E-ISSN:2456-3110

Research Article

Nutritional Status

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 10 November
Publisherwww.maharshicharaka.in

Impact of Ayurvedic Interventions to improve the Nutritional Status among Adolescent Girls and Children under-five years in Devbhumi Dwarka district of Gujarat

Soni J.1*, Saxena D.2, Saha S.3, Qureshi A.4, Patel B.5, Patel F.6, Bhagiya S.7, Shukla V.8, Yadav P.9
DOI: http://dx.doi.org/10.21760/jaims.7.10.17

1* Jimeet Soni, Research, Indian Institute of Public Health, Gandhinagar, Gujarat, India.

2 Deepak Saxena, Faculty, Indian Institute of Public Health, Gandhinagar, Gujarat, India.

3 Somen Saha, Faculty, Indian Institute of Public Health, Gandhinagar, Gujarat, India.

4 Abid Qureshi, Research, Indian Institute of Public Health, Gandhinagar, Gujarat, India.

5 Bhavna Patel, Director, Department of AYUSH, Government of Gujarat, Gujarat, India.

6 Falgun Patel, I/C Deputy Director, Department of AYUSH, Government of Gujarat, Gujarat, India.

7 Shital Bhagiya, Lecturer, State Model Institute of Ayurveda Sciences, Gandhinagar, Gujarat, India.

8 Vivek Shukla, District Ayush Officer, Jilla Panchayat, Devbhumi, Dwarka, Gujarat, India.

9 Pooja Yadav, Research, Indian Institute of Public Health, Gandhinagar, Gujarat, India.

Introduction: Anaemia is the global public health crisis, so also in India. The most direct connection between Pandu Roga and nutritional deficiency anaemia can be found in Ayurveda. Ayurvedic remedy was put through a clinical study on anaemic adolescent girls because anaemia is commonly prevalent that affects the society and the side effects of oral allopathic iron preparations are highly common. The present study assesses the impact of ayurvedic medicines in improving the nutritional status among anemic adolescent girls and severely underweight children under five years of age in Devbhumi Dwarka district of Gujarat. Method: The pre-post study was registered with Clinical Trial Registry of India conducted at Devbhumi Dwarka district of Gujarat. A total of 450 anaemic adolescent girls and 179 severely underweight children were screened respectively. Adolescent girls were provided with Faltrikadhi Kavath, Purnanavardi Mandur, and Amalaki Rasayan. Under-five children was given Shishubhaishaj granules in powder form. The study was conducted in three phases (Baseline, Intervention and Endline Assessment). Results: A total of 219 adolescent girls and 120 under-five children was evaluated during endline assessment. The mean improvement in Hb was +0.36 gm/dL for 219 subjects, however subjects (n=99) with better compliance shows significant improvement (+1.07 gm/dL, P=0.005). Under five children shows improvement in their anthropometric measurements (WAZ). Conclusion: The present study revealed that Ayurvedic intervention can improve Hb status of adolescent girls only with better compliance. The study also reports the reason of non-compliance and ways to address it.

Keywords: Anaemia, Ayurveda, Iron-deficiency anaemia, Malnutrition, Underweight

Corresponding Author How to Cite this Article To Browse
Jimeet Soni, Research, , Indian Institute of Public Health, Gandhinagar, Gujarat, India.
Email: 		Jimeet Soni, Deepak Saxena, Somen Saha, Abid Qureshi, Bhavna Patel, Falgun Patel, Shital Bhagiya, Vivek Shukla, Pooja Yadav, Impact of Ayurvedic Interventions to improve the Nutritional Status among Adolescent Girls and Children under-five years in Devbhumi Dwarka district of Gujarat. J Ayu Int Med Sci. 2022;7(10):133-143.
Available From
https://www.jaims.in/jaims/article/view/2001

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-09-24 2022-09-26 2022-10-03 2022-10-10 2022-10-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Jimeet Soni, Deepak Saxena, Somen Saha, Abid Qureshi, Bhavna Patel, Falgun Patel, Shital Bhagiya, Vivek Shukla, Pooja Yadavand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Pandu Roga (Anaemia) remains an important public health concern worldwide, more so in India.[1] Anaemia affects over half of the adolescent girls particularly from low socio-economic groups.[2] However, one in every two women who enters into pregnancy is anaemic.[3] Anaemia during adolescent period affects the growth and development with increasing risk of infections leading to adverse outcomes. As per National Family Health Survey (NFHS-5) conducted in 2019-2020 in India, the prevalence of anaemia among non-pregnant women was 65.1 percent and 69 percent among women age 15-19 years, a higher proportion of women were anaemic, compared to the previous survey round.[4] Ayurveda offers the most direct link between Pandu Roga and iron deficiency anaemia (IDA).

