Anemia Mukt Bharat -An Intensified National - PowerPoint Presentation

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Anemia

Mukt

Bharat

-An Intensified National

Iron Plus Initiative

18th September, 2018

Ministry of Health and Family Welfare

Government of India

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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 age50%

of pregnant women58% of breastfeeding mothers

High Prevalence across all agesSlow progress in most of the States

Trend in Prevalence of Anemia among Children and Women A Snapshot of Anemia in Indiav

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Anemia

prevalence among Pregnant Women (15-49 yrs)States/ UTsMore than 50%11 States and 2 UTsBihar, Himachal Pradesh, Jharkhand, Madhya Pradesh, Uttar Pradesh, MeghalayaTripura, Andhra Pradesh, Gujarat, Haryana,

West BengalA & N islands and D & N Haveli40% to 50%

10 States and 1 UTChattishgarh, Odisha, Rajasthan, Uttarakhand

, Assam, Karnataka, Maharashtra, Punjab, Tamil Nadu, Telangana

DelhiLess than 40%8 States and 2 UTsJammu & Kashmir, Arunachal Pradesh, Manipur,

Mizoram, Nagaland, Sikkim, Goa,

KeralaLakhwadeep and Puducherry

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Anemia Prevalence among Pregnant Women (NFHS-4)

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Low Iron Stores

During pregnancy in anemic mothers

Poor iron stores from infancy, childhood deficiencies and adolescent Anemia

Dietary

Inappropriate IYCF esp. Complementary Feeding Practices

Excessive consumption of ‘Iron Inhibitors’ (tea, coffee, calcium-rich foods) and low intake of ‘Iron Enhancers’ (Vitamin C etc.)

Low bioavailability of dietary iron

50% of the population is consuming < 50% RDA

Iron Loss

Due to parasitic load (malaria, intestinal worms)Poor environmental sanitation, unsafe drinking water and inadequate personal hygieneMaternal AnemiaIncreased iron requirement due to tissue, blood formation and energy requirement during pregnancy

Iron loss from post-partum haemorrhage Teenage pregnancy

Repeated pregnancies with less than 2 years interval Causes of High Burden of Anemia

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Diminished concentration, disturbance in perception, delayed psychomotor development

Impaired language and motor skills, Diminished IQ equivalent to a 5–10 point

About 20 % of maternal deaths are caused by Anemia worldwide

tube defects, infants of low birth weight and still birthsAnemiNeuralc pregnant women are more prone to increased morbidity and ; there is a three times greater incidence of premature delivery in severely anemic women

Decreased work output and work capacityPhysical and cognitive losses due to IDA in South Asia are staggering: close to $ 4.2 billion annually in Bangladesh, India and Pakistan

In the WHO/World Bank rankings, Iron Deficiency Anemia is the third leading cause of DALYs lost for females aged 15–44 years and

1.18 % of Gross Domestic Product (GDP) loss. Median total loss (physical and cognitive) combined are 4.05% of GDP in developing countries.

Public Health Implications of Anemia

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Current – close to 1%

Committed to achieve target – 3%Short term, Long term and Intergenerational benefits Improvements enhance human capitalContribute to a virtuous cycle by fostering economic development

Enhances health & nutrition of women and childrenWorld Health Assembly has proposed a target of 50% reduction in Anemia among women by 2025 and NHP 2017 commits to reduce

anemia prevalence by 3% per year Annual average rate of reduction (AARR) of anemia prevalence

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Why Should We Address Anemia?

Improvements enhance human capital

Contribute to a virtuous cycle by fostering economic development

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Milestones in Control of Anemia in India

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1970

60 mg Iron supplementation for PW and 20 mg for

1-5 yr X100 days

1991

60 mg Iron changed to 100mg

2007

5-10 yrs age group added

2013Wkly and biwkly supplementation. Test and treat (NIPI)Life cycle approach

2018I-NIPI Program intensification (Anemia Mukt

Bharat) PLW 60mgX180 days, IFS for WRA 6X6X6 strategyLife cycle approachAnemia control efforts in India started in 1970 with supplementation of Iron and folic acid across age groupsAnemia level in various population groups remained highIFA coverages remained less than 30%More than 50% cases of anemia attributed to Iron deficiency

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Learning from Best Performing

States/ Districtsv

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States with >=30% Anemia Decline

What Did They Do?v

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Anemia

Mukt Bharat will use a 6x6x6 strategy to combat anemia

6

interventions

institutional

mechanisms

6X6X6

strategy

6

6

Anemia

Mukt

Bharat

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Estimated

450 millionbeneficiariesReaching nearly 50% of the country’s population

Six Beneficiaries

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To reduce the prevalence of anemia by 3 percentage points per annum

