PRAYAS: Cohort profile for Pooled Research and Analysis for Yielding Anemia-free Solutions in India
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Purpose
This cohort would aim to estimate the prevalence of anemia among children under 18 years, non-pregnant and non-lactating (NPNL) women, and pregnant women (by trimester), with further stratification by age group, year, and region of India. Cohort would also help address extended deliberation concerning etiological fraction of iron and other key erythropoietic micronutrient deficiencies contributing to anemia in India. Additionally, this will help assess the effectiveness of existing anaemia prevention and treatment interventions and examine factors associated with non-response, thereby supporting the “test–treat–track” approach.
Participants
Children under 18 years, pregnant women, and non-pregnant-non-lactating women (NPNL) in India.
Findings to date
This cohort profile comprises 88 datasets spanning between 1994 to 2023, encompassing a total of 319,721 participants for prevalence analysis [children(19,762), NPNL(17,883), and pregnant women(282,076)]. Additionally, 59,292 participants were included in intervention studies [children(13,435), NPNL(11,594), and pregnant women(34,263)]. RCTs comprised 55.7% (49/88) of the datasets whereas observational studies comprise 35.2% (31/88) of the datasets. Majority of the studies were from the norther region - 38 studies (43.2%), followed by the western part - 20 studies (22.7%). The southern part contributed 16 studies (18.2%). Major [59/88 (67%)] datasets in cohort were from community-based studies. The sample included NPNL and pregnant women with a median age of 26 years (IQR 23-32), and 23 years (IQR 21-25) respectively. Information from 6 months up to 18 years was pooled within the children’s cohort. Within the pregnancy cohort the mean gestational age at enrollment was 10.24 weeks(SD-17.65). Of total 10.8% (34,442/ 319,721), 9% (28,672), 4.5% (14,240) of the sample had information on complete blood count, ferritin and vitamin B12 respectively. A total of 33 datasets (sample - 59,292) were from intervention studies. Among pregnant women, a broader range of interventions was implemented, including intravenous iron sucrose, ferric carboxymaltose, iron isomaltoside, IV iron combined with vitamin B12, folic acid, and niacinamide, integrated interventions, as well as low-dose calcium supplementation. A similar set of interventions were delivered to NPNL group with being distinct which compared Ferrous sulfate tablets of 60 mg elemental iron daily with a control of 120 mg on alternate days. Ferrous sulfate was the major interventions amongst children along with food supplements and some were Ayush trials.
Future plans
The PRAYAS will provide robust, high-quality evidence to inform public health policy in India. The findings will feed into the Anemia Mukt Bharat program recommendations for pregnant women, NPNL women and children to guide targeted strategies for reduction of anemia and its associated health burdens across vulnerable populations.
Strengths and limitations of this study
The harmonized PRAYAS pooled Indian dataset is one of the largest, reliable and most comprehensive datasets on pregnant/ non-pregnant and non-lactating women and children.
One of its kind of dataset with information on hemoglobin levels, relevant biochemical and key micronutrients parameters and varied interventions from across India.
Heterogeneity of interventions, dosage, duration and data collection approaches.
Studies lack critical parameters needed to assess changes in haemoglobin concentration like non-availability of key erythropoietic micronutrients in most of the studies, limiting the scope of certain analyses.
