This document outlines India's Intensified Nutritional Iron Plus Initiative (INIPI) to address anemia prevalence. It defines anemia, discusses causes like iron deficiency, and impacts like reduced productivity. INIPI aims to reduce anemia in 6 target groups through 6 interventions administered via 6 institutional mechanisms. Interventions include iron supplementation, deworming, and nutrition education. The initiative aims to decrease national anemia prevalence by 18% by 2022 through screening, treating, and preventing anemia.

1. Intensified Nutritional Iron Plus Initiative
(INIPI )
Guided by – Dr. V.K.Arora
Dr. Saumitra
Presented by – Dr. Rachna Kanwar
Dr. Shyam Singh Bhati

2. Contents :
• 1 What is anemia
• 2 Prevalence of anemia in India
• 3 Classification of anemia
• 4 Adolescent anemaia
• 5 Anemia during pregnancy
• 6 Clinical features of anemia
• 7 Health economics of anemia
• 8 Sources of Iron
• 9 Approach to a diagnosis of anemia
• 10 Management of anemia and INIPI
• 11 Prevention of anemia

4. Definition of anaemia
• Decrease in haemoglobin concentration in blood or decreased total
circulating red cell mass below the lower limit of normal values according
to the age and sex of the individual is known as anaemia.
• Haemoglobin :
Women : <12 g/dl
Men : <13 g/dl
Haematocrit:
Women : <36 %
Men : <41 %

13. Anemia & Malnutrition
Three standard indices of physical that describe the nutritional status of
children
MILD ANAEMIA MODERATE ANAEMIA SEVERE ANAEMIA ANY ANAEMIA
10.0-10.9 g/dl 7.0-9.9 g/dl <7.0 g/dl <11.0 g/dl
Height –for-age
(stunting)
Weight –for-
height
(Wasting)
Weight –for-age
(Underweight)

24. ANEMIA AND PREGNANCY
1. Anaemia in pregnant women reduces womens ability to survive
bleeding during and after child .
2. Risk of maternal mortality decreases by about 20% for each one g/dl
increase in Hb.
3. Reduction in severe anemia is evidenced in pregnant women who
receive regular malaria prophylaxis in malaria endemic areas.
4. 20 %maternal deaths are attributable due to anemia in India.
5. Micronutrient deficiencies during pregnancy results in spontaneous
abortions, Preterm labour, IUGR, LBW babies and maternal deaths.

29. Health Economics of Anemia…..Contd….
Impact on Children
1. Iron deficiency anemia severely affects cognitive performance.
2. It also impacts language skills, motor skills and coordination
among infants and young children ,and a deficit of 5 to 10 points in
intelligent quotient (IQ)
3. Inferior school performance
4 . Reduced future earnings and productivity
5 .Depressed immunity
6.. Repeated infections

30. Health Economics of Anemia……
• Impact on productivity :
1. In an anemic individual ,the aerobic capacity ,endurance and
Energy efficiency are compromised 10-50 %.
2. India loses 0.9% of its gross domestic product ( GDP) due to
IDA
3. This could means a loss of up to $20.25 billion (Rs. 1.35 lakh
crore), according to the World Bank estimate of India GDP
In 2016

31. • Cost implications include:
- Increased length of hospital stay
- Expenses related to referral , transport of cases to hospitals with
paediatric care facilities
- Cost of incubators and intensive care
- Cost of post maternity care
THESE ALL RESULT IN BURDEN ON STATE HEAILTH BUDGET

42. National Iron Plus INITIATIVE
Launched on 2oct ,2015 by honourable home minister
AGE GROUP
6-60 MONTHS
5-10 YEARS
Intervention/dose
IFA syrup
WIFS Junior (pink)
Regime
Biweekly through
out the period 6-60
months of age
Weekly throughout
he period 5-10
years of age
Service delivery
Through
ASHA/(AWC)
In govt. school
(Class1-5)through
teachers ,same as
WIFS
Coverage/Status
In all 33 districts
In all 33 districts

44. Objective
• The Ministry of health and Family welfare ,government of
India has launched the Weekly Iron and Folic acid
supplementation (WIFS)programme to reduce the prevalence
and severity of nutritional anemia in adolescent population
(10-19 years) and NIPI for age group 6 months to 10 years .

