This document discusses nutritional anemia (iron deficiency anemia) in India. It defines anemia, describes the causes and risk factors, prevalence rates in different states and groups, signs and symptoms, consequences, control programs and strategies. Some key points are: - Nutritional anemia is the most common micronutrient deficiency globally, affecting over 2 billion people worldwide. - In India, prevalence is highest among young children (6-59 months), with Bihar having the highest rate at 78%. - Causes include inadequate intake of iron-rich foods, poor absorption from diets high in phytates, blood loss from hookworm infection, and increased demands from pregnancy and growth. - Control programs

1. By-Dr.Kumar Himanshu
PGT-2nd Year
Dept. Of Community Medicine
Katihar Medical College,Katihar

2.  Defined by WHO:
It is a condition in which the haemoglobin
level in the blood is lower than the normal,
as a result of deficiency of one or more
nutrients, specially iron.
 Less frequent causes are deficiency of folic
acid or vitamin B12.

3.  Iron is an essential mineral for human
development and function, it helps formation of
Hb-the oxygen carrying component of RBC.
 As these cells(Hb) carry oxygen to the muscles
and brain, iron is critical for motor and cognitive
development in Childhood, and for physical
activity in all humans.
 Iron is also critical to the health of a pregnant
mother and her unborn child, As woman needs
more iron during pregnancy because the fetus
and placenta both need additional iron
 The central function of Iron is “OXYGEN
TRANSPORT” and Cell respiration.

4. GROUP
Hemoglobin [ g/dl] MCHC [ per
cent]
Adult males 13 34
Adult females, non
pregnant
12 34
Adult females ,
pregnant
11 34
Children, 6 months to
6 years
11 34
Children, 6-14 years 12 34
WHO CUT OFF POINT FOR DIAGNOSING
NUTRITIONAL ANAEMIA

5.  Infants.
 Preschool children.
 Adolescent girls.
 Pregnant women.
 Lactating mothers..
 Sometimes males

6. AGE AND
SEX GROUP
ANAEMIC MILD MODERATE SEVERE
CHILDREN -
6-59 Months
<11.0 g/dl 10-10.99g/dl 7-9.99g/dl <7g/dl
CHILDREN 5-
11 YEARS
<11.5 g/dl 10-11.49g/dl 7-9.99g/dl <7g/dl
CHILDREN
12-14 YEARS
<12.0g/dl 10-11.99g/dl 7-9.99g/dl <7g/dl
NON
PREGNANT
WOMEN
<12.0g/dl 10-11.99g/dl 7-9.99g/dl <7g/dl
PREGNANT
WOMEN
<11.0g/dl 10-10.99g/dl 7-9.99g/dl <7g/dl
MEN <13.0g/dl 10-12.99g/dl 7-9.99g/dl <7g/dl

7.  Nutritional Anemia (Iron deficiency) is the most
common micronutrient deficiency in the World
with highest Prevelance in developing
countries.
 It is estimated that it affects nearly one-third
of global popullation (over 2 billion),two third
of preganant and one third of non- pregnant
women in developing countries.
WORLD

8.  Prevalence of ananemia is concentrated in sub-
Saharan Africa,South Asia and part of Latin
America.
 South East Asia has largest number of anaemia.
 Among South Asia –INDIA has the highest
prevalance of anaemia.

9.  Iron deficiency is the most widespread
micronutrient deficiency affecting all age
groups irrespective of gender , caste, creed
and religion
 Overall 72.7% of children children below 3
years in urban areas and 81.2% in rural areas
are anaemic.
 Nutritional Anaemia is a Health problem,
social problem and an economic problem in
our country.

