The document discusses the National Iron Plus Initiative in India to address anemia. It provides background on the high prevalence and burden of anemia globally and in India. Some key points discussed include:
- Anemia is most commonly caused by iron deficiency and affects over 1.9 billion people worldwide, with the highest burden in Asia and Africa.
- In India, over 50% of pregnant women and young children suffer from anemia.
- Consequences of anemia include increased mortality and morbidity, as well as reductions in work and economic productivity.
- The National Iron Plus Initiative was launched in 2013 to strengthen India's efforts through strategies like weekly iron supplementation and nutrition counseling.
- However, the initiative requires strengthening in
The Anemia Mukt Bharat programme (AMB), its implementation, the global burden of anaemia, the aetiology of anaemia, the 2030 Sustainable Development Goals, its successes and shortcomings, the most effective interventions, the reasons the AMB programme was successful in Madhya Pradesh, and its future objectives are all covered in detail in this presentation.
Rashtriya bal swasthya karyakram (RBSK) is a health programme launched for screening of over 27 crore children from 0 to 18 years for 4 Ds - Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities by the ministry of health and family welfare under national rural health mission (NRHM) in india
Poshan Abhiyaan is a programme started by Indian government to eradicate malnutrition. It is started in 2018 on 8th of March on the occasion of International Womens Day.
The Anemia Mukt Bharat programme (AMB), its implementation, the global burden of anaemia, the aetiology of anaemia, the 2030 Sustainable Development Goals, its successes and shortcomings, the most effective interventions, the reasons the AMB programme was successful in Madhya Pradesh, and its future objectives are all covered in detail in this presentation.
Rashtriya bal swasthya karyakram (RBSK) is a health programme launched for screening of over 27 crore children from 0 to 18 years for 4 Ds - Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities by the ministry of health and family welfare under national rural health mission (NRHM) in india
Poshan Abhiyaan is a programme started by Indian government to eradicate malnutrition. It is started in 2018 on 8th of March on the occasion of International Womens Day.
In 2011 to reduce neonatal mortality government of India launched Home based new born care program based on Gadchirolli model of SEARCH. This presentation will tell about how the program is enrolling in our country.
Launched by the ministry of health & family welfare, government of India, under the national health mission.
It envisages Child Health Screening and Early Intervention Services
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
Every pregnancy is special and every pregnant woman must receive special care.The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is being introduced to ensure quality Antenatal to over 3 crore pregnant women in the country.
Under the campaign, a minimum package of antenatal care services would be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd and 3rd trimester of pregnancy.
We all want it
ANAEMIA MULTA BHARAT
Introduction
Global burden
National scenario
Causes and consequences of anaemia
Mile-stones
Strategies of Anaemia Mukt Bharat
Institutional mechanisms including NCEAR-A
Conclusion-new changes and recommendation
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
In 2011 to reduce neonatal mortality government of India launched Home based new born care program based on Gadchirolli model of SEARCH. This presentation will tell about how the program is enrolling in our country.
Launched by the ministry of health & family welfare, government of India, under the national health mission.
It envisages Child Health Screening and Early Intervention Services
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
Every pregnancy is special and every pregnant woman must receive special care.The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is being introduced to ensure quality Antenatal to over 3 crore pregnant women in the country.
Under the campaign, a minimum package of antenatal care services would be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd and 3rd trimester of pregnancy.
We all want it
ANAEMIA MULTA BHARAT
Introduction
Global burden
National scenario
Causes and consequences of anaemia
Mile-stones
Strategies of Anaemia Mukt Bharat
Institutional mechanisms including NCEAR-A
Conclusion-new changes and recommendation
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
Anemia in Women of Reproductive Age Group at GCUOG 16/07/2022.pptxNiranjan Chavan
Anemia in pregnancy is one of the most important factors related to maternal morbidity and mortality.
Oral iron provides an inexpensive and effective means of restoring iron balance in a patient with iron deficiency without complicating comorbid conditions.
