National Anemia Prophylaxis Programme

NATIONAL ANAEMIA PROPHYLAXIS PROGRAMME

ANKIT TALUJAM.B.A (HCM) 2009-11

Roll no. - 1504

Anaemia: A Global Challenge

Anemia is one of the world's most widespread health problems. It affects more than 2 billion people worldwide, women and children being more affected.

In India, about 52% of the women of reproductive age & 74% of children are anemic.

Reducing the number of women dying in childbirth by 3/4ths by 2015 is one of the key goals of the Millennium Declaration of the World Health Organization.

http://www.bsog.in/Anemia%20Monograph.pdf

Hemorrhage30%

Anemia19%

Sepsis16%

Abortion9%

Obst. Lab10%

Toxemia8%

Others8%

CAUSES OF MATERNAL MORTALITY SRS-1998

Anaemia directly causes 20% of maternal deaths and indirectly accounts for another 20% of maternal deaths. These figures have remained unchanged in the last five decades .

A N A EM IA IN PR EG N A N C Y -A SIA N C O U N T R IES

W H O 1992

0

10

20

30

40

50

60

70

80

90

Bangladesh China India Indonesia Malaysia Myanmar Nepal Pakistan Philippines Singapore Srilanka Thailand

Prevalence of anaemia is high in South Asia. Even among South Asian countries prevalence of anaemia in pregnancy is highest in India.

NHFS-IIIPrevalence of Anemia in

India India Rural Urba

n

Anemia among children

69.5 71.5 63.0

Anemia among women (15-49)

56.2 57.4 50.9

Source: NFHS-III

Major causes of anemia

Inadequate iron, folate intake due to low vegetable consumption and perhaps low B12 intake

Poor bioavailability of dietary iron from the fibre, phytate rich Indian diets

Chronic blood loss

Increased requirement of iron during pregnancy

MICRONUTRIENTSVIT-A

72% of the children in 103 countries received 2 doses of Vit-A in 2007 as compared to 16% in 1999

IODINECountries with IDD as a major public health concern, reduced from 110 to 47 between 1993 and 2007 with the use of fortified salt

IRON should also make such progress

National Policies

National Nutrition Policy, 1993 advocates a comprehensive inter-sectoral strategy for alleviating all the multi-faceted problems of under/malnutrition and its related deficiencies and diseases

National Population Policy, 2000 advocates convergence of services at village levels

National Health Policy, 2002 emphaises health needs of women and children

NRHM, 2005 - Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition.

National Programme

Program started in 1970

Aims at significantly decreasing the prevalence and incidence of anemia in women in reproductive age group, especially pregnant and lactating women, and pre-school children.

DIET DIVERSIFICATION: Promotion of regular consumption of foods rich in iron.

SUPPLEMENTATION: Provisions of iron and folate supplements in the form of tablets (folifer tablets) to the "high risk" groups: Pregnant women and young children.

TREAT INFECTION

TREAT SEVERE ANEMIA: Identification and treatment of severely anemic cases.

Strategy for the program

Distribution of iron folic acid (adult and paediatric doses) to pregnant and lactating women, and children aged 1 to 5 years.

Provision in ICDS

Department of Food is responsible for promoting consumption of iron rich food.

Promoting cultivation of iron rich food

Promoting consumption or iron rich diet.

Revised Guidelines, April 2007

Infants between 6-12 months included

For children 6-60 months, ferrous sulphate and folic acid should be provided in a liquid formulation containing 20mg elemental iron and 100 mcg folic acid per ml of the liquid formulation

National IMNCI guidelines to be followed

Revised Guidelines, April 2007Children 6-10 years will be provided 30 mg

elemental iron and 250 mcg folic acid per child per day for 100 days in a year

Adolescents 11- 18 years will be supplemented at the same doses and same duration as adults. Adolescent girls will be given priority

Multiple channels and strategies are required to address the problem of iron deficiency anemia.

Double fortified salts/sprinklers /ultra rice and other micronutrient candidates or fortified candidates should be explored as an adjunct or alternate supplementation strategy

Groups to be targeted for Iron supplementation to prevent IDA

Population group Dosage Schedule Duration ofSupplementaion

Low Birth Weight Infants 2 to 23 months of age

2 mg / kg / day 2 months to 23 monthsof age

Normal Infants 6 to 23 months of age *

2 mg / kg / day 6 months 23 months of age

Children 24 to 59 months of age *

2 mg / kg / day up to 30 mg 3 months

School Aged children *(above 60 months age)

Iron: 30 mg / dayFolic Acid: 250 :g / day

3 months

All women of childbearing age *

Iron: 60 mg / dayFolic Acid: 400 :g / day

3 months

Pregnant and Lactating Women

As above Throughout pregnancy

Way Forward

A National task force on Anaemia should be constituted by the Department of Health Research

Develop Integrated training module on micronutrients for capacity building of multisectoral service providers – NIHFW