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Strategies for prevention of anemia
1. STRATEGIES FOR PREVENTION
OF ANEMIA
Dr.Ginic Gupta
Junior Resident
Upgraded Department of community medicine and public health
KGMU Lucknow
2. WHAT IS ANEMIA?
• Anemia is a condition in which the number of
red blood cells and/OR their oxygen-carrying
capacity is insufficient to meet the body’s
physiological needs.
• In Ayurveda- Anemia is referred as “PANDU
ROG” meaning disease with pallor.
3.
4. Cut-off points for the Diagnosis of
Anemia
• Adult males 13 g/dl (venous blood)
• Adult Females, non pregnant 12g/dl
• Adult Females,Pregnant 11g/dl
• Children 6 months to 6 years 11g/dl
• Children 6 yrs to 14 years 12g/dl
5. ANEMIA CLASSIFICATION
• MILD – Hb level : 10-10.9 g/dl
• MODERATE- Hb level : 7- 9.9 g/dl
• SEVERE – Hb levels : less than 7 gm/dl
6. HEALTH CONSEQUENCES OF ANEMIA
1) Children and Adoloscents
• Poor cognition,concentration ,memory and
school performance
• Depressed immunity, repeated infections
• Poor motor development outcomes
• Increased fatigue/shortness of breath,low
indurance
• Irregular menstruation
• Child mortality
8. Cont..
3) Pregnant Women
• Premature birth
• Low birth weight
• Increased blood loss during delivery
• Increased chances of PPH
• Maternal mortality
• Perinatal mortality
• Neonatal mortality
• Immune suppression and increased morbidity
9. Cont..
4) Lactating Women
• Decreased Quality of life
• Increased tiredness,breathlessness ,
palpitations,
• Increased risk of infections
• Increased stress , higher risk of depression
10. Global Burden of Anemia
• Anemia is the most common public health
problem affecting around 1.9 billion
population of the world(1)
• 90% of the cases of Anemia were in
Developing countries(2)
• Africa and Asia accounts for 85% of anemia
cases(2)
• Global burden of disease 2017
• WHO Global Database on Anemia 2008
11. Deaths due to Anemia
• In Asia, Anemia is the second leading cause of
maternal mortality(1)
• Mortality due to Anemia contributes to-
a)22%(n=115,000) of the total maternal
deaths every year(2)
b)24%(n=591,000) of the total perinatal
deaths every year(2)
c)90,000 deaths in both sexes and all age groups
were due to iron deficiency anemia alone
13. Evolution of Anemia control Program
in India
2012
• National Nutritional Anemia Profylaxis Program(NNAPP) launched
• Beneficiaries included Pregnant $ lactating Women, and Preschool children
1989
• Looking at the high prevalence of Anemia in Pregnant Women(about80%)
program was revamped as National Nutritional Anemia Control
Program(NNACP) as focus shifted from prevention to control
• NNACP screened all pregnant women for Anemia and changed IFA doses
from 60 mg to 100 mg of elemental iron
1992-
97
• NNACP became part of child survival safe Motherhood Programme and then
a part of Reproductive Child Health Programme
1972
• WHO in 2008 position statement for weekly Iron and Folic Acid
suppliments(WIFS) for Prevention of Anemia in Adoloscent Girls and Boys
• Ministry of Health and Family Welfare launched WIFS programme
14. Cont..
2013
• National Iron Plus Initiative(NIPI) lanched
• A Package of Services for treatment and management of
Anemia
15. Need of a Newer Programme
• The fact is that in spite of all the programs, no marked
improvement had been noticed in the magnitude of anemia.
There are evidences that despite the pregnant women
receiving 100 IFA tablets free of cost; the prevalence of anemia
has still remained alarming.
• Research reveals that the compliance rate of IFA is as low as
around 30%. To overcome this, there was a strong felt need for
focusing on Social and Behavior Change Communication (SBCC)
at community level. Considering this, the present Government
decided to give a right impetus and focus for driving the
existing programs into a full-fledged Mission.
• Hence, by political will to strengthen the existing mechanisms
and foster newer strategies, Anemia Mukt Bharat was
launched in September 2018 for combating anemia.
