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Definition♦ Anemia - insufficient Hb to carry out O2 requirement by tissues.♦ WHO definition : Hb conc. < 11 gm %♦ CDC definition : Hb conc. < 11gm % in 1st and 3rd trimesters and < 10.5 gm% in 2nd trimester♦ For developing countries : cut off level suggested is 10 gm %
WHO Classification of AnaemiaDegree Hb% Haematocrit (%)Moderate 7-10.9 24-37%Severe 4-6.9 13-23%Very Severe <4 <13%
Magnitude of Problem♦ Globally, is about 30 %♦ In developing countries & India, incidence is around 40 – 90%.♦ Responsible for 40% of maternal deaths in third world countries.♦ Important cause of direct and indirect maternal deaths
Reason For Increased Incidence Of Anemia♦ Poor pre-pregnancy iron balance due to – untreated systemic diseases & menstrual disorders♦ Improper supplementation of iron in pregnancy ( late registration and poor follow up)♦ Repeated childbearing♦ Lack of awareness and illiteracy
Reason For Increased Incidence Of Anemia♦ Low socioeconomic status and poor hygiene♦ Chronic malnutrition♦ Poor availability of iron due to predominantly veg diet, diet low in calories but rich in phytates. Food and religious taboos♦ GI infections and infestations (e.g. Kala azar, worm infestations)
Complications - Pregnancy IUGR CCF PIH INFECTIONIUD IUH Medical PRETERM Disorder LABOUR
Available studies on prevalence of nutritionalanemia in India show that 65% infant andtoddlers, 60% 1-6 years of age, 88% adolescentgirls (3.3% has hemoglobin <7 gm./dl; severeanemia) and 85% pregnant women (9.9%having severe anemia. The prevalence ofanemia was marginally higher in lactatingwomen as compared to pregnancy. Thecommonest is iron deficiency anemia.
launched in 1970to prevent nutritional anemia in mothers andchildren.1 tablet of iron and folic acid daily for a period of100 days.taken up by Maternal and Child Health (MCH),Division of Ministry of Health and Family Welfare.Now it is part of RCH programme.
The Ministry of Health and Family Welfare has revised theguidelines on IFA supplementation related to the NationalNutritional anaemia Prophylaxis programme.The infants between 6-12 months should also be included inthe programme as there is sufficient evidence that irondeficiency affects this age also.Children between 6 months to 60 months should be given20mg elemental iron and 100 mcg folic acid per day per childas this regimen is considered safe and effective.National IMNCI guidelines for this supplementation to befollowed.
For children (6-60 months), ferrous sulphate and folic acid should beprovided in a liquid formulation containing 20 mg elemental iron and100mcg folic acid per ml of the liquid formulation. For safety reason,the liquid formulation should be dispensed in bottles so designed thatonly 1 ml cab be dispensed each time.The current programme recommendations for pregnant and lactatingwomen should be continued.
School children, 6-10 year old, and adolescents, 11-18 year olds,should also be included in the National Nutritional AnaemiaProphylaxis Programme (NNAPP).Children 6-10 year old will be provided 30 mg elemental iron and250 mcg folic acid per child per day for 100 days in a year.Adolescents, 11-18 years will be supplemented at the same doses andduration as adults. The adolescent girls will be given priority.Multiple channels and strategies are required to address the problemof iron deficiency anaemia. The newer products such as doublefortified salts / sprinkles/ ultra rice and other micro nutrientcandidates or fortified candidates should be explored as an adjunct oralternate supplementation strategy.