IV iron is appropriate for patients who are unable to tolerate gastrointestinal side effects of oral iron.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
Anaemia Free India Focuusing on 12 gm Haemoglobin for Children , Girls & Wo...Lifecare Centre
ANAEMIA : its prevalence across age and gender group has increased. Aneamia has increased by 2-9% among children , Pregnant women and men according to data shared in the National Family health survey 5 (NFHS-5) released November 24, 2021
Anemia Free India Focuusing on 12 gm Haemoglobin for Children , Girls & Women : Dr Sharda Jain
Participants will be able to
Discuss the markers of malnutrition in CKD
Identify causes of malnutrition in CKD
Discuss current recommendations for treatment of malnutrition in CKD
IDD situation in our country has improved
A good number of thyroid disorder patients are either undiagnosed and or untreated
Thyroid disorder in pregnancy- Rate high
As a sound thyroid functioning status is crucial for growth, development in children; reproduction, psychological and general wellbeing in adults, we must be proactive in screening, diagnosing and treating our patients.
د فيصل الناصر - Faisal Alnasir is a Professor and Chairman at Dept Of Family & Community Medicine at Arabian Gulf University.
http://www.faisalalnasir.com
65 million (17%) of 387 million persons with diabetes mellitus (DM) globally reside in India.The prevalence of DR in urban areas is between 13–18% and in rural areas is 9–10%.In India, in 1970–1975 DR was the 20th cause of blindness, and today, it is the 6th cause of blindness.
Diabetes mellitus is a major global public health problem. The rise in global prevalence is expected to reach 5.4% or 300 million worldwide by 2025, with developed countries carrying a larger burden (1). Malaysia is not spared from this phenomena, with an alarming rise in prevalence of Type 2 diabetes mellitus (T2DM) over the past fifteen years, from 8.3% (NHMS 1, 1996) to 20.8% (NHMS IV, 2011) (2). What is most worrying is the figure for undiagnosed diabetics, which recorded almost a ten-fold increase (from 1.8% to 10.1%) within the same period. The national economic burden for provision of ambulatory or outpatient care for diabetes patients alone was estimated to cost the Ministry of Health RM 836 million, which took up 2.2% of the nation’s total health expenditure for 2009 (3). The average provider cost per outpatient visit for diabetes treatment at primary care was RM393.24, compared to RM 2707.44 at Specialist diabetic clinics. Treatment at primary care health centres was also highly cost effective compared to Specialist diabetic clinics (4). Due to the chronic nature of the disease, its many related complications and the progress in medical expertise, the costs to provide health care for the this group can only be expected to escalate in years to come. Strategies to effectively treat the chronic diseases (i.e. NCDs and T2DM) have been in place since the 1990s, however, the National Strategic Planning for Non-Communicable Diseases, (NSPNCD)(5) recommends that efforts should be channeled towards primary prevention, early NCD risk factor identification and NCD risk factor intervention or “clinical preventive services”. The clinical preventive services however, need to be emphasised, as early preventive measures can reduce long-term complications and morbidity related to diabetes. The risk factors which should trigger clinicians to provide clinical preventive measures include: obesity, sedentary lifestyles, dietary indiscretions, elderly (for late onset diabetes, pancreas insufficiency), family history of diabetes (risk in offspring of one diabetic parent: 30%, both parents: 60%). The 10th Malaysian Plan : Country Health Plan aims to restructure the national healthcare financing and healthcare delivery system to ensure universal health coverage of healthcare services to be provided at minimal cost using the existing infrastructure in delivering continuity of care across programmes, across healthcare settings and across healthcare providers (6). To reduce the fragmentation of care which commonly occurs in most NCD programmes, there is a need to involve healthcare providers within the healthcare service to be orientated in their roles and contribution in providing a seamless long-term care programme. It is hoped that this effort will benefit not only the patients but also provide relevant feedback on quality of healthcare service provision by the stakeholders. The current public health centre set up which combines Outpatient Primary Care
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. NATIONAL IRON PLUS INITIATIVE
DR.S.DINESH BABU
PG REGISTRAR
DEPARTMENT OF COMMUNITY HEALTH,
CHRISTIAN MEDICAL COLLEGE, VELLORE
24-10-2020 1
2. SYNOPSIS
• Introduction
• Global burden
• National scenario of anemia trends
• Causes and consequences of anaemia
• Mile-stones
• Strategies of Anaemia Mukt Bharat
• Institutional mechanisms including NCEAR-A
• Conclusion-new changes and recommendation
24-10-2020 2
3. INTRODUCTION
• Anemia results as a manifestation
of various underlying deficiency
and disease conditions.