Half of the adolescent girls (50.9 percent) are anaemic in Devbhumi Dwarka district.[4] Undernutrition among children under five years is major public health concern in India. Children under five-years with underweight (weight for age; WAZ <-3SD score) is 36.2 percent in Devbhumi Dwarka district which is above national average.[4]

Pandu Roga is characterized as pallor of body resembles anaemia wherein reduction in red blood cell (RBC) count and decrease Hb concentration in RBC resulting in symptoms like paleness (yellow skin and eyes), tiredness, dizziness, weakness, vertigo etc. Numerous side effects are produced by modern medicines while treating it. To tackle such burden of malnutrition there is compelling need to adopt and promote various approach to achieve better nutrition outcome.

The correcting agents for anaemia are found to be practiced in Ayurvedic since centuries.[5] Bhaishajya Ratnavali, a classic ayurvedic compendium has compiled different formulations for treatment of various diseases.[6] It has been stated the use of Shishubhaisajh in children can increase the weight, Hb and improve overall health. Charaka Samhita described Punarnava Mandura’s use in treating Anaemia.[7] Amalaki (Phyllanthus emblica L.), which contains Tridoshahara characteristics, particularly Pittashamaka (which calms Pitta) and Rasayana (which rejuvenates), nourishes the dhatus and is also known to improve iron absorption.[8]

Phalatrikadi Kwatha pharmacodynamically reveals that it is an apt formulation for anaemia management.[9] An Ayurvedic remedies was put through a clinical study on anaemic adolescent girls because anaemia is a commonly prevalent in society and the side effects of oral allopathic iron preparations are highly common.

The study aimed to assess the impact of ayurvedic intervention Faltrikadhi Kavath, Purnanavardi Mandur and Amalaki Rasayan tablets to improve the nutritional status of anaemic adolescent girls and Shishubhaishaj granules powder for severely underweight under five children in Devbhumi Dwarka district of Gujarat.

Materials and Methods

Study design and settings: A pre-post study was conducted in anaemic adolescent girls and underweight children under five years of age. This study was carried out in two blocks of Devbhumi Dwarka district, Gujarat. The villages from respective blocks were selected based on the availability of the Ayurvedic dispensaries in that region. Intervention was supported by the Office of Director AYUSH, Gujarat and field intervention was coordinated by the District AYUSH Officer, Devbhumi Dwarka.

Study Duration: The study was conducted from April 2021 to March 2022 in three phases. The baseline assessment was done prior to initiating the interventional phase. The duration of interventional trial was 180 days. Two consecutive mid-term follow-ups were conducted during interventional phase. First follow-up was done after one month and second follow-up after three months of baseline respectively. Endline assessment was conducted after six months of interventional phase.

Sample Size: The sample was distributed across two blocks. Almost 60% participants were from Okha Mandal block and remaining 40% from Bhanvad block based on the population size. A total of 450 adolescent girls and 179 under five children were considered.

Selection of Cases: For the study, adolescent girls of 11 to 19 years with haemoglobin level <12 gm/dL and under five children who were underweight WFH <-3SD, <-2SD and <-1SD scores were selected. Pregnant and lactating adolescent, participant having any acute illness


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within last 7 days, having any co-morbidity or serious illness were excluded. Participants were included into the study after obtaining written informed consent from their parents.

Ayurvedic Medicine: Punarnava Mandur is an Ayurvedic medicine quoted in Bhaishajya Ratnavali[6] and Charaka Samhita.[7] Faltrikadhi Kavath and Amalaki Rasayan were other two Ayurvedic medicine used for treatment of Pandu Roga stated ayurvedic literature.[8],[9] All three remedies were given in tablet form. Shishubhaisaj granules in powder form were prescribed for under five children. For trial; Faltrikadhi Kavath (500 mg) 2 tablets twice a day, Punarnava Mandur (250 mg) 1 tablet twice a day and Amalaki Rasayan (500 mg) 1 tablet twice a day was given. Whereas Shishubhaisaj granules powder 10-20 grams per day for under-five children was given. The contents of ayurvedic medicines are presented in Table-1.

