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Introducing a method of iron supplementation to Anganwadi Centres in Madhepura, Bihar, India

Last registered on August 18, 2020
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Pre-Trial

Trial Information

General Information

Title
Introducing a method of iron supplementation to Anganwadi Centres in Madhepura, Bihar, India
RCT ID
AEARCTR-0005449
Initial registration date
February 11, 2020

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
February 11, 2020, 1:43 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
August 18, 2020, 5:52 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country
India
Region
Madhepura, Bihar

Primary Investigator

Name
Lisa Bogler
Affiliation
University of Göttingen
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Other Primary Investigator(s)

PI Name
Ann-Charline Weber
PI Affiliation
University of Göttingen
Contact Investigator
PI Name
Sebastian Vollmer
PI Affiliation
University of Göttingen
Contact Investigator
PI Name
Abhijeet Kumar
PI Affiliation
University of Göttingen
Contact Investigator

Additional Trial Information

Status
Completed
Start date
2019-11-19
End date
2020-08-15
Keywords
Health, Other
Additional Keywords
institutions
JEL code(s)
Secondary IDs
Abstract
Anaemia prevalence among children is high in rural Bihar, India. As anaemia has adverse effects on attentiveness and the ability to concentrate as well as cognitive development of children, finding channels to combat anaemia is a key concern of the central and state governments of India. Iron-deficiency is a major factor contributing to anaemia in general and it is presumed to be the case in Bihar as well.
We implement an iron-supplementation intervention targeted at children aged 3 to 6 years who attend pre-primary childcare centres, called Anganwadi Centres, in Madhepura district in Bihar, India. Anganwadi Centres are part of the Integrated Child Development Services Scheme, a government programme aiming to improve child health and development. The study evaluates the introduction of a sustainable method of low-dosed iron supplementation, a reusable iron ingot, in the institution of Anganwadi Centres and its potential to reduce iron-deficiency anaemia among children.

This study is currently on hold due to the corona pandemic. It is not possible to conduct the study in Anganwadi Centres at the moment.
External Link(s)

Registration Citation

Citation
Bogler, Lisa et al. 2020. "Introducing a method of iron supplementation to Anganwadi Centres in Madhepura, Bihar, India." AEA RCT Registry. August 18. https://doi.org/10.1257/rct.5449-3.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
Our intervention introduces a reusable iron ingot as a method of iron supplementation to Anganwadi Centres. The iron ingot releases a constant, low dose of bio-absorbable iron when boiled in water with some drops of lemon juice. Regular consumption of this iron-enriched drinking water can increase the haemoglobin content in the blood, reducing iron-deficiency anaemia.
In the light intervention treatment group, Anganwadi Workers (Sevikas) were invited to a two-hour training led by local female facilitators. They were introduced to the reusable iron ingot as a method of iron supplementation. Each Anganwadi Worker received five iron ingots for use at her Anganwadi Centre. They were instructed to provide the iron-enriched drinking water to the children attending the Anganwadi Centre every day.
In the intensive intervention treatment group, Anganwadi Workers were invited to a four-hour training led by local female facilitators. The content was similar to the training in the light intervention, but additionally contained elements aimed to increase motivation and confidence in overcoming challenges among the Anganwadi Workers. The helpers of these Anganwadi Workers (Sahikas) were invited to a two-hour training about the iron ingot following the four-hour session. Anganwadi Workers in this treatment group received iron ingots for use at the Anganwadi Centres as well as a regular supply of lemons and sugar required for using the iron ingots. In addition, they received a follow-up call to clarify potential questions.

The implementation of workshops was completed by January 2020. The delivery of sugar and lemons stopped in March 2020, when Anganwadi Centres were closed due to the Corona pandemic. While Anganwadi Centres are closed, Anganwadi Workers are not able to provide iron-enriched drinking water to the children.
Intervention (Hidden)
Intervention Start Date
2020-01-04
Intervention End Date
2020-05-16

Primary Outcomes

Primary Outcomes (end points)
Adoption of iron-supplementation method in Anganwadi Centres, haemoglobin level and anaemia among children
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Functionality of Anganwadi Centres
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study included one control and two treatment arms. One treatment arm received a light intervention, representing a potential government role-out of the programme. The second treatment arm received a more intensive intervention. The control group did not receive any intervention.
Experimental Design Details
Randomization Method
Randomization was done by a computer, assignment into treatment or control groups was done with equal probability
Randomization Unit
Anganwadi Centres
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
800 Anganwadi Centres
Sample size: planned number of observations
36.000 children
Sample size (or number of clusters) by treatment arms
265 Anganwadi Centres in each arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Ethikkommission der Georg-August-Universität Göttingen
IRB Approval Date
2019-10-16
IRB Approval Number
NA
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
March 16, 2020, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
May 24, 2021, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
1732 Anganwadi Centres in the first observational visit, 834 Anganwadi Centres in the second observational visit and included in the randomized trial, 1631 Anganwadi Workers in the phone survey
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
1732 Anganwadi Centres in the first observational visit, 834 Anganwadi Centres in the second observational visit and included in the randomized trial, 1631 Anganwadi Workers in the phone survey
Final Sample Size (or Number of Clusters) by Treatment Arms
277 Anganwadi Centres in the control group, 277 Anganwadi Centres in the light treatment arm, 279 Anganwadi Centres in the intensive treatment arm
Data Publication

Data Publication

Is public data available?
Yes
Public Data URL
https://data.goettingen-research-online.de/dataverse/anganwadi-ironsupplementation

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Program Files

Program Files
Yes
Program Files URL
https://doi.org/10.25625/LEEJIS
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
To reduce anaemia prevalence among children, we tested the introduction of cast iron ingots to prepare iron-enriched drinking water in pre-schools (Anganwadi centres) in Bihar, India. We implemented a randomized controlled trial among 820 Anganwadi centres with one control and two treatment arms, one arm receiving more comprehensive training and support than the other, between January and March 2020. As children's anaemia status could not be measured at follow-up due to COVID-19, we focused on intermediate steps and used observations of Anganwadi centres and a phone survey with Anganwadi workers to evaluate the intervention. Outcomes included the worker mentioning the newly introduced method without being prompted, the worker remembering detailed steps, and observed indications of the method's use in the centre. These outcomes capture key steps required to be fulfilled for the intervention to reduce anaemia: awareness of the method, knowledge of how to use it, and usage. While a large share of Anganwadi workers remembered the method and could explain its steps, indication of its usage was generally rare but more common in the intensive treatment arm. Successful implementation of the iron supplementation method in the daily routine of Anganwadi centres would require substantial improvements in their functionality.
Citation
Lisa Bogler, Ann-Charline Weber, Abhijeet Kumar, Sebastian Vollmer (2026). Iron-fortified drinking water in Anganwadi Centres in rural India: a randomized controlled trial. Review of Development Economics 0:1-12. doi: 10.1111/rode.70122
URL
https://doi.org/10.1111/rode.70122

Reports & Other Materials