45. Target groups
A.)Weekly Iron and Folic Acid Supplementation (WIFS) programme will be
planned and implemented for the following two target groups in
a) both rural and urban area:
1. Adolescent girls and boys enrolled in govt./ govt. aided schools
from 6th to 12th class
2.Adolescent girls who are not in school through AWC.
B.) National iron plus initiative
1. Girls and boys enrolled in government school/government aided
schools from 1st to 5th class
2. 6 months to 60 months children through AWC.

47. WIFS-IFA DRUGS ( STORAGE )
A. Selection of proper place
1. Lock and key room
2. Limited access to the store
B. Keep store in good condition
1. control the temperature in the store
2.control the light in store
3. prevent water damage and control humidity
4. keep the store free of pests
C. Keep your store clean and organised
1. clean the store and keep it tidy
2. store supplies on shelves

48. WIFS - IFA DRUGS ( Administration level )
• ADMINISTRATION- IFA drugs should be administered WEEKLY; in
schools it should be given on Monday; in AWC should be given on
Thursday to adolescents (10-19 years ) /school going adolescents and
school adolescent girls after midday meal/poshahaar (NOT EMPTY
STOMACH)
• FEFO(FIRST EXPIRY FIRST OUT)
• Check expiry in routine

49. I-NIPI
• 1. COMES UNDER POSHAN Abhiyaan
• 2. PM overarching scheme for holistic nourishment .
• 3. 6x6x 6 Strategy
a. 6 interventions
b. 6 beneficiaries
c. 6 institutional mechanisms
• VISION- ANEMIA MUKT BHARAT
• OBJECTIVE –Decrease anemia prevalence by 18% in all target by 2022

50. INIPI

51. Beneficiaries :
 6-59 months (Child ).
5-9 years .
Adolescents male and female (15 -19 years ).
Female of reproductive age group (20-45 years ),who are not non
pregnant/ non lactating.
Pregnant female.
Lactating women.

52. 6 INTERVENTIONS
 Prophylactic IFA Supplementation.
Deworming
Intensified year round behaviour change communication campaign
Treating of anemia using digital methods and patient care.
Mandatory provision of IFA fortified food in public health
programme.
Addressing non nutritional cause of anemia in endemic area like
malaria ,fluorosis ,sickle cell anemia.

53. 6 Institutional mechanisms
Fixed day
Institution Based ,
Supervised consumption ,
Educating correct dietary practices and increasing iron intake,
 Screening for moderate /severe anemia and referring,
ANNUAL / biannual deworming
Albendazole is contraindicated in 1st trimester and can be
given in 2nd and 3rd trimester. DOC in 1st trimester is Mebendazole
100 mg BD for 3 days .

54. ANEMIA M/M UNDER INIPI
ADOLESCENTS : periodicity – Annual
Screened by –RBSK team in School
Hb (8-10.9) { mid and moderate anemia }
60 mg ELEMENTAL IRON *BD *3 MONTHS
follow up -1st follow up after 45 days and 2nd follow up after 90 days ,
if hb level are normal then discontinue and shift to prophylactic dose , if even after 3
months hb < 12 then refer to FRU and DH. IF HB <7 ( SEVERE ) M/M is based on
investigation and diagnosis.
 PREGNANT : periodicity – Every ANC visit
7- 10.9 Hb –IFA BD or I/V iron sucrose
Follow-up – every 2 months
if there is no improvement [hb increase 1 gm/ dl] refer to DH/FRU
< 7 gm – Rx by dr at PHC /CHC/ FRU/DH

55. Dosing :
Age group Dose/Week Formulation Dosing iron (mg) Folic acid (ug) colour
6- 59 months Biweekly Liquid (ml) 20 100 N/A
5-9 years Weekly Tablet 45 400 Pink
10- 19 years Weekly Tablet 100 500 Blue
20- 44 years (non
pregnant /non
lactating )
Weekly Tablet
60 400 Red
Pregnant and
lactating
Daily Tablet
60 500 Red

64. References
1. http://rajswasthya.nic.in/
2. http://nrhm.gov.in/nrhm-
3. http://themedicalpost. Net /2010/07/18 thegeneral-concept-of-anemia
4. http://en.Wikipedia.org/wiki
5. http://www.medicinennet.com/anemia/article.htm