraich districts. These statistics emphasize the urgent requirement for effective interventions to combat anaemia and improve the health outcomes of vulnerable populations.²

Anaemia poses a significant health challenge in India, particularly in rural areas where access to healthcare services is often limited.³ The Hans Foundation (THF), a leading philanthropic organization committed to enhancing the well-being of marginalized communities, recognizes the urgent need to address this issue. Through its Mobile Medical Units (MMUs), THF aims to provide essential healthcare services to underserved populations, including diagnosis and treatment for anemia.⁴ This study assessed the prevalence, causes, and effectiveness of MMU interventions in combating anaemia in rural regions, focusing on Jharkhand and Uttar Pradesh.

Materials and Methods

Ethics

Participants were thoroughly informed about the study’s purpose, procedures, risks, and benefits through sessions in local languages. Written informed consent was obtained from all participants, with additional parental consent for those under 18 years. Data was anonymized using unique codes, stored in a secure, password protected database, and personal identifiers were removed before analysis and publication. Participation was voluntary, with participants free to withdraw at any time without consequences, and clear communication of this right was provided.

Study Design

A mixed-method research approach was utilized, combining quantitative surveys and qualitative interviews. The study was conducted in four districts:

Ranchi and Khunti in Jharkhand, and Prayagraj and Bahraich in Uttar Pradesh. This design enabled a comprehensive assessment of anaemia prevalence, risk factors, and the effectiveness of MMU interventions.

Participants

The study included 399 women beneficiaries who had utilized primary health services from MMU within three months prior to the survey. Respondents were categorized into several groups: pregnant women, lactating mothers, mothers of young children, women of reproductive age, adolescent girls, and elderly women. This diverse sample provided a broad perspective on anaemia prevalence and treatment adherence across different demographic groups.

Data Collection and Sample Covered

Quantitative Data

Structured surveys were administered to collect data on demographic details, anaemia prevalence, risk factors, and the effectiveness of MMU interventions. The surveys included questions on health status, treatment adherence, dietary habits, and awareness of anaemia related government schemes.

The study covered a total of 399 women across four districts: Prayagraj and Bahraich in Uttar Pradesh, and Ranchi and Khunti in Jharkhand. In Uttar Pradesh, the sample included 95 women from Prayagraj and 97 women from Bahraich, totalling 192 women. In Jharkhand, the sample included 103 women from Ranchi and 104 women from Khunti, totalling 207 women (Table 1).

The respondents were categorized into various demographic groups: 63 currently pregnant women, 60 currently lactating women, 66 mothers of children below five years, 76 women of reproductive age (20-49 years), 65 adolescent girls (15-19 years), and 69 elderly women (above 60 years). This distribution ensures a comprehensive representation of different population segments in assessing anaemia prevalence and severity (Table 2).

Qualitative Data

Key Informant Interviews (KIIs), In-depth Interviews (IDIs), and Focus Group Discussions (FGDs) were conducted to gather detailed insights into the experiences and perceptions of anaemia, cultural determinants, and barriers to accessing MMU services. These qualitative methods provided context and depth to the quantitative findings, highlighting personal and community-level factors influencing anaemia prevalence and treatment adherence.

Data collection was carried out by trained field researchers using Computer-Assisted Personal Interviewing (CAPI) technology to ensure accuracy and efficiency. The quantitative survey tool and qualitative interview guides were developed based on existing literature and refined through pilot testing.

A total of 20 interviews were conducted, with four interviews involving Medical Officers (MOs) from Mobile Medical Units (MMUs) and 16 interviews with Front Line Workers (FLWs) and Village Health Workers (VHWs). These interviews aimed to gather in-depth insights from healthcare providers directly involved in MMU operations and community healthcare delivery, complementing the quantitative survey data and providing a comprehensive understanding of the MMU program’s impact on anaemia prevalence and treatment adherence in rural areas.