Table 1: Contents of Ayurvedic Medicines

Ayurvedic Medicine Contents (mg)
Phaltrikadhi Kavath tablet Haritaki 50 mg, Bibhitak 50 mg, Amla 50 mg, Guduchi 50 mg, Vasa 50 mg, Kalmegh 50 mg, Katuki 50 mg, Nimb 50 mg (each 500 mg uncoated tablet contains)
Purnanavardi Mandur tablet Punarnava 4.25 mg, Nasotar 4.25 mg, Sunth 4.25 mg, Marich 4.25 mg, Pipper 4.25 mg, Vavding 4.25 mg, Devdar 4.25 mg, Chitrak 4.25 mg, Pokhar mul 4.25 mg, Haridra 4.25 mg, Daru haridra 4.25 mg, Danti mul 4.25 mg, Baheda 4.25 mg, Amala 4.25 mg, Chavak 4.25 mg, Indrajav 4.25 mg, Kutki 4.25 mg, Pippari mul 4.25 mg, Nagarmoth 4.25 mg, Mandur bhasma 169.25 mg, Process in Gomutra QS (each 250 mg tablet contains)
Amalaki Rasayan tablet Amalaki Rasayan 500 mg (each 500 mg uncoated tablet contains)
Shishubhaisaj Granules Powder Nagali 20 mg, Brahmi 20 mg, Amalaki 20 mg, Sunthi 12.5 mg, Yastimadhu 10 mg, Ashvagandha 10 mg, Vidarikand 10 mg, Shatavari 10 mg, Palash 10 mg, Bhallatak Beej Maja 10 mg, Gokshur 10 mg, Pippali 2.5 mg, Karkatshringi 2.5 mg, Nagarmoth 2.5 mg, Chocolate Flavor 50 mg, Sharkara 800 mg (each gram granules contains)

Procurement and administration of medicine

The trial drug was prepared in the Government Ayurvedic Pharmacy, Rajpipla, Gujarat. For adolescent girls, it was made in tablet form, while for children under five, it was manufactured in powder form for simple administration. All drugs were administered under supervision of Vaidhyas (Ayurvedic Medical Officers) of public AYUSH dispensary.

Tools: Enrolment of adolescent girls were done after evaluating their capillary blood via finger-prick method using Hemocue Hb 201+ Analyzer machine with Hb status <12 gm/dL. Under-weight children were screened based on weight for age criteria. (WAZ score). The data were collected using a pre-tested questionnaire via the ‘KoBo Collect’ Application which was then extracted into excel for further analysis.

Study parameters: Demographic details, dietary patterns, knowledge of anaemia, past medical history and anthropometric measurements were carried out in adolescent girls. In under-five children, demographic details, feeding practices, past medical history and their anthropometric measurements were taken during baseline. The data on the regularity of medicine consumption, any improvement or side-effects following medications was taken on mid-term follow-ups and endline evaluations respectively.

Ethical Consideration: Institutional Ethics committee’s (IEC) approval was taken with Registration No. TRC/2021-22/03 from Indian Institute of Public Health, Gandhinagar. The study was also registered with clinical trial registry of India (CTRI) with Registration No. REF/2021/08/046471. Participant’s consent was taken as per IEC and CTRI guidelines.

Observations and Results

Population characteristics

In this study, 450 adolescent girls and 179 under-five children were registered. Out of which, 219 (48.67%) adolescent girls and 120 (67.03%) under-five children completed their course of interventional trial; while others dropped out.

Among the 219 anaemic adolescent girls, 11.87% girls were between 11-13 years, 49.77% between 14-16 years and 38.36% were between 17-19 years of age. 63% of them were school going girls; of which 27.85% were from higher secondary, 29.68% secondary and 5.5% pursuing their primary education. However, 35.6% girls were non-school going and 1.4% girls were never been to school. Most parents were having secondary education, whereas 19.6% of fathers and 35.6% of mothers were illiterate. Most of the mothers were housewives (77.2%) whereas fathers were labour 42%, farmer 16.4% and self-employed


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35.2%. The majority of adolescents have taken food groups in their regular diet were 100% cereals, 93.2% pulses, 88.1% green leafy vegetables, 63.9% fruits, 60.3% milk and milk products and 26% were non-vegetarians. The food apart from home meal includes 53.4% packaged junk foods, 42.5% biscuits, 25.1% chocolate, and 24.2% locally availed junk food.