• It is associated with overall
development of children and also
associated with increased maternal
mortality, reduces work efficiency in
adults.
24-10-2020 3
4. ANEMIA
• Anemia is a condition in which the
number of red blood cells or their
oxygen-carrying capacity is insufficient
to meet the body’s physiological
requirements, which vary by age, sex,
altitude, smoking habits, and during
pregnancy.
24-10-2020 4
5. Symptoms
• The manifestations of anemia
vary by its severity and range
from fatigue, weakness,
dizziness and drowsiness to
impaired cognitive
development of children and
increased morbidity.
24-10-2020 5
6. Anemia in pregnancy
• Anemia in pregnancy is
associated with post-partum
haemorrhage , neural tube
defects, low birth weight,
premature births, stillbirths
and maternal deaths.
24-10-2020 6
7. Malaria endemic
regions
• In malaria endemic regions,
anemia is one of the most
common preventable causes of
maternal and child deaths.
• In its most severe form,
anemia can also lead to death.
24-10-2020 7
8. Iron deficiency
• There are many causes of
anemia, out of which iron
deficiency accounts for about
50 % of anemia in school
children and among women of
reproductive age-group, and
80 % in children 2–5 years of
age.
24-10-2020 8
9. Nutritional deficiencies
• Other nutritional deficiencies
besides iron, such as
• vitamin B12,
• folate and
• vitamin A,
can cause anemia although the
magnitude of their contribution
is unclear.
24-10-2020 9
10. Infectious diseases
• Other than malaria - helminth
infections, tuberculosis and
haemoglobinopathies - are other
important contributory causes to
the high prevalence of anemia.
24-10-2020 10
11. DEFINITIONS:
• The World Health Organization (WHO) and the
American College of Obstetricians and
Gynecologists (ACOG) define anemia in pregnancy
as follows :
• First trimester – Hemoglobin <11 g/dL
(approximately equivalent to a hematocrit <33
percent)
• Second trimester – Hemoglobin <10.5 g/dL
(approximate hematocrit <31 or 32 percent)
• Third trimester – Hemoglobin level <11 g/dL
(approximate hematocrit <33 percent)
# Obstet Gynecol. 2008 Jul;112(1):201-7. doi: 10.1097/AOG.0b013e3181809c0d.
ACOG Practice Bulletin No. 95: anemia in pregnancy
24-10-2020 11
12. What is to be
expected?
• Normal pregnancy is
characterized by profound
changes in almost every organ
system to accommodate the
growing and developing
fetoplacental unit
• Expanded plasma volume
• Physiologic anemia
• Mild neutrophilia
• Mildly prothrombotic state
24-10-2020 12
13. Plasma Volume:
• Increases by 10 to 15 percent at 6
to 12 weeks of gestation, expands
rapidly until 30 to 34 weeks
• Increased metabolic demands of
the uterus and placenta
• Facilitate delivery of nutrients to
the developing fetus and removal
of waste
• Protect against the effects of
impaired venous return when the
mother is supine or standing, and
• Protect the mother from excessive
blood loss during delivery
24-10-2020 13
14. Red blood cells
• Red blood cell (RBC) mass begins
to increase at 8 to 10 weeks of
gestation
• Reaches levels 20 to 30 percent
higher than in nonpregnant
women by the end of pregnancy
24-10-2020 14
18. Approach to IDA in
pregnancy
• Cumulative total requirements are:
• 300 to 350 mg for the fetus and
placenta,
• 500 mg for the expansion of the
maternal red blood cell (RBC) mass, and
• 250 mg associated with blood loss
during labor and delivery
• Decreased Absorption in pregnancy
• Nausea and vomiting of pregnancy,
inflammatory bowel disease, bariatric
surgery (e.g., gastric bypass)
• Bioavailability of compound
24-10-2020 18
22. • Examples of available preparations (with the amount of elemental
iron per dose) include:
• FERRIC MALTOL – 30 mg tablet contains 30 mg elemental iron
• FERROUS FUMARATE – 324 or 325 mg tablet (contains 106 mg
elemental iron per tablet)
• FERROUS GLUCONATE
• 240 mg tablet (contains 27 mg elemental iron per tablet)
• 324 mg tablet (contains 38 mg elemental iron per tablet)
• 325 mg tablet (contains 36 mg elemental iron per tablet)
• FERROUS SULFATE
• 325 mg tablet (contains 65 mg elemental iron per tablet)
• 220 mg/5 mL oral elixir (contains 44 mg elemental iron per 5 mL)
• 75 mg/mL oral solution (contains 15 mg elemental iron per mL)
• Polysaccharide iron complex
24-10-2020 22
23. Iron sucrose:
• Each mL contains 20 mg
elemental iron as iron sucrose in
water for injection
• 200 mg administered on 5
different occasions within a 14-day
period (total cumulative dose:
1,000 mg in 14-day period)
• May repeat treatment if clinically
indicated.
