India has the largest burden of anemia in the world. In the last 50 years, policy and programmatic efforts have been made to reduce the rates of anemia prevalence, however, progress has been slow. In fact, the prevalence of anemia remains high amongst children and pregnant women. Anemia poses multiple health risks, including maternal mortality, low absorptive capacity of other micronutrients (folic acid, vitamin B), motor and mental impairment in children, low work productivity amongst adults and even death. Iron-deficiency anemia is also the leading cause of disability in India. Anemia poses a loss of 4% of the GDP for adults and children combined.
The poor progress in reduction of rates of anemia is underscored by the persistent gaps in the coverage of essential nutrition and health interventions, especially in the first 1000 days of the child, amongst other factors. Within this context, the medical journal, BMJ Global Health, released a study in August 2018 that explores the trends and drivers of change in the prevalence of anemia among one million women and children in India, between 2006 and 2016.
According to data from the 1999 and 2006 National Family Health Survey (NHFS 2 and 3) in India, the prevalence of anemia increased from 74% to 79% amongst children 6-36 months and 52%-56% amongst women aged 15-49 years. This is particularly surprising because the economic growth in India was rapid during this period and it is expected that economic development spurs reduction of anemia rates in developing countries. In addition, the limited progress in anemia reduction has not been uniform across states.
However, the National Family Health Survey-4 has revealed that between 2006 and 2016, improvements in nutrition and health interventions were the biggest drivers of anemia reduction amongst children. For pregnant women, the key drivers included improvements in maternal schooling and socio-economic status (SES). Other driving factors included higher maternal body mass index, greater consumption of animal-source food, sanitation and less children per household.
Despite some success in the past decade, anemia remains a persistent public health concern in India. For instance, the traditional approach of fortifying foods (wheat) with iron or providing iron supplements fell short because of low uptake and lack of attention to other drivers.
ICDS primarily focused on food supplementation (this implies receipt not consumption) rather than high quality nutrition education and healthcare services. Moreover, the food provided through social welfare programmes is not necessarily rich in micronutrients required to combat anemia. Increase in the consumption of dark green leafy vegetables, if not meat and fish, as critical sources of nutrients, is one way of combating anemia. With renewed focus on fortification of foods in India, the private sector in the food industry can play a crucial role in ensuring far-reaching impacts to reduce anemia prevalence.
Overall, India’s limited success in reducing anemia can be attributed to implementation challenges, poor distribution channels as well as poor coverage and targeting. In order to accelerate reductions in anemia, it is critical to gather evidence around the individual, household and community-level factors that could explain changes in prevalence of anemia over time. In the absence of such evidence, the policy-makers in India are challenged to determine the investments with greatest impact on anemia reduction.
A holistic approach is required to reduce widespread prevalence of anemia.Amongst children aged 6-59 months, the interventions must be directed towards pregnant/lactating women, the mothers and children (ICDS), This includes consumption of iron and folic acid (IFA) tablets, deworming, full immunisation and Vitamin A supplementation. However, in 2016, the coverage of nutrition and health interventions in the form of IFA consumption was at 30%, deworming during pregnancy (18%) and early childhood (32%).
In case of non-pregnant women, the poor progress can be attributed to the fact that there is inadequate policy focus on this segment of the population. Most national-level anemia programmes, or any nutrition/health related interventions ae usually focused upon young children, adolescents and pregnant/lactating women. This reflects the importance accorded to the reproductive potential of women, as bearers of future human capital in the country.
The guidelines under the 2018 Anemia Mukt Bharat haveunderline an integrated approach to strengthen coverage and implementation. These centre around IFA supplementation but also lay emphasis upon behaviour change communication to improve pill-taking compliance, deworming, education on appropriate dietary choices and child feeding practices, promotion of delayed cord clamping, mandatory provision of fortified foods in public health programmes as well as screening and treatment of non-nutritional causes of anaemia with a focus on malaria.
However, the socio-economic status and education of women, along with the levels of household sanitation, remain the most critical determinants underlying the reduction of anemia prevalence in India. Women must be enabled to make improved dietary choices for themselves and their families. They must be provided with access to timely and high-quality health services, regardless of their socio-economic stature. Broader goals include creation of livelihood opportunities for poor households to boost their socio-economic conditions and improving sanitation and hygiene practices in society.
India Outbound
February 18, 2019
source https://indiaoutbound.org/trends-in-anemia-reduction-in-india/
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