23. Guidelines for Prophylaxis of Anemia
Children 6-59 months:
Bi-weekly 1 ml iron and folic acid
syrup.Containing 20 mg elemental iron+100mcg
of Folic acid per ml
Children 5-9 years:
Weekly 1 iron and Folic Acid Tablet. Each tab
containing45 mg elemental iron+400 mcg Folic
acid (sugar coated ,Pink color)
10-19 years adoloscent girls and boys:
Weekly 1 iron and Folic acid Tablet. Each tab
containing 60 mg elemental iron+500 mcg Folic
acid (blue color)
24. Guidelines for Prophylaxis of Anemia
Reproductive age women(20-49 yrs):
Weekly 1 iron and folic acid tab.Each tab containing
60mg elemental iron+500 mcg folic acid(red color)
Pregnant women:
Daily 1 iron and folic acid Tab starting from 4th month
,continued throughout pregnancy (min 180 days
during pregnancy) containing 60 mg elemental iron
500 mcg folic acid
(red color)
Lactating mothers (0-6 months of child)
Daily 1 iron and Folic acid tab continued for 180 days
post partum
Each tab containing 60 mg elemental iron+ 500 mcg
Folic acid
(Red color)
25. Deworming
• Children 12-59 months of Age- Biannual dose of 400 mg
Albendazole (1/2 tablet to children 12-24 months and 1
tablet to children 24-59 months)
• Childrten 5-9 years of Age – Biannual dose of 400 mg
albendazole(1 tab)
• School going and out of School adoloscent girls and
boys,10-19 years of age- Biannual dose of 400 mg
albendazole(1 tab)
• Women of Reproductive Age(non pregnant, non
lactating)20-49 years-Biannual dose of 400 mg
albendazole(1 tab)
• Pregnant women- 1 dose of 400 mg Albendazole(1
tab),after the first trimester preferably during 2nd trimester.
26. Food Based Strategies
• Dietary diversification and enhancing the
Bioavailability of Micronutrients.
• Infants and Young child feeding: Promotion of
Breastfeeding and Complementory Feeding.
• Food Fortification.
27. Food Fortification
• Mandatory Provision of Iron and Folic Acid
fortified Products in government health
programmes:
-Iron fortified Whole wheat Flour/Refined
Floor/Rice (sodium Federate NaFeEDTA
@20 mg/kg)
-Iron fortified Salt/Double fortified salt
(Fe @ 850-1100 ppm)
28. Parentral Iron Tharapy
Intravenous iron sucrose- Has a very high potential for reducing the
burden of iron deficiency anemia
because it overcomes the problems of compliance and absorption, compared to
oral iron
supplementation and has an excellent safety record.
Indications for Intravenous Iron Sucrose Therapy:
• Intolerance to oral iron
• Poor compliance to oral iron
• Inadequate absorption due to gastrointestinal disorders – malabsorption
• Lack of response to oral iron
• Pregnant women with severe IDA, presenting late in pregnancy
• As the first line therapy in cases of moderate and severe Iron deficiency
anemia in second
and third trimester of pregnancy.
• Post-partum anemia
29. Availability-Iron Sucrose
• IV iron sucrose is available as 2.5 ml & 5ml
single dose ampoules. One ampoule of 2.5 ml
contains 50 mg and one ampoule of 5 ml
contains 100 mg of elemental iron.
JECTOFER
• Iron-Sorbitol-Citric Acid Complex- A new
intramuscular iron preparation
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38. NCEAR-A
• National Centre of Excellence and Advanced
Research on Anemia Control
• Established at AIIMS New Delhi
• To develop and provide technical support to
the Ministry of Health and Family
Welfare,Govt. of India,for incorporating
scientific policy and community perspective in
policy and programmatic decisions for control
of Anemia.
39. References
(1)Global burden of disease study 2017.Lancet.2018
nov.10;392(10159)
(2)WHO Global Database on Anemia.Geneva,world
Health Organization 2008.
(3)https://anemiamuktbharat.info
(4) niti.gov.in/content/anemia-alert-government
(5) Park’s 25th Edition
(6)Harrison’s 20th Edition
(7) Achieving Anemia free India --NCEAR AIIMS New
Delhis