Beneficiary-wise Targets v

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Six Interventions

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1

Prop

h

ylactic

iron

folic

acid

supplementation

3

Intensified year-round Behavior

Change Communication

Campaign

Solid Body Smart

Mind

,delayed cord clamping

5

Mandatory pr

o

vision of iron

public health prog

r

ammes

ANGAN

W

ADI

2

P

eriodic deworming of children,

adolescents, pregnant women

4

T

esting of anemia using digital

methods and point of care

treatment

HOSPI

T

AL

6

Addressing non-nutritional causes of anemia in endemic pockets, with special focus on malaria,

haemoglobinopathies

and

fluorosis

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Age group

Dose6 – 59 months of age Biweekly, 1 ml Iron and Folic Acid syrupEach ml of Iron and Folic Acid syrup containing 20 mg elemental Iron +

100 mcg of Folic AcidBottle (50ml) to have an ‘auto-dispenser’ and information leaflet as per MoHFW guidelines in the mono-carton5- 10 years

children Weekly, 1 Iron and Folic Acid tabletEach tablet containing 45 mg elemental Iron + 400 mcg Folic Acid

Sugar-coated, pink colour

Intervention- 1Prophylactic IFA supplementation- Regimev

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Age group

DoseAdolescentgirls and boys,10-19 years of ageWeekly, 1 Iron and Folic Acid tablet

Each tablet containing 60 mg elemental iron + 500 mcg Folic AcidSugar-coated, blue colour

Women ofreproductive age(non-pregnant, non-lactating)20-49 years

Weekly, 1 Iron and Folic Acid tabletEach 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 upto the first trimester of the pregnancy are advised to have 400 mcg of Folic Acid tablets, dailyPregnant women andlactating 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), continuedThroughout pregnancy (minimum 180 days during pregnancy)To be continued for 180 days, post-partum

Each tablet containing 60 mg elemental Iron + 500 mcg Folic AcidSugar-coated, red colour

Cont...Prophylactic IFA Supplementation- Regime

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Focus on Social mobilization and behaviour change: 4 key behavioursCompliance to Iron Folic Acid supplements and dewormingAppropriate 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 Intervention 3Intensified 360 Degree IEC/ BCC for Anemia Prevention & BehaviourChange

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Solid Body, Smart Mind

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Testing:

Use of digital hemoglobinometers In two age groups- to begin withSchool-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 AnalyzersThis may be extended to all age groups, later Intervention 4

Test and Treat Strategy v

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Mild/moderate

First level of treatment (at all levels of care)Two IFA tablets (each with 60 mg elemental iron and 500 mcgfolic acid), once daily, for 3 months

Line listing of all anemic cases; Two Follow-upsFirst follow-up after 45 days and second follow-up after 90 days at nearest health facility

If hemoglobin levels have come up to normal level, discontinue the treatment and continue with the prophylactic IFA doseIf no improvement after first level of treatmentIf no improvement after three months of treatment, RBSK team will refer the adolescent to First Referral Unit (FRU)/District Hospital (DH)

Severe anemiaManagement to be done by medical officer at FRU/DH based on investigation and diagnosis

Anemia Management Protocol for Adolescents

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Management protocol for severe anemia contraindicated for patients of thalassemia major and sickle cell disease.

Anemia Management Protocol forPregnant Womenv

Mild/moderate

First level of treatment (at all levels of care)Two tablets of iron and folic acid tablet (60 mg elemental iron and 500 mcg folic acid) daily, orally given by the health provider during the ANC contact.

* Parental iron (IV Iron sucrose or Ferric Carboxy Maltose may be considered as the first line of treatment in pregnant women who are detected to be anemic late in pregnancy or in whom compliance is likely to be low (high chance of lost to follow-up).Follow-up Every two

months, during the ANC contactIf no improvement after first level of treatmentIf no Hb (<1g/dl) increase; Refer to FRU/DH (case may be managed with IV Sucrose/FCM)

Severe anemia (5-6.9 g/dl)By medical officer, using IV Sucrose/FCM. Immediate hospitalization if pregnant woman is in 3rd

trimester.

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Six

Institutional Mechanismsv

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Target based monitoring

SIX performance indicators v

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Coordinated management efforts – intra & inter ministerial

Target based monitoring and KPI reviews and awards; Private schools; 60 mg instead of 100 mg prophylactic dose, sugar coated.Communication materials for extensive awareness, intensive 360 degree communication campaigns - Creating a Jan Andolan…Use of digital methods of hemoglobin estimation and point of care treatment, newer treatment strategies – IV Iron Sucrose and FCMLinkage with Malaria; mandating use of fortified food in public health programmes, specially double fortified salt (iron and iodine) Linkage with academic – national and regional networks- (re) learning and policy decisions

What’s New?

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LET US MAKE

INDIA ANEMIA-FREE