10.  It was found that except for Punjab ,all other
states had more than 50% Prevalance of
anaemia
 Bihar had the highest Prevalance- 78% of
anaemia among age group 6-59 months,
followed by
 UP-73.9%
 Karnataka -70.4%
 Rajasthan- 69.7% according to NFHS-3(2005-06)

11. Anaemia
among
Children and
Adult %
URBAN RURAL TOTAL
NFHS 3(2005-O6)
TOTAL
CHILDREN AGE
6-59 MONTHS
55.9% 59.4% 58.4% 69.4%
NON PREGNANT
WOMEN AGE 15-
49 YRS
50.9% 54.3% 53.1% 55.2%
PREGNANT
WOMEN AGE 15-
49 YRS
45.7% 52.1% 50.3% 57.9%
ALL WOMEN
AGE 15-49 YRS
50.8% 54.2% 53.0% 55.3%
MEN AGE 15-49
YRS
18.4% 25.1% 22.7% 24.2%
NFHS -4 (2015-2016)

12. Prevalance of anaemia in Bihar(NFHS-3)
Age group 6-59 months
MILD-29.6%
MODERATE-46.8%
SEVERE-1.6% TOTAL=78.0%
NFHS-4 = TOTAL = 63.5%(U-58.8% R-64.0%)
All women age 15-49 yrs
MILD-(10-11.99g/dl)-15.96%
MODERATE-(7-9.99g/dl)-50.5%
SEVERE-(<7g/dl)-1.0%
TOTAL=67.4%
NFHS-4 = TOTAL = 60.3%(U-58.7% R-60.5%)

13. Prevalence% Public health Problem.
<5 Not a problem
5-19.9 Low magnitude(mild)
20-39.9 Moderate
magnitude(moderate)
40 and above High magnitude(severe)

14.  Inadequate Food Intake of iron rich diet (less than
20mg/day) and Folic acid(less than 70ug/day)
i.e meat, fish, poultry product, green leafy
vegetables.
 Insufficient iron absorption due to poor bio availability
of iron in phytate and fibre rich Indian diet.
 Presence of persistent diarrhoea and chronic blood
loss due to hook worm infestation.
 Chronic diseases like malaria repeated pregnancies
and short birth spacing leading to further increased
demand of iron.
 Delayed weaning and insufficient cereal, pulses
and leafy vegetables.

15.  Poverty, reproductive behaviour of having too many
children and repeated pregnancies deplete iron
status of women .
 The prevalence of under nutrition and anaemia was
higher when interval between two children were
less than 2 years.
 With bigger family size under nutrition and anaemia
were found to be more prevalent.

16.  There is a strong co-relation between the
educational level of mothers and child
nutrition.

17. 1.Nutrition.
2.Maternal Health.
3.Anaemia Control .
4.Spacing of pregnancies.
5.Antenatal Care.
6.Awareness about hygiene and sanitation.
7.Immunization
8.Acess to health services when necessary.

18.  Early marriage and adolescent pregnancy
aggravate anaemia and results in poor iron
stores in the off spring
 The mother who becomes pregnant again too
early and whose youngest baby is dispalced
from the breast and prematurely weaned
,the baby is more prone to dvelope
undernutriton ,anaemia and diarrohea.

19.  Breast feeding promotes infant growth and
survival.
 EBF should be initiated within one hour of
delivery.
 The strategy includes EBF for 6 months of
age and nutritionally adequate safe
complementary feeding starting from the age
of 6 months with continued breast feeding up
to 2 years or beyond.

20.  Nearly two-third of women discards the
colostrum before they bagan breast feeding ,5 %
woman give prelactecals to their
newborn,which cause infection.
 Most of mother delay weaning /complementary
feeding in young children 9 months or beyond.
 Unclean food,utensils,dirty hands,unsafe
water,unsafe excreta disposalleads to infection-
diarrohea.

21.  Heavy work load and long hours of work
combined with inadequate food intake
leads to chronic malnutrition and anaemia.
 Traditional social value requiring women to
eat last in the family and observing rituals
like fast of certain foods thought to be hot or
abortifacient (sugar , jaggeries and even iron
and folic acid tablets) seem to be important
social factors contributing to anaemia.