Almost 76.3% of adolescent girls were aware about anaemia, 17.4% got to know from anganwadi workers and 5.94% from school. On asking about the symptoms, 20.1% narrated paleness of skin, 7.3% fatigue, 5.9 vertigo, 5.5% weakness and 2.3% loss of appetite. Almost two-thirds (63.5%) adolescent girls received iron-folic acid tablets, and 96.4% of adolescent consumed it. During the baseline, 13.2% of girls were observed with sign of pale skin/eye/tongue by research team, 8.2% were having weakness, 7.8% fatigue, 6.8% vertigo, 3.7% loss of symptoms and 76.3% having no any symptoms. The socio-demographic, dietary patterns and knowledge on anaemia details is given in Table-2.

Table 2: Demographic details, dietary patterns and knowledge of anaemia among adolescent girls

Adolescent girls (N=219)
Variable Type (N) (%)
Age 11-13 years 26 11.87
14-16 years 109 49.77
17-19 years 84 38.36
Schooling School going 138 63
Non-school going 78 36.6
Never been to school 3 1.4
Education Primary 12 5.5
Secondary 65 29.68
Higher Secondary 61 27.85
Religion Hindu 175 79.9
Muslim 43 19.6
Christian 1 0.45
Father’s Education Illiterate 43 19.6
Primary 69 31.5
Secondary 87 39.7
Higher Secondary 7 3.2
Graduate 6 2.7
Mother’s Education Illiterate 78 35.6
Primary 75 34.2
Secondary 56 25.6
Higher Secondary 5 2.3
Graduate 2 0.9
Parents Not-alive Father 7 3.2
Mother 3 1.4
Father’s Occupation Agriculture 36 16.4
Labour work 92 42
Self-employed 77 35.2
Others 6 2.7
NA 8 3.7
Mother’s Occupation Agriculture 23 10.5
Labour work 13 5.9
Self-employed 7 3.2
Housewife 169 77.2
Others 3 1.4
NA 4 1.8
Food Groups consumed at Home Cereals 219 100
Pulses 204 93.2
Green leafy vegetables 193 88.1
Fruits 140 63.9
Nuts & oils 104 47.5
Milk and milk products 132 60.3
Eggs 50 22.8
Non-vegetarians 57 26
Food apart from home Packaged junk food 117 53.4
Biscuits 93 42.5
Cold-drinks 45 20.5
Ice-cream 56 25.6
Chocolate 55 25.1
Locally availed junk food 53 24.2
Betel Nut 2 0.9
WASH After Defecation 171 78.1
Before Eating 219 100
After Eating 217 99.1
After Playing 134 61.2
Awareness about anaemia Aware 52 23.7
Not-aware 167 76.3
Knowledge of anaemia from AWW 38 17.4
School 13 5.94
Symptoms of anaemia narrated by subjects Paleness of Skin 44 20.1
Fatigue/Tiredness 16 7.3
Vertigo 13 5.9
Weakness 12 5.5
Loss of appetite 5 2.3
Low Concentration 1 0.5
IFA tablets Received IFA tablets 139 63.5
Consumed IFA tablets 134 96.4

Among 120 under five children, 55.8% were female and 44.2% were male children. Half of the fathers were labourer and 39.2% were self-employed. The 75.6% of children between 6-24 months were exclusively breastfed.


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At home, 94.3% children consume cereals, 76.7% pulses, 67.5% milk and milk products, 63.3% green vegetables and 44.2% were having fruits in their diet. Food apart from home meal among children comprise 68.3% biscuits, 54.2% fancy food packages, 26.7% ice-cream, 23.3% chocolate, 17.5% cold-drinks and 13.3% junk food in their diet. The socio-demographic details and dietary patterns of under-five children is given in Table-3.

