Prevention and control of anemia: Thailand experiences.

Thailand has addressed nutrition in national development policy since the mid-1970s, including efforts to reduce iron deficiency anemia. Nutritional improvement has been implemented as an integral part of primary health care and community development extending beyond government services to include community participation. Utilization of village health volunteers has been a crucial feature of the program. Available data indicate that anemia rates have declined among pregnant women and preschool children, although there has been no formal evaluation of the program effect. Universal iron supplementation has been the major strategy for pregnant women, using village health volunteers to encourage continuation of the antenatal care schedule and encouraging a preventive approach by health service providers. Program obstacles have included lack of access to iron tablets by some populations and lack of understanding of the importance of anemia. Women's compliance was complicated by fear of having a large fetus, forgetfulness and side effects. Weekly iron supplementation of school children was piloted in 2000, and is now being extended. Other strategies utilized to address iron deficiency include food fortification, dietary improvement and complementary public health measures. Program monitoring and evaluation require strengthening to assess the effectiveness of intervention strategies and provide proper data for decision-making.