Background
Iron deficiency is the most prevalent nutritional deficiency on the globe. In India, pregnant women are amongst the most vulnerable population for iron deficiency anaemia. Even though iron supplements are prescribed, the compliance to therapy is inconsistent. Since India has a predominant rural population, shortage of medical manpower and lack of healthcare facilities may contribute to poor compliance with therapy.

Method 
A controlled trial study was conducted with 140 pregnant women, from a rural area of J N Medical College, Belgaum, India. Direct observers were assigned as volunteers, who monitored consumption of oral iron supplementation tablets by pregnant women. The direct observer was a consenting adult from the same village. Detailed history and baseline investigations were done before the initiation of study and periodical assessment of haemoglobin levels were used to monitor progress.

Results
The mean adherence rate and haemoglobin levels in the direct observers’ group were higher compared to the control group, across all visits. The mean haemoglobin value of participants in study group during 1st visit was 7.97 gm%, whereas in control group, it was 7.98 gm%; in the 2nd visit, mean haemoglobin level in the study group was
8.47 gm% and 8.18 gm% in the control group; in the 3rd visit, mean haemoglobin was 8.99 gm% in the study group and 8.42 gm% in control group. There was no statistical difference in the mean haemoglobin values between two groups in the first two visits. Although the mean haemoglobin values were similar on baseline investigations (1st visit), there was a difference of 0.30 gm% in 2nd visit and 0.57 gm% difference in the 4th Visit. The difference in haemoglobin values at 4th visit was statistically significant.

Conclusion
The deployment of a direct observer, to monitor the administration of oral iron supplementation is feasible and helps to improve compliance with oral iron tablets.