24-10-2020 23
24. GLOBAL BURDEN OF ANEMIA
• Anemia is the most common public health problem affecting
around 1.9 billion population in the world.
• 90% of the cases of anemia were in the developing countries
• Asia and Africa accounts for 85 % of anemia cases.24-10-2020 24
25. PUBLIC HEALTH IMPLICATIONS OF ANEMIA
• It decreases the work output and work capacity.
• Physical and cognitive losses due to IDA in South Asia are close to $ 4.2
billion annually in Bangladesh, India and Pakistan.
• About 20 % of maternal deaths are caused by Anemia worldwide
• Anemic pregnant women are more prone to increased morbidity ; 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 contributes
1.18 % of Gross Domestic Product (GDP) loss.
• Median total loss (physical and cognitive) combined are 4.05 % of GDP
in developing countries.
24-10-2020 25
26. ANEMIA AND SUSTAINABLE DEVELOPEMENTAL GOALS - 2030
SDG GOALS ROLE OF ANEMIA
GOAL 1: NO
POVERTY
Anemia is estimated to contribute to 17% lower productivity in heavy manual labour and 5 % lower
productivity in other manual labour.
GOAL 2: ZERO
HUNGER
Target 2.2 -Anemia is a part of all forms of malnutrition which is committed to be end by 2030 and
addressing by 2025, the nutritional needs of adolescent girls, pregnant and lactating women and older
persons.
GOAL 3: GOOD
HEALTH &
WELLBEING
Target 3.1 (Maternal mortality)- Iron reduces maternal anemia,20% maternal deaths are due to
anemia, Iron prevents maternal deaths during perinatal period
Target 3.2 (child mortality) – Iron prevents IUGR,LBW and prematurity. Iron enhances immunity,
reduces frequency and severity of infections and decreases childhood mortality and mortality .
Target 3.3 – Malaria causes hemolysis and anemia
GOAL 4 :
QUALITY
EDUCATION
Iron reduces frequency and severity of infections, morbidity and mortality.
Improves school attendance, retention, learning abilities and school achievements
GOAL 5:
GENDER
EQUALITY
Anemia in girls is often more severe than boys.
Anemia adversely influences school attendance and achievement.
Iron improves women’s health ,increases work performance and productivity
24-10-2020 26
27. 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
High Prevalence
across all ages
Slow progress in
most of the States
74 69.4
52 55.2
58.5
53.1
80
60
40
20
0
100
NFHS 2 NFHS 3 NFHS 4
Children
WRA (15-49 yrs)
Trend in
Prevalence of
Anemia among
Children and
Women
A Snapshot of Anemia in India
24-10-2020 27
29. 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
Anemia Prevalence among Pregnant Women (NFHS-4)
24-10-2020 29
31. CAUSES OF ANEMIA
Iron deficiency,
Haemoglobinopathies,
Malaria are three leading
causes Of anemia Globally.
