Anaemia

Context:

Webinar on Rice Fortification: A complementary approach to address Nutritional Anaemia

What is Anaemia?

• Anaemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking, and pregnancy status.
• According to the World Health Organization (WHO), anaemia among women is defined as a hemoglobin concentration of <120 g/L for non-pregnant women aged 15 years and above, and a hemoglobin concentration of <110-g/L for pregnant women.
• Iron deficiency is thought to be the most common cause of anaemia globally, although other conditions, such as folate, vitamin B12 and vitamin A deficiencies, chronic inflammation, parasitic infections, and inherited disorders can all cause anaemia.
• In its severe form, it is associated with fatigue, weakness, dizziness and drowsiness. Pregnant women and children are particularly vulnerable.

Anaemia burden in India:

• In Phase I of the NHFS, result factsheets have been released for 22 states and UTs.
• In a majority of these states and UTs, more than half the children and women were found to be anaemic.
• In 15 of these 22 states and UTs, more than half the children are anaemic. Similarly, more than 50 percent of women are anaemic in 14 of these states and UTs.
• The proportion of anaemic children and women is comparatively lower in Lakshadweep, Kerala, Meghalaya, Manipur, Mizoram, and Nagaland.
• However, it is higher in Ladakh, Gujarat, J&K, and West Bengal, among others.
• Anaemia among men was less than 30 percent in a majority of these states and UTs.

Why is anaemia so high in the country?

• Iron-deficiency and vitamin B12-deficiency anaemia are the two common types of anaemia in India.
• Among women, iron deficiency prevalence is higher than men due to menstrual iron losses and the high iron demands of a growing foetus during pregnancies.
• Lack of millets in the diet due to overdependence on rice and wheat, insufficient consumption of green and leafy vegetables could be the reasons behind the high prevalence of anaemia in India.

Scenario in western Himalaya?

• In the union territory of Ladakh, a whopping 92.5 per cent children, 92.8 per cent women, and around 76 per cent men are anaemic in the given age groups, as per the survey.
• The high prevalence in this region could be due to the short supply of fresh vegetables and fruits during the long winter each year.
• Crops here are generally only grown in summer and during winter; residents fail to get a regular supply of green vegetables and fresh produce from outside, due to restricted connectivity in harsh weather.
• However, there could be other factors as well and the causes of anaemia here are yet to be scientifically ascertained.

Why there is still such high prevalence of anaemia even within the developed markets?

• Poor eating habits (not eating enough fruits, vitamin C, and legumes such as and beans and peas) and lack of access to healthcare are the main causes for such a high prevalence of anaemia among women.
• Iron supplementation programs have not been successful in decreasing anaemia in India.
• Anaemia is difficult to diagnose, as the symptoms are non-specific in the mild early stages. Studies suggest that more than 50% of people with anaemia are not aware that they have the condition.
• High prevalence of conditions that can cause anaemia, such as Chronic Kidney Diseases (CKD): In people with CKD, anaemia arises due to kidney damage lowering the production of hormones that direct haemoglobin production.

Global burden of Anaemia:

• Globally, anaemia affects 1.62 billion people, which corresponds to 24.8% of the population. The population group with the greatest number of individuals affected is pregnant women (41.8%). In women, anaemia may become the underlying cause of maternal mortality and perinatal mortality.
• Nine out of ten anaemia sufferers live in developing countries, about 2 billion people suffer from anaemia and an even larger number of people present iron deficiency.
• WHO has estimated that prevalence of anaemia in developed and developing countries in pregnant women is 14 per cent in developed and 51 per cent in developing countries and 65-75 percent in India alone.
• Prevalence of anaemia in South Asian countries is among the highest in the world. It is estimated that about half of the global maternal deaths due to anaemia occur in South Asian countries and India alone contributes to 50% of global maternal deaths and about 80 per cent of the maternal deaths due to anaemia in South Asia.

The steps taken to tackle anaemia under the National Health Mission (NHM):

• Anaemia Mukt Bharat(AMB): It has been launched in the year 2018 as part of Intensified National Iron Plus Initiative (NIPI) Program for accelerating the annual rate of decline of anaemia from one to three percentage points.
  • The target groups for AMB are Children 6-59 months, 5-9 years, Adolescent Girls & Boys of 10-19 years, Women of Reproductive Age (15-49 years), Pregnant Women and Lactating Mothers.

• Weekly Iron and Folic Acid Supplementation (WIFS): This Programme is being implemented to meet the challenge of high prevalence and incidence of anaemia amongst adolescent girls and boys.
  • The intervention under WIFS includes supervised weekly ingestion of Iron Folic Acid (IFA) tablet.
  • To control worm infestation biannual deworming with Albendazole is provided.

• Health management information system & Mother Child tracking system is being implemented for reporting and tracking the cases of anaemic and severely anaemic pregnant women.

• Universal screening of pregnant women for anaemia is a part of ante-natal care and all pregnant women are provided iron and folic acid tablets during their ante-natal visits through the existing network of sub-centres and primary health centres and other health facilities as well as through outreach activities at Village Health & Nutrition Days (VHNDs).

• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): It has been launched to focus on conducting special ANC check up on 9th of every month with the help of Medical officers/ OBGYN to detect and treat cases of anaemia.
• Operationalization of Blood Bank: in District Hospitals and Blood Storage Unit in subdistrict facilities such as Sub-Divisional Hospital/ Community Health Centers is being taken to tackle complications due to severe anaemia.

Source: PIB

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