As a nation, India is currently reassessing its anemia policy, with a shift from the National Family Health Survey (NFHS) to the Diet and Biomarkers Survey (DABS-I) for anemia prevalence estimation. This decision is influenced by concerns raised about the accuracy of hemoglobin level estimates from NFHS in light of the expanding burden of anemia across the country.
Understanding Anemia
Anemia is a health condition characterized by an insufficient number of red blood cells or inadequate oxygen-carrying capacity to fulfill physiological needs. These physiological demands are shaped by age, sex, altitude, smoking habits, and pregnancy status. Iron deficiency is the most common cause of anemia. However, other factors like folate, vitamin B12 and A deficiencies, chronic inflammation, parasitic infections, and inherited disorders also contribute to the condition. Severe anemia often presents symptoms like fatigue, weakness, dizziness, and drowsiness. Pregnant women and children are especially susceptible to the condition.
Anemia Burden In India
NFHS-5 (2019-21) showed a substantial increase in the prevalence of anemia in India, with 57% of women aged between 15 and 49 and 67% of children between 6 and 59 months affected. Researchers have cautioned against the over-diagnosis of anemia in India, as global cutoffs for hemoglobin levels by the World Health Organization (WHO) may not be suitable for the country. This is because cutoff points depend on age, sex, physiological status, altitude, and other factors. Differences in blood sampling methods identified between NFHS and the suggested venous blood sampling could potentially lead to lower false values.
Diet And Biomarkers Survey (DABS-I)
The DABS-I is a comprehensive national-level dietary survey created to determine food and nutrient adequacy across various age groups and regions. It collects individual dietary intake data and offers nutrient composition information for cooked and uncooked foods. DABS-I is expected to provide better estimates for anemia prevalence and aid in devising targeted interventions.
Importance Of Anemia Data
Anemia data is a critical public health indicator, particularly for vulnerable populations like pregnant women and children under the age of five. Studies on anemia prevalence aid in tracking progress in reproductive health and understanding its impact on work capacity and national development.
Government Initiatives Against Anemia
The government launched Anaemia Mukt Bharat (AMB) in 2018 as part of the Intensified National Iron Plus Initiative (NIPI) Program to accelerate the annual rate of decline of anemia by one to three percentage points. The target groups for AMB include children aged 6-59 months, 5-9 years, adolescent girls and boys aged 10-19 years, women of reproductive age (15-49 years), pregnant women, and lactating mothers.
Other Government Strategies For Combating Anemia
The government has implemented the Weekly Iron and Folic Acid Supplementation (WIFS) Programme to confront the high prevalence of anemia among adolescent girls and boys. Under WIFS, supervised weekly ingestion of Iron Folic Acid (IFA) tablets is facilitated. The government has also operationalized blood banks in district hospitals and blood storage units in sub-district facilities like Sub-Divisional Hospital/ Community Health Centers to manage severe anemia complications.
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) has been launched with a focus on conducting special antenatal care check-ups on the 9th of every month with the help of medical officers/ OBGYN to detect and manage anemia cases. Other moves include controlling worm infestation through biannual deworming with Albendazole and implementing health management information and mother-child tracking systems for reporting and tracking anemia cases in pregnant women.
Universal Screening & Supplementation For Pregnant Women
Universal screening of pregnant women for anemia is part of antenatal care, and all pregnant women are provided iron and folic acid tablets during their antenatal visits. These tablets are available through the existing network of sub-centers, primary health centers, other health facilities, and outreach activities at Village Health & Nutrition Days (VHNDs).
Interventions Of Anaemia Mukt Bharat(Ongoing And Proposed)
Among the interventions being undertaken are the provision of prophylactic Iron and Folic Acid Supplementation to children, adolescents, and women irrespective of anemia; promoting the intake of iron-rich, protein-rich, and vitamin C-rich foods through dietary diversity and food fortification; practice of delayed cord clamping in all health facility deliveries followed by early breastfeeding initiation within an hour of birth; and bi-annual mass deworming for children aged 1-19 years under the National Deworming Day (NDD). The AMB initiative also integrates deworming of women of reproductive age and pregnant women as part of the NDD strategy and addresses non-nutritional causes of anemia with special focus on malaria, hemoglobinopathies, and fluorosis.