24-10-2020 31
32. SEVERITY OF CONSEQUENCES OF ANEMIA
SEVERE CONSEQUENCES :
1) PREGNANT WOMEN : MATERNAL MORTALITY
2) CHILDREN : PREMATURE BIRTH,LOW BIRTH WEIGHT,PERINATAL,
NEONATAL,CHILD MORTALITY
3) ADULT : INCREASED RISK OF DEATH DUE TO IRREGULAR HEART BEATS,
MURMUR,CARDIAC ARREST , CONGESTIVE HEART FAILURE
MODERATE CONSEQUENCES :
1) CHILDREN : POOR COGNITION,PHYSICAL DEVELOPMENT
2) ADULTS : POOR WORK PRODUCTIVITY
MILD CONSEQUENCES :
1) FATIGUE,IRRITABILTY AND WEAKNESS,DYSPNOEA
2) DECREASED APPETITE
3) ORTHOSTATIC HYPOTENSION
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33. Milestones in Control of Anemia in India
1970
60 mg IFA for PW
20 mg for 1-5 yr X100 days
1991
60 mg Iron
changed to
100mg
2007
6-10 yrs age group &
Adolescents added
2013
Weekly and biweekly
supplementation.
Test and treat (NIPI)
Life cycle approach
2018
(Anemia Mukt
Bharat)
P & LW 60mgX180
days, IFA for WRA
6X6X6 strategy
Life cycle approach
NATIONAL NUTRITIONAL ANEMIA PROPHYLAXIS
PROGREMME (NNAPP) (1970)
TO
INTENSIFIED NATIONAL IRON PLUS INITIATIVE AND
ANEMIA MUKT BHARAT (2019)
NNAPP
NNACP
NIPI
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I-NIPI
38. WHY THERE IS NEED FOR
STRENGTHENING OF NIPI
PROGRAMME..
• Need to be revised for dose,
frequency and duration of IFA,
based on global scientific
evidence.
• The iron doses administered to
the pregnant mothers for the
prevention and treatment of
anaemia are high.
• There is a need to lower the iron
doses in view of adverse effects.
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39. NUTRITION
COUNSELLING
• The beneficiaries do not collect or
consume supplements regularly
simply because the majority of them
are not given proper nutrition
counselling.
• There is a need to improve the
compliance in the consumption of
IFA tablets by giving high priority to
interpersonal counselling to
beneficiaries.
24-10-2020 39
40. HEALTH BUDGET
• The budget provision for the
scheme should be increased.
• The State-level programme
officers should be trained to
calculate the requirement of IFA
for each group of beneficiaries
and cost of supportive activities
of NIPI so that they can make
provision in the PIP submitted to
MoHFW for sanctioning of the
budget accordingly.
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41. DEWORMING
• In regions with high prevalence of
anaemia, regular mass deworming
of under-five children should be
undertaken for the prevention of
anaemia.
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42. Malaria & anemia
• Malaria, being an important
cause of anaemia, requires
an efficient implementation
of National Vector Borne
Control Programme in
malaria-hyperendemic
regions.
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43. Other causes of
anemia
• Interventions for other
causes of anaemia such as
1) Haemoglobinopathies-
sickle cell anaemia and
thalassaemia
24-10-2020 43
46. IFA DOSAGE
• IFA administration to children aged 5-10 yr
should be initiated in the majority of States.
• More than 50 per cent of pregnant mother
suffer from anaemia; however, under NIPI,
almost all are provided prophylactic dose of
IFA tablets for 100 days.
• This will possibly improve their Hb level but
not make them non-anaemic.
• In actual practice, all beneficiaries are given
the same number of tablets irrespective of
the degree of anaemia.
24-10-2020 46
47. Test and treat
strategy
• The test-and treat strategy of the
programme requires estimation
of Hb. However, the
functionaries are not provided
with facilities to carry out the Hb
estimation.
• Supervision and monitoring of
programme are given a low
priority at all the levels: central,
state, district, block and PHC
levels.
24-10-2020 47
48. PROPER REPORTING..
• The performance reporting of the programme requires
improvement.
• The States submit reports about the number of individuals
who initiated the prophylaxis course rather than who have
completed the consumption of 100 tablets. This type of
format of reporting does not reflect the correct status of
performance achievements.
• The status of compliance and supervision issues of weekly
IFA administration with IFA tablets in schools has not been
documented in detail to improve the programme.
• There is a need to document this process.
24-10-2020 48
49. Initiation of complementary
foods..
• All beneficiaries or their care givers
need to be counselled on appropriate
infant and young child feeding with
emphasis on timely initiation of
complementary foods.
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50. INTENSIVE NATIONAL
IRON PLUS INITIATIVE
• Reducing anemia- important objectives
of the POSHAN Abhiyaan launched in
March 2018.
