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Anemia Mukt Bharat -An Intensified National Iron Plus Initiative

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Presentation on theme: "Anemia Mukt Bharat -An Intensified National Iron Plus Initiative"— Presentation transcript:

1 Anemia Mukt Bharat -An Intensified National Iron Plus Initiative
18th September, 2018 Ministry of Health and Family Welfare Government of India

2 High Prevalence across all ages Slow progress in most of the States
A Snapshot of Anemia in India v High Prevalence across all ages Slow progress in most of the States Trend in Prevalence of Anemia among Children and Women 58% of children (6-59 months) 54% of adolescent girls (15-19 years) 29% of adolescent boys (15-19 years) 53% of women in their reproductive age 50% of pregnant women 58% of breastfeeding mothers

3 among Pregnant Women (15-49 yrs)
v Anemia Prevalence among Pregnant Women (NFHS-4) Anemia prevalence among Pregnant Women (15-49 yrs) States/ UTs More than 50% 11 States and 2 UTs Bihar, Himachal Pradesh, Jharkhand, Madhya Pradesh, Uttar Pradesh, Meghalaya Tripura, Andhra Pradesh, Gujarat, Haryana, West Bengal A & N islands and D & N Haveli 40% to 50% 10 States and 1 UT Chattishgarh, Odisha, Rajasthan, Uttarakhand, Assam, Karnataka, Maharashtra, Punjab, Tamil Nadu, Telangana Delhi Less than 40% 8 States and 2 UTs Jammu & Kashmir, Arunachal Pradesh, Manipur, Mizoram, Nagaland, Sikkim, Goa, Kerala Lakhwadeep and Puducherry

4 Causes of High Burden of Anemia
v Causes of High Burden of Anemia Low Iron Stores During pregnancy in anemic mothers Poor iron stores from infancy, childhood deficiencies and adolescent Anemia Dietary Inappropriate IYCF esp. Complementary Feeding Practices Excessive consumption of ‘Iron Inhibitors’ (tea, coffee, calcium-rich foods) and low intake of ‘Iron Enhancers’ (Vitamin C etc.) Low bioavailability of dietary iron 50% of the population is consuming < 50% RDA Iron Loss Due to parasitic load (malaria, intestinal worms) Poor environmental sanitation, unsafe drinking water and inadequate personal hygiene Maternal Anemia Increased iron requirement due to tissue, blood formation and energy requirement during pregnancy Iron loss from post-partum haemorrhage Teenage pregnancy Repeated pregnancies with less than 2 years interval

5 Public Health Implications of Anemia
v Reduced physical development Impact on pregnancy outcomes Reduced cognitive development Economic impact Decreased work output and work capacity Physical and cognitive losses due to IDA in South Asia are staggering: close to $ 4.2 billion annually in Bangladesh, India and Pakistan About 20 % of maternal deaths are caused by Anemia worldwide tube defects, infants of low birth weight and still births AnemiNeuralc pregnant women are more prone to increased morbidity and ; there is a three times greater incidence of premature delivery in severely anemic women Diminished concentration, disturbance in perception, delayed psychomotor development Impaired language and motor skills, Diminished IQ equivalent to a 5–10 point In the WHO/World Bank rankings, Iron Deficiency Anemia is the third leading cause of DALYs lost for females aged 15–44 years and % of Gross Domestic Product (GDP) loss. Median total loss (physical and cognitive) combined are 4.05% of GDP in developing countries.

6 Why Should We Address Anemia?
Improvements enhance human capital Contribute to a virtuous cycle by fostering economic development v Why Should We Address Anemia? Short term, Long term and Intergenerational benefits Enhances health & nutrition of women and children Contribute to a virtuous cycle by fostering economic development Improvements enhance human capital World Health Assembly has proposed a target of 50% reduction in Anemia among women by 2025 and NHP 2017 commits to reduce anemia prevalence by 3% per year poor growth, development and cognition in children, increased risk of preterm delivery, low birth weight and reduction in neonatal iron stores during pregnancy reduction in work efficiency and productivity in general It is estimated anemia contributes to around 0.4 per cent of Global DALYs. Evidence is that anemia elimination can increase productivity by up to 17 per cent. Reduction of anemia prevalence by 50 percent has been stated as one of the goals in 12th Action Plan. The National Health Policy 2017 also lays a special focus on the health challenges of adolescents and Children as one of the key policy intervention for achieving the RCH outcomes. Annual average rate of reduction (AARR) of anemia prevalence Current – close to 1% Committed to achieve target – 3%

7 Milestones in Control of Anemia in India
v Milestones in Control of Anemia in India Anemia control efforts in India started in 1970 with supplementation of Iron and folic acid across age groups Anemia level in various population groups remained high IFA coverages remained less than 30% More than 50% cases of anemia attributed to Iron deficiency 2018 I-NIPI Program intensification (Anemia Mukt Bharat) PLW 60mgX180 days, IFS for WRA 6X6X6 strategy Life cycle approach 2013 Wkly and biwkly supplementation. Test and treat (NIPI) Life cycle approach 2007 5-10 yrs age group added 1991 60 mg Iron changed to 100mg 1970 60 mg Iron supplementation for PW and 20 mg for 1-5 yr X100 days

8 Learning from Best Performing States/ Districts
v

9 States with >=30% Anemia Decline What Did They Do?
v States with >=30% Anemia Decline What Did They Do?

10 Anemia Mukt Bharat v 6 interventions institutional mechanisms 6X6X6 strategy Anemia Mukt Bharat will use a 6x6x6 strategy to combat anemia