Table 3: Demographic details and dietary patterns among under five children

Under five children (N=120)
Variable Type (N) (%)
Gender Female 67 55.8
Male 53 44.2
Age 8-12 months 11 9.17
13-24 months 30 25
25-36 months 29 24.17
37-48 months 31 25.83
48-60 months 19 15.83
Caste ST 46 38.3
SC 11 9.2
OBC 58 48.3
General 5 4.2
Religion Hindu 111 92.5
Muslim 9 7.5
Father’s Education Illiterate 18 15
Primary 40 33.3
Secondary 49 40.8
Higher Secondary 3 2.5
Graduate 9 7.5
Diploma 1 0.8
Mother’s Education Illiterate 19 15.8
Primary 52 43.3
Secondary 34 28.3
Higher Secondary 2 1.7
Graduate 12 10
Diploma - -
Parents Not-alive Father 2 1.7
Mother 1 0.8
Father’s Occupation Agriculture 6 5
Labourer 60 50
Self-employed 47 39.2
Others 5 4.2
Food Groups consumed at Home Breastfeed 31 25.8
Cereals/grains 113 94.2
Pulses 92 76.7
Green leafy vegetables 76 63.3
Fruits 53 44.2
Milk and milk products 81 67.5
Food apart from home Fancy food packages 65 54.2
Biscuits 82 68.3
Chocolate 28 23.3
Locally availed junk food 16 13.3
Ice-cream 32 26.7
Cold-drinks 21 17.5


Effect on Haemoglobin: During endline evaluation, 219 adolescent girls were followed up during the end-line assessment. It has been observed that, total of 63 (28.77%) adolescent girls have become normal. The mean hemoglobin estimation of 219 subjects was +0.37 gm/dL from 10.44 gm/dL to 10.81 gm/dL. However, 90 (41.09%) were mild anaemic, 62 (28.31%) were moderately anaemic and only 4 (1.83%) were severe anaemic as seen in Figure-1. A total of 28.77% adolescents have become normal.

jaims_2001_01.JPGFigure 1: Anaemic status of adolescent girls (N=219)

Table 4: Anaemic Status of subjects who have taken medicine regularly (N=99)

Range Baseline Endline
Normal (≥12 gm/dL) - 41 (41.41%)
Mild Anemia (10 - 11.9 gm/dL) 68 (68.69%) 39 (39.40%)
Moderate Anemia (9.9 - 7 gm/dL) 26 (26.26%) 18 (18.18%)
Severe Anemia (≤7 gm/dL) 5 (5.05%) 1 (1.01%)

Among the adolescent girls 99 (45.20%) of them who consistently used ayurvedic medications had shown significant improvement (p-value = 0.005) as seen in Table-4. It has been observed that 68 (68.69%) subjects who were mild anaemic were reduced to 39 (39.40%). 26 (26.26%) moderate anaemic reduced to 18 (18.18%). 5 (5.05%) severe anaemic reduced to 1 (1.01%). However, it shows the positive outcome as a total of 41 (41.41%) subject have become free from anaemia.


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jaims_2001_02.JPGFigure 2: Comparison of mean Hb of adolescent girls based on regularity of medicine consumption

Adolescent girls were observed on their body mass index (BMI) range presented in Figure-3. Severe thinness i.e. (BMI <16) changed from 33.33% to 23.29%, moderate thinness (BMI 16-17) from 8.67% to 17.35%, mild thinness (BMI 17-18.5) from 21% to 17.35%. Normal range (BMI 18-25) increased from 27.4% to 67 30.59%, Overweight (BMI 25-30) from 6.4% to 8.22%, Obese class I (BMI 30-35) from 2.74% to 3.2% and no one remained in Obese class II (BMI 30-35).

jaims_2001_03.JPGFigure 3: Comparison of BMI range of Baseline and Endline Assessment of Adolescent Girls (n=219)

Effect on malnutrition

The Shishubhaisaj granules powder shows improvement in weight for age (WAZ score) of under-five children.

The mean weight gain among children was +0.86 kg. There were 22.5% children between <-5.5 to -3 SD score i.e., severely underweight which then reduced to 15.83% in endline. 29.16% were between <-3 to -2 SD score i.e., moderately underweight which improved to 35%. 29.16% were between <-2 to -1 SD i.e., mild underweight which reduced to 26.67% and 16.67% children having <-1 SD improved to 18.33% whereas 4.17% children became normal during endline as in Table-5. Moreover, Mid Upper Arm Circumference (MUAC) was increased to +0.73 cm during endline.

