Recent research challenges the conventional understanding that iron deficiency is the primary cause of anaemia in India, suggesting a need for diversified policy interventions to address the issue effectively.
About Anaemia
- Anaemia is a medical condition where the number of red blood cells (RBCs) or the haemoglobin levels in the blood are below normal, leading to reduced oxygen supply to the body’s tissues.
- Key Symptoms of Anaemia: Fatigue, weakness, pale skin, and shortness of breath.
- Types of Anaemia:
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- Iron-Deficiency Anaemia: Caused by insufficient iron levels needed to produce haemoglobin.
- Commonly due to poor diet, blood loss, or absorption issues.
- Vitamin-Deficiency Anaemia: Caused by a lack of Vitamin B12 or folate, essential for RBC production.
- Aplastic Anaemia: Occurs when the bone marrow fails to produce enough RBCs.
- Sickle Cell Anaemia: A genetic condition where RBCs are abnormally shaped, leading to blockages and reduced oxygen flow.
- Hemolytic Anaemia: Results from the premature destruction of RBCs.
- Thalassemia: A genetic disorder causing abnormal haemoglobin production.
- Anaemia of Chronic Disease: Associated with long-term illnesses like cancer or kidney disease.
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Status of Anaemia in India
- Prevalence Trends:
- Anaemia prevalence among women of reproductive age increased from 53.2% (NFHS-4) to 57.2% (NFHS-5).
- In children, the prevalence rose from 58.6% to 67.1% during the same period.
- Recent study findings show lower anaemia prevalence compared to NFHS data:
- Women (15–49 years): 41.1% (study) vs. 60.8% (NFHS-5).
- Adolescent girls (15–19 years): 44.3% vs. 62.6%.
- Adolescent boys: 24.3% vs. 31.8%.
- Iron Deficiency: Only 9% of anaemia cases were due to iron deficiency, while 22% were from unknown causes.
- Geographic Variation: States like Assam reported high anaemia prevalence (50%-60%) but low iron deficiency (18%).
Factors Contributing to Rising Anaemia
- Nutritional Deficiencies: Deficiency in Vitamin B12, folate, and other erythropoietic nutrients.
- Erythropoietic nutrients are essential nutrients that support red blood cell production by aiding hemoglobin synthesis and erythropoiesis.
- Environmental Factors: Air pollution and unhygienic environments exacerbate anaemia prevalence.
- Blood Collection Methods: Capillary blood samples (used in NFHS) may overestimate anaemia prevalence due to contamination with body fluids.
- Dietary Patterns: Inadequate dietary diversity limits nutrient absorption.
6x6x6 strategy Under AMB
- Six Beneficiary Groups:
- Children (6–59 months)
- Children (5–10 years)
- Adolescents (10–19 years)
- Pregnant women
- Lactating mothers
- Women of reproductive age (20–49 years)
- Six Interventions:
- Prophylactic iron and folic acid supplementation
- Biannual deworming
- Behaviour change communication campaigns
- Testing and treatment for anaemia
- Provision of iron-fortified foods
- Addressing non-nutritional causes of anaemia
- Six Institutional Mechanisms:
- Convergence of departments
- Supply chain management
- Training of healthcare providers
- Monitoring and evaluation frameworks
- Public health campaigns
- Community engagement and adoption
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Government Initiatives to Tackle Anaemia
- Anaemia Mukt Bharat (AMB) Strategy (2018): Reduce anaemia prevalence across six age groups through the 6x6x6 strategy, which includes six interventions, six beneficiary groups, and six institutional mechanisms.
- National Deworming Day (NDD) (2015): Biannual mass deworming for children and adolescents (1–19 years) to reduce worm infestations that contribute to anaemia.
- National Sickle Cell Anaemia Elimination Mission (2023):To eliminate sickle cell disease as a public health problem by 2047, focusing on screening, diagnosis, and management in tribal areas.
- Strengthening Supply Chains for IFA Supplements :To ensure uninterrupted availability of iron and folic acid supplements across health centers.
- National Centre of Excellence and Advanced Research on Anaemia Control (NCEAR-A) (2018): To enhance capacity building and develop training toolkits for healthcare providers.
Challenges in Addressing Anaemia
- Single-Focus Interventions: Policies focused primarily on iron supplementation are insufficient to address multifactorial anemia.
- Diet Accessibility: High-quality, nutrient-rich foods remain unaffordable for a significant portion of the population.
- Policy Implementation: Lack of integration between nutrition-focused interventions and broader public health initiatives.
- Data Collection: Reliance on less accurate blood collection methods (capillary samples) skews prevalence estimates.
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Way Forward
- Diversified Nutritional Interventions: Promote balanced diets with fruits, milk, and vegetables to improve nutrient absorption.
- Improved Data Collection: Transition to venous blood draws as recommended by WHO for accurate anaemia estimation.
- Enhanced Public Health Initiatives: Expand Anaemia Mukt Bharat with focus on dietary diversity and behavior change communication.
- Economic Accessibility: Subsidize nutrient-dense foods to ensure wider population access.
- Holistic Interventions: Combine iron supplementation with other measures like deworming, fortification of staples, and point-of-care treatment.
January 18, 2025