11 Six Beneficiaries Estimated 450 million beneficiaries
v Estimated 450 million beneficiaries Reaching nearly 50% of the country’s population

12 Beneficiary-wise Targets
v To reduce the prevalence of anemia by 3 percentage points per annum

13 Six Interventions v 2 1 4 3 6 5 Prop h ylactic iron folic acid
supplementation 3 Intensified year-round Behavior Change Communication Campaign Solid Body Smart Mind ,delayed cord clamping 5 Mandatory pr o vision of iron public health prog r ammes ANGAN W ADI 2 P eriodic deworming of children, adolescents, pregnant women 4 T esting of anemia using digital methods and point of care treatment HOSPI AL 6 Addressing non-nutritional causes of anemia in endemic pockets, with special focus on malaria, haemoglobinopathies and fluorosis

14 Intervention- 1 Prophylactic IFA supplementation- Regime v Age group
Dose 6 – 59 months of age Biweekly, 1 ml Iron and Folic Acid syrup Each ml of Iron and Folic Acid syrup containing 20 mg elemental Iron mcg of Folic Acid Bottle (50ml) to have an ‘auto-dispenser’ and information leaflet as per MoHFW guidelines in the mono-carton 5- 10 years children Weekly, 1 Iron and Folic Acid tablet Each tablet containing 45 mg elemental Iron mcg Folic Acid Sugar-coated, pink colour

15 Prophylactic IFA Supplementation- Regime
Cont... Prophylactic IFA Supplementation- Regime v Age group Dose Adolescent girls and boys, 10-19 years of age Weekly, 1 Iron and Folic Acid tablet Each tablet containing 60 mg elemental iron mcg Folic Acid Sugar-coated, blue colour Women of reproductive age (non-pregnant, non-lactating) 20-49 years Each tablet containing 60 mg elemental Iron mcg Folic Acid, sugar-coated, red colour All women in the reproductive age group in the pre-conception period and up to the first trimester of the pregnancy are advised to have 400 mcg of Folic Acid tablets, daily Pregnant women and lactating mothers (0-6 months child) Daily, 1 Iron and Folic Acid tablet starting from the fourth month of pregnancy (that is from the second trimester), continued Throughout pregnancy (minimum 180 days during pregnancy) To be continued for 180 days, post-partum Each tablet containing 60 mg elemental Iron mcg Folic Acid Sugar-coated, red colour

16 Intervention 3 Intensified 360 Degree IEC/ BCC for Anemia Prevention & BehaviourChange v Focus on Social mobilization and behaviour change: 4 key behaviours Compliance to Iron Folic Acid supplements and deworming Appropriate Infant and Young Child Feeding (IYCF) Increase intake of iron-rich, protein-rich and vitamin C rich foods through diet diversification and consumption of fortified foods. Practice of delayed cord clamping in all health facility deliveries followed by early initiation of breastfeeding within 1 hour of birth Solid Body, Smart Mind

17 Intervention 4 Test and Treat Strategy Testing: v
Use of digital hemoglobinometers In two age groups- to begin with School-going Adolescent girls and boys years, WIFS beneficiaries, using RBSK mobile teams Pregnant women at all ANC contact points. At all high case load facilities at block level and above, hemoglobin level estimation will be done using Semi-Auto Analyzers This may be extended to all age groups, later

18 Anemia Management Protocol for Adolescents
v Mild/moderate First level of treatment (at all levels of care) Two IFA tablets (each with 60 mg elemental iron and 500 mcg folic acid), once daily, for 3 months Line listing of all anemic cases; Two Follow-ups First follow-up after 45 days and second follow-up after 90 days at nearest health facility If hemoglobin levels have come up to normal level, discontinue the treatment and continue with the prophylactic IFA dose If no improvement after first level of treatment If no improvement after three months of treatment, RBSK team will refer the adolescent to First Referral Unit (FRU)/District Hospital (DH) Severe anemia Management to be done by medical officer at FRU/DH based on investigation and diagnosis

19 Anemia Management Protocol forPregnant Women
v Mild/moderate First level of treatment (at all levels of care) Two tablets of iron and folic acid tablet (60 mg elemental iron and 500 mcg folic acid) daily, orally given by the health provider during the ANC contact. * Parental iron (IV Iron sucrose or Ferric Carboxy Maltose may be considered as the first line of treatment in pregnant women who are detected to be anemic late in pregnancy or in whom compliance is likely to be low (high chance of lost to follow-up). Follow-up Every two months, during the ANC contact If no improvement after first level of treatment If no Hb (<1g/dl) increase; Refer to FRU/DH (case may be managed with IV Sucrose/FCM) Severe anemia (5-6.9 g/dl) By medical officer, using IV Sucrose/FCM. Immediate hospitalization if pregnant woman is in 3rd trimester. Management protocol for severe anemia contraindicated for patients of thalassemia major and sickle cell disease.

20 Six Institutional Mechanisms
v

21 Target based monitoring SIX performance indicators
v

22 What’s New? v Coordinated management efforts – intra & inter ministerial Target based monitoring and KPI reviews and awards; Private schools; 60 mg instead of 100 mg prophylactic dose, sugar coated. Communication materials for extensive awareness, intensive 360 degree communication campaigns - Creating a Jan Andolan… Use of digital methods of hemoglobin estimation and point of care treatment, newer treatment strategies – IV Iron Sucrose and FCM Linkage with Malaria; mandating use of fortified food in public health programmes, specially double fortified salt (iron and iodine) Linkage with academic – national and regional networks- (re) learning and policy decisions

23 LET US MAKE INDIA ANEMIA-FREE


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