Fight against iron deficiency anemia

The first step is the scaling up of Iron and Folic Acid Supplementation programme.

Anemia is a condition where the human body has less than the normal level of heamoglobin which compromises oxygen carrying capacity of blood cells. Anemia is a severe public health problem in India with more than 74 per cent of the population having hemoglobin levels of less than 11gm. This has devastating effects on health of the people as well as physical and mental productivity thus affecting the quality of life.

he National Family Health Survey-3  (NFHS) data shows that anemia is widely prevalent among all age groups in the country and is particularly high among pregnant women, women in reproductive age group, adolescent girls and boys and children under the age of 5. In Karnataka, trends are similar to that of the national level. In India,  dietary deficiency is the major cause of nutritional anemia. Anemia can also be due to infections such as worm infestations, malaria, chronic diseases like TB, rheumatoid arthritis. In some cases it may be genetic in origin. Anemia in India occurs primarily due to iron deficiency and is the most widespread nutritional disorder in the country today. Iron deficiency occurs due to various reasons. 

Body demand for iron

Adolescents, both girls and boys,  are also at risk to iron deficiency due to significantly increased nutritional requirement during the second growth spurt which occurs at the onset of puberty. Adolescent girls are more vulnerable to anemia  due to the increased requirement of iron in the body to compensate for loss of blood during menstruation.  Similarly, iron deficiency anemia is more prevalent among women as compared to men, due to menstrual iron losses. Pregnant women in particular are more at risk  due to the  iron demands of a growing fetus which are approximately two times the demands in a non-pregnant state.

Iron deficiency has multifaceted adverse impact on human beings.  It affects the cognitive performance, behaviour and physical growth of infants, pre-school and school going children. In adolescents, it impairs physical growth, weakens cognitive development, reduces physical fitness and work capacity, diminishes concentration in daily tasks and leads to loss of appetite as well as irregular menstruation. In pregnant women, it enhances the risk of pre-term delivery and babies with low birth weight, especially in teenage pregnancies.

A multipronged approach is required to prevent and correct both iron deficiency and iron deficiency anemia. This includes measures to improve iron intake through food based approaches such as dietary diversification and food fortification, iron supplementation as well as improved health services and sanitation. In a scenario such as India, where it is difficult to influence dietary behaviour due to widely varying food preferences and cultural practices, the first step towards addressing iron deficiency would be the implementation and scaling up of Iron and Folic Acid (IFA) Supplementation programme and management of all forms of iron deficiency anemia.

As a part of this strategy, the ministry of health and family welfare has started  a prophylactic (preventive) weekly Iron and Folic Acid Supplementation (WIFS) programme to meet the challenge of high prevalence of anemia amongst adolescents girls and boys. WIFS is an evidence based programme response to the prevailing anemia situation among adolescent girls and boys through supervised ingestion of IFA supplementation and biannual deworming. 

The programme will follow a fixed day approach in the administration of supervised weekly IFA supplementation of 100 mg elemental iron and 500 microgram of Folic Acid to school going adolescent boys and girls  as well as out of school adolescent girls on every Monday. The nodal teachers and anganwadi workers will ­screen the target groups for moderate and severe anemia and refer them for appropriate management and treatment to the nearest public health facility.

The programme also includes a component of deworming  every six months to control helminthic infestation. Since supplementation efforts need to be supported by inculcating healthy eating habits and hygiene practices, nodal teachers and anganwadi workers have been trained to  provide information and counseling on improving dietary intake of iron as well as for taking action to prevent worm infestation to the adolescent girls and boys and their caregivers by holding monthly nutrition and health education sessions in schools and anganwadi centers. The long term goal of this programme is to break the intergenerational cycle of anemia while the short term  benefit will be that of a nutritionally improved human capital.

(The writers are with the National Rural Health Mission)

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