Anaemia Mukt Bharat
Context:
Recently, the Union Minister of State for Health and Family Welfare provided information on Anaemia Mukt Bharat (AMB) strategy.
About Anaemia Mukt Bharat:
The Anemia Mukt Bharat- intensified Iron-plus Initiative aims to strengthen the existing mechanisms and foster newer strategies for tackling anemia.
It focusses on six target beneficiary groups, through six interventions and six institutional mechanisms to achieve the envisaged target under the POSHAN Abhiyan.
Introduction
Anemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet the body’s physiological requirements, which vary by age, sex, altitude, smoking habits, and during pregnancy.
The manifestations of anemia vary by its severity and range from fatigue, weakness, dizziness and drowsiness to impaired cognitive development of children and increased morbidity.
Anemia in pregnancy is associated with post-partum haemorrhage, neural tube defects, low birth weight, premature births, stillbirths and maternal deaths. In malaria endemic regions, anemia is one of the most common preventable causes of maternal and child deaths. In its most severe form, anemia can also lead to death.
There are many causes of anemia, out of which iron deficiency accounts for about 50 percent of anemia in school children and among women of reproductive age-group, and 80 percent in children 2–5 years of age. Other nutritional deficiencies besides iron, such as vitamin B12, folate and vitamin A, can cause anemia although the magnitude of their contribution is unclear. Infectious diseases – in particular malaria, helminth infections, tuberculosis and haemoglobinopathies – are other important contributory causes to the high prevalence of anemia.
Anemia is defined as haemoglobin concentration below established cut-off levels in the blood. The haemoglobin cut-offs which are used for diagnosing anemia across ages are described below.
Haemoglobin levels to diagnose anemia (g/dl)
Population | |||
Mild | Moderate | Severe | |
Children 6–59 months of age | 10–10.9 | 7–9.9 | <7 |
Children 5–11 years of age | 11–11.4 | 8–10.9 | <8 |
Children 12–14 years of age | 11–11.9 | 8–10.9 | <8 |
Non-pregnant women (15 years of age and above) | 11–11.9 | 8–10.9 | <8 |
Pregnant women | 10–10.9 | 7–9.9 | <7 |
Men (15 years of age and above) | 11–12.9 | 8–10.9 | <8 |
According to the National Family Health Survey 4 (NFHS-4), 2015/16, anemia prevalence across all ages is extremely high in India; varying from 30 percent to 69 percent. It is also to be noted that in the last 10 years (NFHS-3, 2005/06 to NFHS-4, 2015/16), the percentage point reduction of anemia prevalence has been extremely low in most age groups.
Prevalence of anemia in India
| Age group | 2006 (NFHS-3) | 2016 (NFHS-4) | Decline in 10 years (2006–2016) in percent points |
| Children 6–59 months (Haemoglobin<11 g/dl), % | 69 | 58 | 11 |
| Adolescent girls 15–19 years (Haemoglobin<12 g/dl), % | 56 | 54 | 2 |
| Adolescent boys 15–19 years(Haemoglobin<13 g/dl), % | 30 | 29 | 1 |
| Women of reproductive age(Haemoglobin<12 g/dl), % | 55 | 53 | 2 |
| Pregnant women (Haemoglobin<11 g/dl), % | 58 | 50 | 8 |
| Lactating women(Haemoglobin<12 g/dl), % | 63 | 58 | 5 |
Objectives
The reduction of anemia is one of the important objectives of the POSHAN Abhiyaan launched in March 2018. Complying with the targets of POSHAN Abhiyaan and National Nutrition Strategy set by NITI Aayog, the Anemia Mukt Bharat strategy has been designed to reduce prevalence of anemia by 3 percentage points per year among children, adolescents and women in the reproductive age group (15–49 years), between the year 2018 and 2022.
Beneficiaries and Targets
The strategy is estimated to reach out to 450 million beneficiaries with specific anemia prevalence targets for year 2022 to be achieved among various population groups
Anemia Mukt Bharat beneficiaries and anemia reduction targets for different age groups for 2022
| Age Group | Estimated beneficiaries (in millions) |
| Children (6–59 months) | 124 |
| Children (5–9 years) | 134 |
| Adolescent boys (10–19 years) | 47 |
| Adolescent girls (10–19 years) | 68 |
| Women of reproductive age (20–24 years) | 17 |
| Pregnant women | 30 |
| Lactating women | 27 |
| Total beneficiaries | ~450 million |
Estimated number of beneficiaries will be annually revised and updated. While all women of reproductive age should ideally be covered, the estimated number of beneficiaries are those women aged 20–24 years from Mission Parivar Vikas Yojana who will be initially covered in Anemia Mukt Bharat.