• In 2019, The Ministry of health and
family welfare after Complying with the
targets of POSHAN Abhiyaan and
National Nutrition Strategy set by NITI
Aayog, the Anemia Mukt Bharat
strategy has been designed to reduce
prevalence of anemia by 3 % points per
year among children, adolescents and
women in the reproductive age
group(WRA).
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51. Objectives of Anemia Mukt Bharat strategy
Reduction in morbidity and mortality due to
anemia
To reduce anemia prevalence by 3 percent per annum in
all age groups (children, adolescents, pregnant women
and WRA)
Impact
To increase the proportion of eligible target beneficiaries
who consumed IFA tablet as per protocol by 50% (by
NFHS-5)
Output
To increase community knowledge and risk perception
through improved social support.
To ensure that state governments have enhanced capacity
to deliver services and supplies for prevention and
management of anemia
Process
Outcome
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52. To reduce the prevalence of anemia by 3 percentage points per annum targets
Beneficiary Wise Targets of AMB for 2022
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53. Anemia Mukt Bharat
6 x 6 x 6 strategy to
fight anemia
6
6X6X6
strategy
6
interventions
6
institutional
mechanisms
Anemia Mukt Bharat- STRATEGY
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55. 1
Prophylactic iron folic acid
supplementation
3 Intensified year-round Behavior
Change Communication
Campaign "Solid Body Smart
Mind" ,delayed cord clamping
5
Mandatory provision of iron
public health programmes
ANGANWADI
2
Periodic deworming of children,
adolescents, pregnant women
4
Testing of anemia using digital
methods and point of care
treatment
HOSPTIAL
6
Addressing non-nutritional causes
of anemia in endemic
pockets, with special focus on
malaria, haemoglobinopathies and
fluorosis
SIX INTERVENTIONS
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56. 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 +
100 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 + 400 mcg Folic Acid
• Sugar-coated, pink colour
Intervention- 1
Prophylactic IFA supplementation- Regime
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57. 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 + 500 mcg Folic Acid
• Sugar-coated, blue colour
Women of
reproductive age
(non-pregnant,
non-lactating)
20-49 years
• Weekly, 1 Iron and Folic Acid tablet
• Each tablet containing 60 mg elemental Iron + 500 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)
• Tobe continued for 180 days, post-partum
• Each tablet containing 60 mg elemental Iron + 500 mcg Folic Acid
• Sugar-coated, red colour
Cont...
Prophylactic IFA Supplementation- Regime
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58. CONTRAINDICATIONS
Prophylaxis with iron should be
withheld in case of acute illness
(fever, diarrhoea, pneumonia, etc.),
and in a known case of thalassemia
major/history of repeated blood
transfusion.
In case of SAM children, IFA - per
SAM management protocol.
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59. Deworming (Dose and regime)
AGE GROUP DOSE AND REGIME
Children 12–59 months of age Biannual dose of 400 mg albendazole (½ tablet
to children 12–24 months and 1 tablet to
children 24–59 months)
Children 5–9 years of age Biannual dose of 400 mg albendazole (1 tablet)
School-going adolescent girls and boys 10–19
years of age
Out-of-school adolescent girls 10–19 years of age
Biannual dose of 400 mg albendazole (1 tablet)
Women of reproductive age (non-pregnant, non-
lactating) 20–49 years
Biannual dose of 400 mg albendazole (1 tablet)
Pregnant women One dose of 400 mg albendazole (1 tablet), after
the first trimester, preferably during the second
trimester24-10-2020 59
60. INTERVENTION-3
IEC/ BCC FOR ANEMIA PREVENTION & BEHAVIOUR CHANGE
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
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61. INTERVENTION 4
TEST AND TREAT STRATEGY
TESTING:
• Use of digital hemoglobinometers among School-going
Adolescent girls and boys 10-19 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
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62. Test and treat intervention for anemia in Adolescent
Mild / moderate anemia
8-11.9 g/dl
Severe anemia
<8g/dl
Screening for anemia
No anemia
> 12 g/dl
1st follow-up*: after 45 days
Weekly, 1 IFA
tablet (60 mg
elemental Fe
+ 500 mcg
folic Acid)
Sugar coated
blue colour
Refer urgent
to MO at FRU
or DH
2 IFA tablet (60 mg elemental Fe +
500 mcg folic Acid) daily orally for
3 months (under observation by
school teacher)
2nd: follow-up*: after 90 days
Hb ≤ 12g/dl
Hb > 12g/dl
*Follow up by RBSK team / ANM based on the feasibility of the state24-10-2020 62
63. Prophylactic IFA supplementation
during Pregnancy – No anemia
• Daily One IFA tablet.
