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Introduction Population level screen and treat approach for anaemia reduction could be beneficial but its feasibility and impact remains to be tested.Methods This cluster randomised trial in rural Telangana included 14 clusters randomised (1:1) to either intervention or control arms. A cluster included all participants (6 months to 50 years) served by a frontline health worker. In the intervention arm, participants were screened for anaemia at point of care, using WHO 2011 cut-offs, followed by iron–folic acid (IFA) supplementation as per the national guidelines. The control arm participants were eligible for benefits of an ongoing national programme. The primary outcome was mean difference (MD) in haemoglobin between two arms at 6 months. The trial was registered at CTRI (CTRI/2019/01/016918).Results Baseline characteristics of participants in the intervention (n=6131) and control (n=5255) arms were broadly similar. In the intervention arm, 88.6% of eligible participants were screened and intervention was delivered to 97% of participants. There was no difference in population haemoglobin (g/dL) between the arms (MD 0.03, 95% CI −0.06 to 0.12, p=0.464). However, after adjustment for relevant confounders, mean haemoglobin in the intervention arm was significantly higher (MD 0.25 g /dL, 95% CI 0.03 to 0. 48, p=0.028). Anaemia prevalence was lower in the intervention than the control arm in total sample (29.6% vs 32.5%, p=0.002) as well as in adolescent girls (40.7% vs 56.0%, p<0.001) and women of reproductive age (WRA, 52% vs 56.5%, p=0.02). Compliance to IFA (% consumption of prescribed dose) was 32% and 47.5% in those receiving therapeutic and prophylactic doses, respectively.Conclusion This study demonstrates the feasibility of implementing a population level screen and treat approach. The intervention reduced anaemia prevalence significantly among vulnerable groups, particularly adolescent girls and WRA. Modest improvement in population haemoglobin and anaemia reduction suggests a need for strategies to improve the compliance to IFA.Trial registration number CTRI/2019/01/016918.