The Anemia Mukt Bharat strategy will be implemented in all villages, blocks, and districts of all the States/UTs of India through existing delivery platforms as envisaged in the National Iron Plus Initiative (NIPI) and Weekly Iron Folic Acid Supplementation (WIFS) programme.
Anemia Mukt Bharat Anemia reduction Targets for 2022
Age Group | Anemia prevalence (%) | |
Baseline (NFHS 4) | National target 2022 (at 3 percentage points per annum from baseline) | |
Children (6–59 months) | 58 | 40 |
Adolescent girls (15–19 years) | 54 | 36 |
Adolescent boys (15–19 years) | 29 | 11 |
Women of reproductive age | 53 | 35 |
Pregnant women | 50 | 32 |
Lactating Women | 58 | 40 |
Strategy for implementation
A snapshot of the Anemia Mukt Bharat 6X6X6 strategy is depicted below.
Interventions
The Anemia Mukt Bharat strategy is a universal strategy and will focus on the following interventions:
- Prophylactic Iron and Folic Acid supplementation
- Deworming
- Intensified year-round Behaviour Change Communication Campaign (Solid Body, Smart Mind) focusing on four key behaviours
- Improving compliance to Iron Folic Acid supplementation and deworming
- Appropriate infant and young child feeding practices,
- Increase in intake of iron-rich food through diet diversity/quantity/frequency and/or fortified foods with focus on harnessing locally available resources and
- Ensuring delayed cord clamping after delivery (by 3 minutes) in health facilities
- Testing and treatment of anemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents
- Mandatory provision of Iron and Folic Acid fortified foods in government-funded public health programme
- Intensifying awareness, screening and treatment of non-nutritional causes of anemia in endemic pockets, with special focus on malaria, haemoglobinopathies
Prophylactic Iron and Folic Acid (IFA) supplementation
Prophylactic Iron Folic Acid supplementation given to children, adolescents, women of reproductive age and pregnant women, irrespective of anemia is a key continued intervention under Anemia Mukt Bharat.
Prophylactic dose and regime for Iron Folic Acid supplementation
| Age Group | Dose and regime |
| Children 6–59 months of age | Biweekly, 1 ml Iron and Folic Acid syrup Each ml of Iron and Folic Acid syrup containing 20 mg elemental Iron + 100 mcg of Folic Acid Bottle (50ml) to have an ‘auto-dispenser’ and information leaflet as per MoHFW guidelines in the mono-carton |
| Children 5–9 years of age | Weekly, 1 Iron and Folic Acid tablet Each tablet containing 45 mg elemental Iron + 400 mcg Folic Acid, sugar-coated, pink colour |
| School-going adolescent girls and boys, 10–19 years of age Out-of-school adolescent girls, 10–19 years of age | Weekly, 1 Iron and Folic Acid tablet Each tablet containing 60 mg elemental iron + 500 mcg Folic Acid, sugar-coated, blue colour |
| Women of reproductive age (non-pregnant, non-lactating) 20–49 years | Weekly, 1 Iron and Folic Acid tablet Each tablet containing 60 mg elemental Iron + 500 mcg Folic Acid, sugar-coated, red colour |
| Pregnant women and lactating mothers (of 0–6 months child) | Daily, 1 Iron and Folic Acid tablet starting from the fourth month of pregnancy (that is from the second trimester), continued throughout pregnancy (minimum 180 days during pregnancy) and to be continued for 180 days, post-partum Each tablet containing 60 mg elemental Iron + 500 mcg Folic Acid, sugar-coated, red colour |
Note 1: Prophylaxis with iron should be withheld in case of acute illness (fever, diarrhoea, pneumonia, etc.), and in a known case of thalassemia major/history of repeated blood transfusion. In case of SAM children, IFA supplementation should be continued as per SAM management protocol.
Note 2: All women in the reproductive age group in the pre-conception period and up to the first trimester of the pregnancy are advised to have 400 mcg of Folic Acid tablets, daily, to reduce the incidence of neural tube defects in the foetus.
Deworming
Dose and regime for deworming
| Age Group | Dose and regime |
| Children 12–59 months of age | Biannual dose of 400 mg albendazole (½ tablet to children 12–24 months and 1 tablet to children 24–59 months) |
| Children 5–9 years of age | Biannual dose of 400 mg albendazole (1 tablet) |
| School-going adolescent girls and boys 10–19 years of age Out-of-school adolescent girls 10–19 years of age | Biannual dose of 400 mg albendazole (1 tablet) |
| Women of reproductive age (non-pregnant, non-lactating) 20–49 years | Biannual dose of 400 mg albendazole (1 tablet) |
| Pregnant women | One dose of 400 mg albendazole (1 tablet), after the first trimester, preferably during the second trimester |
Source: PIB
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