1. Capsule of Anaemia Programmes
Dr Chitra Nagaraj
Professor of Community Medicine
PESIMSR
Kuppam

3. What Anaemia can do to a Country
Anaemia is the world’s second leading cause of disability and thus one of the most serious global public health problems.
Anaemia affects over half of pre-school children and pregnant women in developing countries and at least 30-40% in industrialized countries.
In poorer malaria endemic countries anaemia is one of the commonest preventable causes of death in children under 5 years and in pregnant women.

4. Global estimates of the prevalence of anaemia
in infants and children aged 6‒59 months, 2011

5. Global estimates of the prevalence of anaemia, all
women of reproductive age, 15‒49 years, 2011

6. Global estimates of the prevalence of anaemia
in pregnant women aged 15‒49 years, 2011

7. Prevalence of anaemia among different age groups in India

8. Prevalence of anaemia among pregnant women in India

9. Health Economics of Micronutrient Deficiencies in Children
Anemia and other key micronutrient deficiencies can directly attribute to
Depressed Cognition
Inferior school performance
Reduced future earnings & productivity
Depressed immunity
Repeated infections

12. Micronutrient deficiencies during pregnancy results in spontaneous abortions, Pre term labour, IUGR, LBW babies and maternal deaths.
The cost implications include:
Increased length of hospital stay
Expenses related to referral, transport of cases to hospitals with pediatric care facilities
Cost of incubators and Intensive care
Cost of post maternity care

13. What anaemia can do to an individual
Anemia reduces the amount of oxygen available in the cells of the body.
As a result, you have less energy available to perform normal functions. 
Important processes, such as muscular activity and cell building and repair, slow down and become less efficient.
When the brain lacks oxygen, dizziness may result, and mental faculties are less sharp. 

14. Haemoglobin levels to diagnose Anaemia

17. Need for Health programmes to address Anaemia
Prevalence high
Morbidity is high
Barriers to health care in terms of Affordability and Availability
National Health Programmes with strategies are most effective.

18. Rationale: Evidence to address the issue through national programme
Anaemia in pregnant women reduces women’s ability to survive bleeding during and after child birth
Risk of maternal mortality decreases by about 20% for each one g/dl increase in Hb
Reduction in severe anemia is evidenced in pregnant women who receive regular malaria prophylaxis in malaria endemic areas

19. Rationale: Evidence to address the issue through national programme (contd)
34.5% of the preterm deliveries are in low income severely anaemic women in India
Dietary Iron consumption in India –expected is 26mgs/day but absorption upto 5% only.
During Pregnancy Hb<10g/L at wk gestation had to 1.75 fold higher relative risk of preterm birth, LBW and preterm mortality.
Early supplementation reduces the iron depletion in the last trimester of pregnancy

20. Rationale: Evidence to address the issue through national programme (contd)
Pregnant women who are in mild –moderate anemia are also at risk of dying.
Severe maternal anemia < 8 gm/L increases the risk of death due to rapid cardiac decompression even without the additional stress of true post partum haemorrhage < 500ml blood loss during delivery could be fatal.
20% maternal deaths are attributable due to anemia in India

21. Strategies for Prevention of Iron Deficiency

22. National Nutritional Anaemia Prophylaxis Programme
The programme was launched in 1970 – to prevent nutritional anaemia in mothers and children
Expectant mothers, nursing mothers, acceptors of family planning.
For children 6 – 60 months and years
Adolescent 11 – 19 years
Children between 6 months to 60 months mg elemental iron mcg folic acid/day/child

23. National Nutritional Anaemia Prophylaxis Programme
Objectives –
Reduce prevelance and incidence of anemia in women in reproductive age group, pregnant, lactating women and preschool children
Organisation
Programme is implemented through the PHC and its Subcentre
The female MHW and other paramedical in the PHC are responsible for distribution of Iron and Folic acid tablets
Vandemataram scheme – 9 feb 2004 – reduce mortality and morbidity of pregnant and lactating women by utilizing vast resources of specialist, trained wok force available in private sector

24. Strategies for prevention of IDA & Malnutrition
Dietary Diversification
Food Fortification
IFA Supplementation with Biannual deworming
Provide Improved Health Services

