India Re-Thinking its Anaemia Policy

Context: The government is set to drop questions related to anaemia from National Family Health Survey, which is slated to begin soon.

 Why is Government re-thinking its policy?

• Efficacy of method: The omission has been suggested after health experts questioned the efficacy of the method being used to estimate haemoglobin levels.
  • Since anaemia is a public health challenge, accurate estimates are needed to tackle the crisis.
• Varying hemoglobin standard of Indian population: India follows WHO cut-offs for haemoglobin levels, which may not be suited to the country. This may lead to over-diagnosis of the condition.
  • The WHO cutoff depends on various factors such as the age, gender, physiological status, altitude and other factors. This value may vary across population.
• Issue with sample collection: Indian study pointed to differences in the way blood is drawn for sampling in NFHS.
  • Hemoglobin measured by NFHS is through a drop of capillary blood that oozes from a finger prick. This can dilute the blood and give false value.
  • The method of venous blood sampling can give a more accurate value.

Suggested alternative method of assessing anaemia: DABS-I

• The authorities are planning to shift to the new Diet and Biomarkers Survey in India (DABS-I) to map diet, nutrition and health status that will help in providing the correct estimate of anaemia among the rural and urban population.
• DABS will define food and nutrient adequacy by collecting individual dietary intake data of different age-groups of people from across the country.
• It will be providing nutrient composition data on cooked and uncooked foods from various regions of the country for the first time. This will provide better estimates.

What is Anaemia?

• Anemia is a medical condition characterized by a lack of healthy red blood cells or hemoglobin in the blood. Hemoglobin is a protein in red blood cells that carries oxygen from the lungs to the body’s tissues.
• When there are not enough red blood cells or hemoglobin in the blood, the body’s cells do not get enough oxygen, which can cause fatigue, weakness, and other symptoms.
• Children and pregnant women are especially vulnerable, with an increased risk of maternal and child mortality.
• WHO standard: According to WHO, women in the reproductive age group and having haemoglobin levels lower than 12 grams per decilitre (g / dL), as well as children under five with haemoglobin levels lower than 11.0 g / dL are considered anaemic.
• Types of anaemia: There are several types of anemia, including:
  • Iron-deficiency anemia, which is the most common type and is caused by a lack of iron in the body.
  • Vitamin-deficiency anemia, which is caused by a lack of vitamin B12 or folata.
  • Hemolytic anemia, which is caused by the destruction of red blood cells.
• Causal factors: Anemia can be caused by a variety of factors, including poor nutrition, chronic diseases such as kidney disease or cancer, inherited conditions such as sickle cell anemia, and certain medications.
• Treatment: Treatment for anemia depends on the underlying cause and may include iron supplements, vitamin supplements, blood transfusions, or other medical interventions.
• Effects of anaemia:
  • Affects physical development: It affects cognitive and physical development in children and reduces productivity in adults.
  • Poor nutrition: Anaemia is an indicator of both poor nutrition and poor health.
    • It can also impact other global nutritional concerns such as stunting and wasting, low birth weight and childhood overweight and obesity due to lack of energy to exercise.
  • Affects productivity: School performance in children and reduced work productivity in adults due to anaemia can have further social and economic impacts for the individual and family.

Prevalence of Anaemia in India and the World

• According to the National Family Health Survey 2019-20, Indian women and children are overwhelmingly anaemic.
  • NFHS-5 found that 57% of women in the age group 15-49 and 67% children between six months and 59 months are anaemic.
  •  A prevalence study on anaemia is useful to monitor the progress of reproductive health. This will help keep track of pregnant women and new mothers
• WHO estimates that 42% of children less than 5 years of age and 40% of pregnant women worldwide are anaemic.
• Prevalence in Indian men: The Lancet Global Health survey revealed that nearly one in four men (23.2%) in the age group 15-54 years in India were anaemic (mild, moderate, or severe).
• Iron-deficiency anemia is the most common form, making up about 50% of all anemia cases in India.

Government intervention to prevent anaemia

• Anaemia Mukt Bharat (AMB): It is a national campaign launched by the Government of India in 2018 with the aim of reducing the prevalence of anaemia among women and children in India through a life cycle approach.
  • The campaign aims to increase awareness about anaemia, promote the consumption of iron-rich foods, and provide iron and folic acid supplements to vulnerable groups, such as pregnant women and children.

• 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) tablets.
  • To control worm infestation, biannual deworming with Albendazole is provided.
• Integrated Child Development Services Scheme (ICDS): Government implements Anganwadi Services, Pradhan Mantri Matru Vandana Yojana and a Scheme for Adolescent Girls under the Umbrella of ICDS as targeted interventions to address the problem of malnutrition in the country.
• POSHAN Abhiyaan: It is a flagship national nutrition mission to improve nutrition among children, pregnant women and lactating mothers.
•  Mid-Day Meal Scheme: It is a school meal programme in India designed to better the nutritional standing of school-age children.
• 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 to detect and treat cases of anaemia.

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