Results

Anaemia Identification

Among the 399 women surveyed, 352 (88%) were diagnosed with anaemia, with 180 (45%) classified as having moderate-to-severe anaemia. The diagnostic criteria used were in line with WHO standards: mild anaemia was defined as a haemoglobin level between 10 11.9 g/dL for non-pregnant women and 10-10.9 g/dL for pregnant women; moderate anaemia as a haemoglobin level between 7-9.9 g/dL; and severe anaemia as a haemoglobin level below 7 g/dL.¹

The prevalence of anaemia varied across different demographic groups. Among the currently pregnant women, 55 out of 63 (87%) were anaemic. For currently lactating women, 54 out of 60 (90%) were anaemic. Among mothers of children below five years, 56 out of 66 (85%) were anaemic. In the group of women of reproductive age (20-49 years), 67 out of 76 (88%) were anaemic. Among adolescent girls (15-19 years), 58 out of 65 (89%) were anaemic, and among elderly women (above 60 years), 61 out of 69 (88%) were anaemic. These f indings highlight the widespread occurrence of anaemia across various demographic groups, emphasizing the need for targeted interventions (Table 3).

Severity of Anaemia by Visits to MMU

At the initial visit, 220 women (55.3%) had moderate anaemia, 156 (39.3%) had mild anaemia, and 5 (1.3%) had severe anaemia. Subsequent visits showed a decrease in moderate anaemia cases to 176 (44%) and an increase in normal haemoglobin levels to 48 (12%), indicating improvement in anaemia status among women attending MMUs (Table 4 and Figure 1).

A correlation was observed between the number of visits to the MMU and the prevalence of anaemia. Among those who visited the MMU once, 94.2% were anaemic. For women who made two visits, 90.2% were anaemic, and for those who visited three or more times, the prevalence dropped to 68.3% (Figure 1).

Paired sample T-tests revealed a statistically significant difference (P <0.005) in anaemia prevalence between the first and third visits, emphasizing the importance of promoting at least three visits to MMUs as part of comprehensive healthcare strategies.⁴ The findings suggest a notable improvement in haemoglobin levels over successive visits for individuals who made three or more visits to the MMUs. The mean Hb level increased from 9.3 g/dL during the first visit to 11.1 g/dL by the fourth visit, although the number of individuals included in the analysis decreased from 33 to 25 over successive visit.

Variability in Hb levels among individuals across visits was observed, with standard deviations ranging from 1.2 to 1.5, indicating fluctuations in Hb levels among individuals. This highlights the need for further investigation into the factors contributing to these f luctuations and ensuring consistent monitoring and intervention.

MMU Visits and Treatment Adherence

The majority of women visited the MMU once within three months preceding the survey. Treatment adherence was high, with 96% of women following medical advice. However, 13.5% received no medication, indicating gaps in service delivery.

The data indicates that 66% of women have received IFA tablets/syrup from government facilities or through ASHA/AWC or at VHSND. Among those not receiving from Government sources, 71% received IFA from the MMU, leaving 29% without receiving any medication. Combining these indicators, 13.5% received no medication, 12.3% only from the government, 22.7% only from MMU, and 51.5% from both. This highlights potential duplication of efforts, suggesting the need for action (Figure 2).

The data indicates that 89% of anaemic women received advice from the MMU, while 11% did not. Among those who received advice, 96% adhered to it (reported during interview), while 4% did not. These findings suggest a high level of engagement with and adherence to the advice provided by the MMU among anaemic women.

This highlights the effectiveness of MMU interventions in providing guidance and support for addressing anaemia and highlights the importance of continued encouragement and education to ensure ongoing compliance with medical recommendations.

Discussion

This study revealed a high prevalence of anaemia among women in rural areas of Uttar Pradesh and Jharkhand, with moderate-to-severe anaemia constituting a significant proportion. The effectiveness of Mobile Medical Units (MMUs) in improving treatment adherence and reducing anaemia prevalence is evident, particularly among women who made multiple visits.⁴

Addressing anaemia in elderly women is particularly important as anaemia can exacerbate health conditions commonly associated with aging, such as cardiovascular diseases, decreased mobility, and cognitive decline.⁵ By targeting this vulnerable group, MMUs can play a crucial role in improving the overall health and quality of life of elderly women in rural areas.

