Effectiveness of an integrated 4T intervention test, treat, talk and track in mitigating anemia among tribal communities in Telangana, India

Vikram Gupta; Nehana Neeladdi; Venkat Rao Mantha; Bhagirath Gop; Dhanaraj Chittapur

doi:10.18203/2394-6040.ijcmph20263190

Authors

Vikram Gupta Department of Public Health, Taal Beehive, Bhopal, Madhya Pradesh, India
Nehana Neeladdi Department of Health and Nutrition, Vijayavahini Charitable Foundation, Hyderabad, Telangana, India
Venkat Rao Mantha Department of Health and Nutrition, Vijayavahini Charitable Foundation, Hyderabad, Telangana, India
Bhagirath Gop Department of Health and Nutrition, Vijayavahini Charitable Foundation, Hyderabad, Telangana, India
Dhanaraj Chittapur Department of Research, Monitoring and Evaluation, Kalike-An Initiative of tata Trusts, Yadgir, Karnataka, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263190

Keywords:

Anaemia, Behaviour change communication, Dietary diversity, Non-invasive screening, Targeted intervention, Telangana tribal community

Abstract

Background: Anaemia affects over 1.6 billion people worldwide, with India bearing a disproportionate burden despite five decades of national programming. Telangana’s 70% prevalence exceeds the 67.1% national average, with tribal districts like Bhadradri Kothagudem suffering from poor dietary diversity, limited healthcare access, and socioeconomic disadvantages. This study evaluated whether an integrated "4T" intervention- Test, Treat, Talk, and Track - could reduce Anaemia in this vulnerable population.

Methods: A community-based longitudinal study was conducted in Laxmidevipally Mandal, Bhadradri Kothagudem, covering 1,228 households across 16 villages with a baseline population of 5,291. Haemoglobin levels were screened using the non-invasive EzeCheck device. Anaemic participants received targeted medical treatment, Behaviour Change Communication (BCC), and Nutri-kits for home kitchen gardens.

Results: Following quarterly follow-ups and matched endline analysis, overall anaemia prevalence dropped significantly from 64.59% to 53.75% (p<0.001), representing a 10.84 percentage point reduction, with the largest reduction occurring among adolescent girls. Severe anaemia fell by 63% (from 9.8% to 3.6%), and mean haemoglobin levels rose from 11.0 to 11.6 g/dl. Among baseline severe cases, 24.4% recovered to normal or mild status, though 51.7% of the total cohort remained persistently anaemic. Furthermore, a notable knowledge-practice gap remained, while 96% of participants recognized green leafy vegetables as essential, only 56% had consumed them in the past 24 hours.

Conclusions: The 4T model successfully yielded measurable health gains. However, high residual Anaemia and behavioural gaps underscore the need for extended, region-specific interventions, consistent Iron Folic Acid (IFA) supply chains, and sustained community communication.

References

World Health Organization. Health topics: anaemia, 2018. Available at: https://www.who.int/health-topics/anaemia#tab=tab_1. Accessed on 20 July 2023.

World Health Organization. Anaemia fact sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/anaemia. Accessed on 5 January 2026.

Haas JD, Brownlie T. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr. 2001;131(2):676S-90S.

UNICEF. Ministry of Health and Family Welfare, Government of India. Comprehensive National Nutrition Survey (CNNS) national report, 2018. Available at: https://knowledge.unicef.org/resource/comprehensive-national-nutrition-survey-2016-2018. Accessed on 5 January 2026.

International Institute for Population Sciences. National Family Health Survey (NFHS-4) 2015-16, India. Mumbai: IIPS; 2017:1-192.

Ministry of Health and Family Welfare. Anaemia Mukt Bharat. 2022. Available at: https://pib.gov.in/PressReleasePage.aspx?PRID=1795421. Accessed on 26 August 2023.

Saini A, Shukla R, Joe W, Kapur A. Improving nutrition budgeting in health sector plans: evidence from India's anaemia control strategy. Matern Child Nutr. 2022;18(2):e13253.

