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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.
- 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
- 7. Cont.. 2) Adults • Low work productivity • Low physical activity, increased fatigue, impaired muscle strength • Increased disability, greater risks of falls • Irritability, mood swings • Higher risks of dementia • Irregular cardiac rhythm,cardiac arrest • Increased hospitalizations, higher risks of death.
- 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
- 12. Prevalence of Anemia in India
- 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.
- 18. Beneficiaries
- 19. 6 Interventions
- 21. Targets Aim:To reduce the Prevalence of Anemia by 3% per annum as per POSHAN Abhiyan targets
- 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
- 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