A Novel School-based Intermittent Delivery System of Iron Supplements for Highly Marginalized Tarahumara Indigenous Women of Reproductive Age of Northern Mexico

ABSTRACT

To develop a novel delivery scheme to bridge the Mexican health system with highly isolated indigenous communities by involving naturally occurring social links: households and boarding schools. This was a school-based placebo-controlled trial with a follow-up period of 16 weeks. Children whose mothers fulfilled the inclusion criteria for anemia acted as iron supplement carriers between schools and homes. Adherence was measured based on teachers’ and mothers’ records. An effectiveness sub-analysis assessed changes in biochemical profiles according to random allocation to either supplementation or placebo groups. There was an overall high adherence in both groups. Analyses revealed that schooling years, literacy, and walking times played a role in high adherence. Logistic regression showed that women had higher adherence odds on the basis of household size, walking times, and previous inclusion in supplement distributions. Adherence significantly decreased the proportion of anemia by 48.2% in the intervention group. The difference at baseline and endpoint significantly reduced the number of iron-deficient anemic women by 67.7% in the supplementation group. This delivery method is a valid alternative to the conventional efforts used to reach Tarahumara indigenous communities, and could also have the potential to be piloted to tackle other health issues hindering these marginalized communities.

KEYWORDS:

• Adherence
• delivery system
• indigenous community
• iron deficiency anemia
• intermittent supplementation

Acknowledgments

The authors wish to thank the Tarahumara schoolchildren, their mothers, and the school teachers and personnel for their participation and support during the execution of the trial. We are also grateful to the field workers involved during the data collection.

Conflict of interest

The authors declare that they have no conflict of interest

Additional information

Funding

This study was funded by the Mexican Institute of Social Security (grant number FOFOI-05/1/I/088) and the Mexican Commission for the Development of Indigenous People (CDI).