22.  Poverty and poor health are inseparately linked.
 Poverty has many dimension-materail
deprivation(of food,shelter,sanitation,and safe
drinking water)social exclusion ,lack of
education,unemployment and low income-all
work together to reduce oppurtunities Limit
choice,undermine hope and has and as a result
thereafter Health.

23.  One of the important cause of anaemia and
under nutrition is inadequate intake of food
and poor household security.
 FOOD SECURITY is now defined as Physical ,
economic and social balanced diet , clean
drinking water , environmental hygiene and
primary health care(M.S Swami Nathan).

24. 8.Smoking.
9.Tobacco Chewing.
10.Libreralization.
11.Globalization.
12.Political Will.

25.  General appearance- Pale,plumpy, person with
poorly built and easy fatigability.
 Head – Headache, giddiness.
 Face – Pale and puffy (oedematous).
 Eyes – Pale conjunctiva
 Hairs – Dry, lustreless.
 Tongue – Pale, smooth tongue with atrophied
papillae.

26.  Abdomen – Anorexia, acidity, ascites may be
present due to associated hypoproteinemia ;
dysphasia often present.
 Respiratory system- breathlessness (Exertional)
 Cardiovascular system- soft systolic murmur,
best heard over the pulmonary area.
 BP- lower than the normal
 Pulse- Rapid and weak
 Feet- Edematous.
 Edema of the face and feet with or without
ascites indicates hypoproteinemia.

28.  Anaemia begins in childhood, worsens during
adolescent in girls and gets aggrevated during
pregnancy
IN PREGNANT WOMEN:
 Anaemia during pregnancy is responsible for
20% of all maternal deaths directly and
indirectly
 Maternal mortality rates shows steep increase
when maternal Hb falls below 5gm%

29.  Healthy women can tolerate loss upto 1 liter
or more during child birth,but for anemic
women even a normal blood loss of 250 ml
can be fatal
 Anemic mothers gives birth to LBW babies.
 Anemic mothers have 3 times graeter risk of
premature delivery and abortion.
 Women work capacity decreases ,they
become lethargic ,tired,breathlessness
occurs and it is documented there is
association between asymptomatic
bacteremia and anaemia.

30.  In children ,iron deficiency in first six months
is dependent upon iron reserve acquired
from mothers during life.
 If women are anaemic ,children born to them
will have less iron reserve.
 An afflicted child is likely to remain
vulnerable to infection and continue to have
lower immunity towards infection throughout
childhood and their overall appetite is
reduced.

31. 1)Anaemia retards physical growth .
2)Mental Development of child.
3)Decreases attention span ,concentration and
school performance.

32. 1)Delay in menstrual cycle.
2)Poor growth.
3)Reduced work capacity.
4)Poor reproductive outcome.
5)It reduces their concentration.
6)It reduces day today performance.

33.  Adequate food and iron rich food during pregnancy,
lactation period, Childhood and Adolescence.
 EBF for 6 months and adding green leafy
vegetables in weaning after 6 months.
 Adding Iron absorption promoters to food i.e Vit-C
rich foods.
 Biannual Deworming Programme.
 Malaria Prophylaxis.
HEALTH PROMOTION

34.  Improvement of Environment and Sanitation.
 Promotion of consumption of contraception and
birth spacing.
 Supplementary food and IFA tablets.
 Nutrititional supplementation through ICDS Scheme
for Pregnant women,lactating mothers and young
children.

35.  FOOD FORTIFICATION – Double
Fortification of salts with iodine and iron
by using Sodium Hexametaphosphate with
Ferrous Sulphate.

36.  Launched in the year 1972.
 This program is being taken up by Maternal
and Child Health (MCH) Division of Ministry of
Health and Family Welfare.
 Now it is a part of RMNCHA Program.