25. Strategies Improve Breast feeding practices – Exclusive breast feeding
Appropriate and adequate complementary feeding with iron rich foods till 2 years of age
Ensuring Dietary Diversification
Fortification of wheat and maize flours with iron, folic acid and other micronutrients is advised in settings where these foods are major staples.
Supplementation of IFA, Vitamin A and other essential micronutrients
Control of other factors affecting Iron, Vitamin A Deficiency by biannual deworming and Vitamin A supplementation, malaria control
In Maharashtra we are approaching this problem in a multi dimensional way.
As we are aware improved breast feeding practices with quality & optimum complementary feeding reduces risk of anemia in children, we are conducting extensive IYCF trainings for the health as well as ICDS staff. Training of AWWs & Supervisors has helped in BCC on IYCF. IYCF Counsellors are being appointed at women’s hospitals and district hospitals under NHM.
We are trying to ensure dietary diversification introduced early in the life of child with complementary feeds. We are establishing kitchen gardens at the AWCs & schools to ensure inclusion of GLVs in the Hot cooked meals. Similarly Adolescents are trained for taking optimal diversified diet through the SABLA trainings.
IFA is supplementaed as a preventive strategy for anemia in a life cycle approach based on the new National iron Plus Initiative guidelines by GoI
Also We have regular biannual deworming and Vitamin A supplementation rounds which supports reduction of anemia in children.

26. National Iron Plus Initiative: A MoHFW Program Supplementation through the Life Cycle along with Biannual deworming

27. Supplementation Interventions by Ministry of Health and Family Welfare (MoHFW)

28. Evaluation of IFA Supplementation
IFA intake remain low
Even though supplementation of diet with iron and folic acid (IFA) has been a part of Government of India programming for over three decades
NFHS data shows that
less than 20 per cent of women below 20 years took IFA supplements
22 per cent of pregnant women reported consuming IFA for 90 days or more when they were pregnant.
There are significant challenges in reaching the at-risk population as well as improving compliance.

29. Key Programmes and Schemes of Other Ministries Integrated Child Development Services (ICDS) Scheme of Ministry of Women & Child Development (MWCD)

30. Key Programmes and Schemes of Other Ministries Integrated Child Development Services (ICDS) Scheme of Ministry of Women & Child Development (MWCD)
Supplementary Nutrition Provided under ICDS bridges the gap between the Recommended Dietary Allowance (RDA) and Avg. Daily Intake (ADI)
Take Home Ration provided is energy dense & micronutrient fortified which provides 500 calories and gms proteins to children between 6 months– 3yrs and 600 calories and gms proteins to Pregnant & Lactating women
Food supplement with 800 gms of calories and gms of proteins is provided to every Severely UnderWeight child per day in the form of Home Cooked Meal or Take Home Ration
Some states supply Multi Micronutrient powder for home food fortification to prevent anemia in children

31. SABLA Scheme of Ministry of Women and Child Development (MWCD)
SABLA, where supplementary nutrition is provided to adolescent girls (AGs) in the form of take home rations (THR) or hot cooked meals.
Under SABLA, each AG will be given at least 600 calories and 18–20 grams of protein and the recommended daily intake of micronutrients, at Rs 5 per day per beneficiary, for 300 days in a year.

32. Other Measures
Partnering with local NGOs to develop kitchen gardens and generate awareness among the communities on locally available nutrient rich vegetables and fruits
Creating Peer groups among adolescent girls through SABLA training to spread knowledge on nutrition.

33. Mid day Meal Programme
Ministry of Education

34. Mid-day Meal Programme
Objectives
Improving the Nutritional status of primary school children particularly those who belong to low socio economic group
To improve attendance and enrolment in schools
To prevent drop outs from primary school
Beneficiaries
Children attending primary schools between 6 to 11 years of age
They are provided 300 Kcal and 10 grams of protein/day/child for 250 days in a year

35. Conclusion
Reducing the burden of anaemia will make a major contribution to achieving several UN Millennium Development Goals.
Since the greatest burden of anaemia falls on the most "hard-to-reach" individuals, any programme that aims to reduce anaemia will need to be accessible by these groups.
Primary health care policies and programmes must be a cornerstone of health care systems.
Interventions which have been shown to impact on anaemia include improving nutrition and iron status and treating helminth and malaria infections.

36. Take Home Message It is our duty to work for this goal
Happy healthy parents make
Happy healthy children
&
Happy healthy nation
It is our duty to work for this goal

38. THANK YOU