WHO DEFINITION• A condition in which the haemoglobin content of blood is lower than normal as a result of deficiency of one or more essential nutrients regardless of the cause of such deficiency
WHO cut off points for diagnosis of Nutritional Anemia Haemoglobin [ g/dl] MCHC [ per cent]Adult males 13 34Adult females, non 12 34pregnantAdult females , pregnant 11 34Children, 6 months to 6 11 34yearsChildren, 6-14 years 12 34
Causes of Anaemia• Most frequent cause – Iron deficiency other causes - Folate deficiency Vitamin B12 deficiency• Groups mainly affected Women of child bearing age [ 4-12 percent in India ] Young children During pregnancy [ 2/3 of pregnant woman and ½ of non pregnant woman in developing countries] During lactation
• Prevalence of anaemia in adolescent girls is very high [ 72.6%]
PATHOGENESIS• Inadequate intake• Poor bioavailability of dietary iron [ impt.]• Excessive losses of iron from body. [ menstruation , malaria , hook worm infestations]• Megaloblastic anaemia – poor socioeconomic groups.
Detrimental Effects• During pregnancy- abortions, premature births, PPH, LBW babies, increased maternal and foetal mortality and morbidity.• Infection - can be caused or be aggravated by diseases, increase susceptibility to infection• Work capacity – great reduction in work performance
• Hb Less than 10g/dl – SEVERE – High dose of iron or blood transfusion. - REFERRAL• If Hb 10 – 12 g/dl Iron and folic acid supplementation Iron fortification Other strategies
1.Iron and Folic Acid supplementation National Nutritional Anaemia Prophylaxis Programme• Launched during 4th five year plan-1970• Programme is based on daily supplementation with iron,folic acid –to prevent mild, moderate cases of anaemia, to double the quantity if pallor (+)
• Beneficiaries – pregnant women , lactating mothers and children under 12 years• DOSAGE1.CHILDREN [ 6m – 5yrs]• If suspected , screening test done at 6 months, 1 year , 2 years.• 20mg iron + 100mcg FA X 100 days• Liquid formulation – 1ml at a time
2. SCHOOL CHILDREN 6 – 10 yrs• 30mg iron + 250 mcg FA X 100 days3. ADULT & Adolescents• 100mg iron + 500 mcg FA X 100 days
4. MOTHERS• 100mg elemental Fe + 500 mcg FA daily until 2-3 months after the Hb level has returned to normal.
2.Iron Fortification• Developed by National Institute of Nutrition, Hyderabad• Addition of ferric ortho phoshapte or ferrous sulphate with sodium bisulphate was enough to fortify salt with iron.• When consumed for 12-18 months – reduce prevalence of anaemia.• Commercial production since 1985.
3.Other Strategies• Changing dietary habits• Control of parasites• Nutrition education