37. The Beneficieries under the programme were:
 Pregnant women and nursing mothers with
Hb less than 8gm/dl
 Children 1-5 yrs with Hb less than 10gm/dl
 Women acceptors of Family Planning.

38.  Under the revised policy,target group has been
expanded to include infants of 6-12
months,school children 5-10 years and
adolescent 10-19 years of age.
 For infants and children ,liquid formulation
having 20mg E.I and 100ug FA per ml were made
available.

39.  Children 6-60 months:
20mg EI+100 ug FA –Biweekly throughout period
of 6-60 months
 School children 5-10 years :
45mg EI+400ug FA- Weekly throughout the
entire period of 5-10 years.
 Adolescents 10-19 years:
100mg EI+500ug FA-Weekly throuhout the entire
period of 10-19 years.

40.  Pregnant Women:
1 tab containing 100mg EI+500ug FA daily starting
after first trimester at 14-16 weeks of
gestetation ,of clinically anaemic ,2 such tabs
daily to be given for 6 months.
 Nursing Mothers:
1 tab containing 100mg EI+500ug FA daily for 6
months.
 Acceptors of Family Planning:
1 tab containing 100mg EI+500ug FA daily for 100
days.

41.  Women in Reproductive Age Group-
1 tab containing 100mg EI+500ug FA Weekly
throughout the reproductive Period

42. Following strategies should be tried:
 Use traditional food processing techniques to
increase bioavailability of iron
 Improve dietary behavior through nutrition
education
 Consume iron-fortified processed
complementary foods
 Supplement infants and young children (iron
syrup, micronutrient powders added to
complementary foods)
 Combinations of the above strategies

43.  The National Iron+Initiative provides a
minimum service package for the management
of anaemia across life stages and at different
level of care.
 This initiative will bring together existing
programs (IFA supplementation. for: pregnant and
lactating women and; children in the age group of
6-:60 months) and introduce new age groups
National Iron+Initiative

44.  ASHA will be given incentives to make home
visits and to provide at least 1 dose per week
under direct observation and to educate the
mother about benefits of iron
supplementation and also how to administer
it.

45.  WIFS scheme is a community based
intervention that addreses nutritional
deficiency anaemia amongst school age
children and adolsescents (boys and girls) in
both rural and urban areas,enrolled in classes
I-XII of government and muncipal schools.
 ‘Out of School’children and adolsecent boys
and girl will be provided through Anganwadi
centres.

46.  Key Feature of this scheme is
1.Suervised administartion –Strategy involved a
“Fixed day- Monday approach for free
distribution of IFA tablets –Blue in colour(Iron
ki nili goli) to distinguish it from red IFA tabs
for pregnant and lactating women.
2.Screening of target group for moderate and
severe anaemia and referral to appropriate
health facility.
3.Biannual De-worming
4.Information and Counseling for improving
dietary intake and preventive actions for
intestinal worm infestation

47.  It is an initiative launched by Federation Of
Obstetrics and Gynaecology Society of
India(FOGSI)Delhi , in collaboration with
Government of India , WHO and UNICEF on
23rd April 2007 at All India Institute of
Medical Sciences(AIIMS),New Delhi.
 Meaning: By the year 2012,every child across
the country should have at least 12g percent
Hb by 12 years of age.

48.  The functionaries of ICDS programme under
the department of women and child
development are equal partners who help
and assist in distribution of iron tablets in
ICDS programme to enhance the coverage of
beneficiaries.
 Anganwadi Workers(AWWs) also impart
nutritional education to mothers to promote
consumption of iron rich foods in the family.
 Other sectors can be involved to enhance the
programme.

49.  Role of media, literature, Panchyat , Civic
Bodies , Medical colleges, and other
educational institutions , NGO’s, Mass
organization for for dissemination of
information to the mass.
 Involving men and other members of the
family in taking care of women in Physiological
states(Pregnancy, Lactation) care of children
and giving due place to a girl child in the
family.