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Anaemia in India
Context:
India has the highest number of anaemic individuals globally, often referred to as a “silent epidemic.”
Overview of Anaemia:
- Anaemia is a condition characterised by low red blood cells or haemoglobin levels, impairing the body’s ability to carry oxygen to tissues.
- It predominantly affects women and children, with severe consequences for cognitive and motor development in children and pregnancy outcomes for women.
- Anaemia is preventable and treatable with proper interventions.
Symptoms:
- Common Symptoms: Fatigue, dizziness, cold extremities, headaches, shortness of breath, especially upon exertion.
- Severe Symptoms: Pale mucous membranes and skin, rapid heart rate, dizziness when standing, easy bruising.
Causes of Anaemia in India:
- Nutritional Deficiencies: Iron deficiency is the leading cause of anaemia, resulting from insufficient dietary intake or poor absorption of nutrients. Other micronutrient deficiencies, such as folate, vitamin B12, and vitamin A, also contribute.
- Socioeconomic Factors: Marginalised status, low income, illiteracy, and restricted healthcare access increase vulnerability. Cultural beliefs and practices lead to restrictive diets during pregnancy or postpartum periods.
- Health Conditions: Chronic diseases (HIV, tuberculosis, malaria) and parasitic infections (hookworms, schistosomiasis) are major contributors. Inherited blood disorders like thalassemia and sickle cell disease.
Global Scope and Impact:
- Prevalence: According to the National Family Health Survey (NFHS-5) 2019-2021, 57% of women and 67.1% of children in India are anaemic.
- Higher prevalence is noted among rural populations, women of reproductive age, young children, and adolescents. Anaemia rates have increased across all categories since NFHS-4 (2015-16), where the frequency of anaemia in women rose from 53% to 57%.
- Vulnerable Groups: Particularly adolescent girls, due to menstrual blood loss and inadequate nutritional intake. Children under 5 years, particularly those born to anaemic mothers. Pregnant and postpartum women, due to physiological changes and blood loss.
- Regional Disparities: States like Jharkhand and Bihar report the highest anaemia prevalence due to poverty, limited healthcare access, and inadequate nutrition. Rural areas (68.3%) exhibit higher anaemia prevalence compared to urban regions (64.2%).
- COVID-19 Impact: The pandemic disrupted nutritional programs and health services, exacerbating the anaemia burden. Studies found that 80% of women hospitalised for COVID-19 in eastern India were anaemic, with severe cases leading to higher fatality rates.
Government Initiatives:
- The Anaemia Mukt Bharat (AMB) strategy, introduced in 2018, aims to reduce anaemia through a lifecycle approach, with six key interventions through a 6x6x6 strategy targeting mothers, children, and adolescents.
- AMB is part of broader initiatives like Mission POSHAN 2.0, focusing on nutrition, food fortification, diet diversity, and millets.
- The Food Fortification Programme aims to improve nutritional outcomes by adding essential micronutrients to staple foods.
Additional Government Activities
- The National Deworming Day program involves biannual mass deworming for children and adolescents aged 1-19 years, carried out on 10th February and 10th August every year. This helps to improve Iron Folic Acid (IFA) supplementation compliance and overall nutrition.
- Mission Poshan 2.0 is a flagship program aiming to combat malnutrition and improve health, wellness, and immunity. It involves distributing fortified rice enriched with iron, folic acid, and vitamin B12 under various schemes like the Targeted Public Distribution System (TPDS) and Integrated Child Development Services (ICDS).
- PMSMA provides fixed-day, free of cost, quality antenatal check-ups by a specialist/medical officer on the 9th of every month for pregnant women, addressing issues like anaemia as well as ensuring that pregnant women receive respectful and quality care during delivery.
- Under JSSK, every pregnant woman is entitled to free delivery, including cesarean sections, in public health institutions along with provision of free transport, diagnostics, medicines, and other consumables.
Recommendations:
- Nutritional Interventions: Increase consumption of iron-rich foods (leafy greens, legumes, fortified cereals). Promote dietary diversity through education and awareness campaigns.
- Health and Clinical Measures: Ensure adherence to IFA supplementation and manage adverse effects. Improve anaemia screening using accurate diagnostic tools like venous blood samples.
- Community and Regional Strategies: Empower community health workers to counsel parents on anaemia prevention. Implement region-specific interventions targeting high-risk groups (pregnant women, lactating mothers, children under five).
- Holistic Approach: Address social, cultural, dietary, and economic factors alongside clinical management for sustainable anaemia prevention.