Table 5: Weight for Age (WAZ) score of under-five children

Variable Type Baseline Endline
Weight for Age (WAZ) N=120 Normal 3 (2.5%) 5 (4.17%)
 <-1SD - 0 Median 20 (16.67%) 22 (18.33%)
<-2SD to -1SD Mild 35 (29.16%) 32 (26.67%)
<-3SD to -2SD Moderate 35 (29.16%) 42 (35%)
<-5.5SD to -3SD Severe 27 (22.5%) 19 (15.83%)

Improvement following intervention

The Ayurvedic medicines - Faltrikadhi Kavath, Purnanavardi Mandur and Amalaki Rasayan were effective among adolescent girls. During endline, 57.53% reported increased appetite, 56.16% felt energetic, 62.56% felt better and 3.20% reported their vertigo went away whereas 28.77% girls reported no any changes. Shishubhaisaj granules powder proves effective as 86.67% children reported increased appetite and 85% were playful.

The changes felt after consumption of ayurvedic medicines among adolescent girls and under five children is presented in Table-6.

Table 6: Changes felt by subjects after intervention

  Adolescent girls Under five children
Variable Type n=219 % n=120 %
Changes felt after intervention No Any 63 28.77% 1 0.83%
Appetite Increased 126 57.53% 104 86.67%
Feeling Energetic 123 56.16% - -
Feeling Better 137 62.56% - -
Vertigo went away 7 3.20% - -
Felt weight increased 1 0.46% - -
Playful - - 102 85%



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Compliance to medication

The study suggests that 54.80% of adolescent girls have shown irregularity in consumption of medicines and 45.20% girls taken it regularly. The compliance was good among children under five years as 85.83% have regular consumption of ayurvedic medicine.

The participants who have consumed the ayurvedic medicine regularly shows strong association in improving their nutritional status.

The frequency of consumption of ayurvedic medicines and its association in improving the nutritional status is presented in Table-7.

Table 7: Frequency of consumption of medicines by study participants

  Adolescent girls Under five children
Variable Type N=219 % P value N=120 % P value
Frequency of consumption of medicines Received Regularly 99 45.20% 0.005* 103 85.83% 0.644
Not taken for 1 week 6 2.74% 0.590 1 0.83% -
2 weeks 1 0.46% - 2 1.67% -
3 weeks - - - 2 1.67% -
1 month 18 8.22% 0.409 1 0.83% -
1.5 months 10 4.57% 0.946 2 1.67% -
2 months 13 5.94% 0.115 2 1.67% -
2.5 months 1 0.46% - - - -
3 months 22 10.04% 0.771 3 2.5% 0.422
>3 months 49 22.37% 0.121 4 3.33% 0.053

*strong association: p-value < 0.05

A 14.17% of children under five and 54.80 percent of adolescent girls did not consistently use ayurvedic medications for the reasons listed in Table-6.

Only 10 (4.57%) of the girls experienced minor adverse effects like nausea and vomiting, but overall the medication was well accepted.

The majority of adolescent girls affirm non-compliance with medications due to higher pill count and strange flavour and taste, forgetting to take them, and experiencing negative drug reactions such nausea, vomiting, and abdominal pain.

Children exhibited better compliance, and just 1.67% of those reported experiencing abdominal discomfort. While 5.83% of children under the age of five disliked the flavour and 4.17% neglected to take them narrated by parents as in Table-8.


Table 8: Reasons for non-compliance among participants

  Adolescent girls Under five children
Variable Type n = 120 % n = 17 %
Reasons of non-compliance More Pill count 64 29.22% - -
Forgot to take 62 28.31% 5 4.17%
Didn’t like the taste 43 19.63% 7 5.83%
Due to adverse drug reaction 10 4.57% 2 1.67%
Fever, Cough & Cold 5 2.28% - -
Taking another medication 3 1.37% - -
Went out of station 2 0.91% - -
Headache 2 0.91% - -
Other Medical Illnesses 2 0.91% 1 0.83%
Miscellaneous Reason 2 0.91% 1 0.83%
Didn’t felt any changes 1 0.45% - -
Refusal from family/friends 1 0.45% 1 0.83%

Discussion

Ayurveda adopts a holistic way in understanding a disease. Pandu disease resembles very similar to anaemia. The present study was planned to assess the efficacy of ayurvedic medicines - Faltrikadhi Kavath, Purnanavardi Mandur and Amalaki Rasayan tablets to improve the nutritional status of anaemic adolescent girls (Pandu Roga) and Shishubhaishaj granules powder for underweight children under five years of age. The trial drugs chosen here strikes at the etio-pathogenesis of the diseases. Most of the previous study used single remedy in either group whereas in this study we use three ayurvedic medicines for anaemia among adolescents.[8],[9] This study presented the prevalence of anaemia in adolescent girls was due to inadequate dietary habits, lack of knowledge about anaemia, unawareness for receiving extra iron-folic acid tablets. Low socioeconomic families have not consumed proper diet resulting their children develop malnutrition leads to several diseases.[1],[2]