• Each tablet containing 60 mg elemental
iron + 500 mcg folic acid, sugar-coated,
red-colour.
• Starting from the 4th month of
pregnancy/from the second trimester / at
14th week of gestation.
• Continued throughout pregnancy.
• Minimum 180 days during pregnancy.
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65. INDICATIONS OF
PARENTERAL IRON
• Severe anemia ( any time during
pregnancy )
• Moderate anemia in 2nd or 3rd trimester.
• Post-partum if oral iron not
suitable/effective.
• Requirement for rapid iron repletion
• Intolerance to oral iron.
• Co-morbidities affecting iron
absorption.
• Chronic Renal impairment
• Ongoing iron losses exceeding
absorptive capacity
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66. FOOD
FORTIFICATION
• Mandatory provision of iron and
folic acid fortified products in
government health programmes.
• Iron fortified whole wheat
flour/refined flour/rice (Sodium
federate NaFeEDTA @20 mg/kg.
• Iron fortified salt/ double
fortified salt (Fe @ 850-1100
ppm).
24-10-2020 66
67. Intervention – 6
Malaria and Anemia
• The testing of malaria and anemia will be
integrated in the identified malaria endemic
regions, e.g., the beneficiaries who report recent
fever and being screened for anemia will also be
tested for malaria as per NVBDCP guidelines, to
ascertain the co- occurrence of malaria.
• Similarly, patients who are being tested for malaria
will also be tested for anemia in these endemic
regions with increase in outreach under NVBDCP
• NVBDCP has provided Long Lasting Insecticide
Nets (LLINs) in all high endemic areas.
• Anaemia Mukt Bharat will play a key role for
utilization of these LLINs by all target groups
especially pregnant mothers and under-five
children by promoting IEC/ BCC.
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69. Intra-ministerial coordination
• Existing (RKSK) National Steering Committee will be expanded to include the
National Anemia Mukt Bharat Steering Committee.
• Steering Committee will have biannual convergent meetings in coordination
with the respective divisions within MoHFW
Existing (RKSK) National Steering Committee will be expanded to include the National
Anemia Mukt Bharat Steering Committe Steering Committee will have biannual
convergent meetings in coordination with the respective divisions within MoHFW.
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70. NCEAR-A
‘National Centre of Excellence and Advanced Research on
Anemia Control (NCEAR-A)’ established at Centre of
Community Medicine, All India Institute of Medical
Sciences (AIIMS), New Delhi.
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71. Vision of NCEAR-A
“ To develop and provide
technical support to the
Ministry of Health and Family
Welfare, Government of India, for
incorporating scientific, policy
and community perspective in
policy and programmatic
decisions for control of anemia.”
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5
1
74. Recommendations of Expert Group Technical Consultation
on ANEMIA (23rd-24th April 2018)
• Recommended prophylactic dosage for PW, WRA and Adolescents to be 60
mg IFA tablets daily instead of ongoing 100 mf IFA tablets
• IFA tablets to be sugar coated instead of enteric coated
• Recommended therapeutic dosage for mild and moderate anemia in PW,
WRA and Adolescents to be single dose of 120 mg IFA (two tablets of 60
mg) daily instead of two divided doses daily
• Recommended referral of severe anemia cases to higher facility level
for management on case by case basis
• Sahli’s or Color Scale method should not be utilized for hemoglobin testing
due to estimation errors. No specific recommendation on estimation method.
24-10-2020 74
75. Further suggested
readings
• AMB Operational Guidelines
for Programme Managers –
handbook
• Anemia Mukt Bharat Portal or
Digital Dashboard
• Achieving Anemia Free
India-NCEAR-A, Centre
of community
Medicine(AIIMS)-Red
book
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