Bottleneck Analysis of Iron and Folic Acid Supplementation among Children Aged 6 Months to 5 Years using the Modified Tanahashi Model: A Community-based Cross-sectional Study

Introduction: Even though there is a public health intervention to provide a biweekly Iron and Folic ACID (IFA) supplementation to children of six months to five years, the prevalence of anaemia in this age group of children in India remains high. Aim: To identify potential bottlenecks in the implementation of IFA supplementation, and suggest measures to address them in children aged six months to five years using the modified Tanahashi model. Materials and Methods: The present cross-sectional study was done from August to September 2022 in randomly selected Anganwadi Centres (AWC) in Koraput district, Odisha, India. A total of 10 AWC and the front-line health service providersAuxiliary Nurse and Midwife (ANM), Accredited Social Health Activist (ASHA) and Anganwadi Worker (AWW) were taken for facility survey. Around 100 mothers /caregivers of children in the age group six months - five years were taken for a community survey. Content analysis was done for the qualitative data. Results: As reported by about three out of 10 (30%) of the AWWs and about four out of 18 (22.22%) of ASHAs, mothers resisted to feed IFA syrup to their children due to misconceptions. About 41 out of 100 (41%) of mothers did not know the recommended schedule for IFA supplementation. None of the mothers orally administered IFA syrup to the children as per the guidelines. The ANMs reported that no screening of children for anaemia was done at the Urban Health and Nutrition Day (UHND). Conclusion: Trained health workers, maintenance of buffer stocks and easy accessibility in terms of distance were the factors increasing the coverage of IFA supplementation. However, irregular administration, less frequent household visits by the healthcare provider, low compliance in service delivery, poor adherence to guidelines, lack of screening at UHNDs, poor awareness among mothers may have resulted in sub-optimal supplementation.