We found good outcome and improvement in the anaemic status of adolescent girls among those with good compliance. It is obvious that the multiple ayurvedic preparation prove effective in tackling anaemia but the frequency of consumption and compliance needs to improve. Adolescent girls claim that they don't take their prescriptions as prescribed because of the greater pill count, unusual flavour and taste. They forget to take them, because few have side effects like nausea, vomiting, and abdominal discomfort.


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Because some adolescent did not take the ayurvedic medications regularly, they do not exhibit any improvement following intervention. Adolescent girls who take the ayurvedic medications often reported improvements in their overall health, an increase in appetite, and relief from their symptoms.

Our study suggested good compliance of the ayurvedic medicines among children under five years of age. Children who have an enhanced appetite and have become more playful or animated respond well to the powdered Shishubhaisaj granules. Even children, according to parents, like to consume the shishubhaisaj powder in with milk, or just dry. The result suggests that Shishubhaisaj is significantly effective in improving underweight child. Both the subjective and haematological measures in this investigation have statistically significant findings.

Apart from the medicines used in the trial for anaemia, many drugs are bestowed with the properties of being Rasayan which aids the body in synthesizing best of the Dhatus (blood components). There are many preparations in modern medicine to improve anaemia, but majority of these include undesirable side-effects like nausea, vomiting, constipation, etc. Therefore, one must take an ayurvedic medicine which is extremely successful in treating aforementioned disease, quick to act, long lasting, more tolerable, and economical in order to overcome anaemia. The study shows adverse drug reactions among adolescent girls and under five children which is less and can be addressed clinically.

The study's overall findings point to the need to increase ayurvedic intervention compliance, raise community awareness of anaemia, and encourage faith in Ayurveda among the general public. Henceforth, there is a need to improve characteristics of the Ayurvedic composition in order to upsurge the acceptance of ayurvedic medicines. Polypills or combination pills can be created to decrease the quantity of pills while simultaneously changing their formulations or composition and flavour, which may improve compliance.

Conclusion

The trial drugs are effective in ameliorating the signs and symptoms of anaemia.

The results of this study make it abundantly clear that consistent medication use significantly improved the anaemia status of adolescent girls. The study shows good compliance among under five children. Results could have been more effective if compliance would increase. Adolescent girls show non-compliance of ayurvedic medicines due to more pill count and dislike to taste.

Our study shows that medication compliance is extremely important, so measures to improve compliance must be addressed. However, to improve the adherence of Ayurvedic medicines and getting the required results we must: reduce the pill count by forming one capsule or combination pill, enhance the taste by changing formation into Chyawanprash form, granules form, palatable syrup form, periodic counselling of beneficiaries which can maximize the compliance, promoting role of Ayush Medicine in treating Anaemia. The study on the improvement in non-iron deficiency anaemia should be most useful in the future since this study considered the iron-deficient anaemic participants. If correct administration and compliance are observed, Ayurvedic medications may manage anaemia more effectively than modern western treatments. Adopting AYUSH dietary regimen can also play a pivotal role in management of the disease.

Acknowledgement

We are obliged and acknowledges the relentless contribution of Dr. Vivek Shukla, District AYUSH Officer, Devbhumi Dwarka district and his team of AYUSH Medical Officers; Dr. Kashyap Chauhan, Dr. Ratnang Dave, Dr. Nilesh Bilwal, Dr. Jigna Kular, Dr. Vishal and Dr. Dimple for their support throughout study. We are thankful to all field worker, anganwadi workers and anganwadi helper who helped us in mobilizing the beneficiaries. We express our gratitude to the participants who gave consent to participate in this study and diligently followed up, without whom this research would not have been possible.

Research Funding

The entire study was funded by Department of AYUSH, Government of Gujarat.

Authors Contribution: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.



Journal of Ayurveda and Integrated Medical Sciences 2022;7(10)140
Soni J et al: Nutritional Status among Adolescent Girls and Children under-five years

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Journal of Ayurveda and Integrated Medical Sciences 2022;7(10)141