Ministry of Health and Family Welfare, Government of India. National Family Health Survey (NFHS-5), 2019-21. Available at: https://www.scribd.com/document/648604280/NationalFamilyHealthSurveyNFHS5201921VolII. Accessed on 20 January 2026.

Kulkarni B, Augustine LF, Pullakhandam R, Pradhan AS, Dasi T, Palika R, et al. Screen and Treat for Anaemia Reduction (STAR) strategy: study protocol of a cluster randomised trial in rural Telangana, India. BMJ Open. 2021;11(12).

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), India, 2019-21: Telangana. Mumbai: IIPS; 2021.

Bhukya A. Assessing tribal health challenges and their impact on well-being: a systematic review of Bhadradri Kothagudem. J Res Humanit Soc Sci. 2025;13:26-32.

Behera S, Kumbhar RK. Tribal health care in India: a systematic review of practices and beliefs. Int Res J Soc Sci. 2023;12(3):61-5.

Deb Roy A, Das D, Mondal H. The tribal health system in India: challenges in healthcare delivery in comparison to the global healthcare systems. Cureus. 2023;15(6):e39867.

National Health Mission. Test-Treat-Talk (T-3) Guidance Note for State Programme Managers. New Delhi: MoHFW, Government of India; 2019.

Das Mahapatra PP, Roy C, Agarwal K, Sharma SD, Chowdhury SR, Sharma S, et al. Non-invasive haemoglobin screening device: a promising digital method for reducing anaemia prevalence through routine screening and timely intervention. Hematology. 2024;29(1):2365078.

World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization; 2011. Available at: https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1. Accessed on 05 January 2026.

Srivastava T, Negandhi H, Neogi SB, Sharma J, Saxena R. Methods for haemoglobin estimation: a review of what works. J Hematol Transfus. 2014;2(3):1028.

Dimauro G, Caivano D, Di Pilato P, Dipalma A, Camporeale MG. A systematic mapping study on research in anaemia assessment with non-invasive devices. Appl Sci. 2020;10(14):4804.

Das Mahapatra PP, Roy C, Agarwal K, Banerjee J, Sharma S. Performance of the non-invasive point-of-care device, EzeCheck, for haemoglobin assessment in adults and children in community and institutional care settings. PLOS Digit Health. 2024;3(5).

EMJ Hematology. Disparities in anaemia as a global health problem, 2023. Available at: https://www.emjreviews.com/hematology/news/disparities-in-anaemia-as-a-global-health-problem/. Accessed on 16 April 2026.

Luo W, Sun H, Cao H, Zhou G, Luo Y. Global, regional, and national burden of anaemia, 1990 to 2021: an observational study analysis for the global burden of disease. Medicine (Baltimore). 2025;104(38):e44380.

National Health Mission. Anaemia Mukt Bharat brochure. New Delhi: MoHFW, Government of India; 2018. Available at: https://www.nhm.gov.in/New-Update-2025-26/Nutrition/AMB-guidelines/AMB-Abhiyaan-Guidelines.pdf. Accessed on 05 January 2026.

Shah N, Zaheer S, Safdar NF, Turk T, Hashmi S. Women's awareness, knowledge, attitudes, and behaviours towards nutrition and health in Pakistan: evaluation of kitchen gardens nutrition program. PLoS One. 2023;18(9):e0291245.

Joe W, Rinju, Patel N, Alambusha R, Kulkarni B, Yadav K, et al. Coverage of iron and folic acid supplementation in India: progress under the Anaemia Mukt Bharat strategy 2017-20. Health Policy Plan. 2022;37(5):597-606.

Kavle JA, Landry M. Community-based distribution of iron-folic acid supplementation in low- and middle-income countries: a review of evidence and programme implications. Public Health Nutr. 2018;21(2):346-54.

Sachdev HPS, Gera T. Preventing childhood anaemia in India: iron supplementation and beyond. Eur J Clin Nutr. 2013;67(5):475-80.

Varghese JS, Swaminathan S, Kurpad AV, Thomas T. Demand and supply factors of iron-folic acid supplementation and its association with anaemia in North Indian pregnant women. PLoS One. 2019;14(1):e0210634.