However, gaps in service delivery, such as the 13.5% of women who received no medication, indicate areas for improvement. The high adherence rate (96%) to medical advice provided by MMUs underscores the potential of these units in influencing positive health behaviours.⁶ The duplication of efforts between government and MMU services suggest a need for better coordination to optimize resource utilization.

Barriers to accessing MMU services, particularly lack of awareness, highlight the importance of targeted educational campaigns to improve community knowledge and engagement. Addressing these barriers through strategic communication and outreach can enhance the reach and impact of MMU interventions.

The improvement in haemoglobin levels among women who made three or more visits to MMUs emphasizes the need for promoting repeated visits as part of anaemia management strategies. This approach can lead to sustained health improvements and better health outcomes.

A significant implication of this study is the focus on elderly women, a demographic often neglected in anaemia management programs such as the Government’s Anaemia Mukt Bharat program. The findings indicate that 88% of elderly women surveyed were anaemic. This highlights a critical gap in current public health initiatives and underscores the need to extend anaemia management efforts to include the elderly.⁶

While MMUs have demonstrated their effectiveness in managing anaemia among women in rural India, there are areas that require attention and improvement. Enhancing service delivery, improving coordination with government programs, and extending focus to include elderly women are essential steps. These actions will ensure a more comprehensive approach to anaemia management, leading to better health outcomes for all demographic groups in these rural communities.

Strengths and Limitations

The comprehensive mixed-method approach provides a robust understanding of anaemia prevalence and treatment adherence. The combination of quantitative and qualitative data offers depth and context to the f indings.

The study was limited to a specific geographic area and a short duration. Future research should explore long-term impacts and replication in diverse settings to validate the f indings.

Implications and Recommendations

The findings of this study have profound implications for enhancing anaemia management in rural India through the strategic use of Mobile Medical Units (MMUs). Strengthening community engagement is paramount for improving communication and building trust within the community. This involves actively involving community members in health initiatives, fostering a sense of ownership, and ensuring that MMU services are culturally acceptable and responsive to local needs. Leveraging local leaders and influencers to advocate for MMU services can significantly increase community buy-in and participation. Regular community meetings and feedback sessions are crucial for understanding and addressing community concerns and barriers to accessing MMU services.

The findings from the study suggested that more than three visits made for service uptake has apparently improved the Hb levels. Therefore, to facilitate regular visits, there must be a comprehensive patient tracking system to ensure consistent service uptake by patients, leading to desired health outcomes.

Developing targeted educational campaigns is essential to raise awareness about anaemia, its consequences, and the availability of MMU services. These campaigns should educate women and their families about the importance of anaemia prevention and treatment, and the role of MMUs in providing essential healthcare services. Utilizing various communication channels, including local media, social media, and community events, can enhance the reach and impact of these campaigns. Educational materials should be culturally sensitive and easy to understand, incorporating visual aids and local languages where appropriate.

Promoting dietary diversification is a key strategy to improve nutritional intake and address the underlying causes of anaemia. Community education programs should emphasize the importance of a balanced diet rich in iron, folate, and other essential nutrients. Collaborating with local agricultural and food programs to increase the availability and affordability of nutritious foods can support dietary improvements. Practical demonstrations, such as cooking classes and nutritional workshops, can help community members learn how to incorporate a variety of healthy foods into their daily meals. Given that MMUs already reach the interior parts of villages and operate almost at the doorstep of the target population, they provide an excellent platform for generating more awareness about locally available and affordable nutritional foods.

Conflicts of Interest

The authors declare no conflicts of interest.

Funding

This study was funded by The Hans Foundation.

Acknowledgments

We thank The Hans Foundation for their support and funding. Our gratitude extends to the healthcare professionals and staff of the Mobile Medical Units in Jharkhand and Uttar Pradesh. We are grateful to the women who participated in the study and to our field researchers for their diligent data collection. Lastly, we appreciate the guidance and feedback from our colleagues and mentors throughout this research.