India’s rethinking on anaemia policy
- June 4, 2023
- Posted by: OptimizeIAS Team
- Category: DPN Topics
India’s rethinking on anaemia policy
- Questions related to anaemia are slated to be dropped from the National Family Health Survey (NFHS-6) scheduled to begin on July 6.
- The omission comes after health experts questioned the efficacy of the method being used to estimate haemoglobin levels.
National Family Health Survey (NFHS):
- The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
- The first National Family Health Survey (NFHS-1) was conducted in 1992-93. Subsequent NFHS’ were conducted as below –
- NFHS-2 was conducted in 1998-99
- NFHS-3 was conducted in 2005-06
- NFHS-4 was conducted in 2015-16
- NFHS-5 was conducted in 2019-21
- The main objective of the NFHS has been to provide reliable and comparable data relating to health and family welfare and other emerging areas in India.
- All the rounds of NFHS have been conducted by the International Institute for Population Sciences (IIPS), Mumbai, as the national nodal agency.
- Nodal Ministry: Ministry of Health & Family Welfare.
- According to the World Health Organization (WHO), anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal.
- Haemoglobin is needed to carry oxygen.
- If there are too few red blood cells, or not enough haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues.
- This results in symptoms such as fatigue, weakness, dizziness and shortness of breath among others.
- The most common nutritional cause of anaemia is iron deficiency although deficiencies in folate, vitamins B12 and A are also important causes.
- Certain chronic diseases, such as kidney disease, liver disease, cancer, or autoimmune disorders, can interfere with the production of red blood cells.
- Inherited conditions, such as sickle cell anemia or thalassemia, affect the structure or function of red blood cells, leading to chronic anemia.
India’s anaemia burden
- India’s anaemia burden has grown alarmingly with NFHS-5 (2019-21) finding that:
- 57% of women in the age group 15-49 and
- 67% children between six months and 59 months are anaemic (from the corresponding 53% and 58.6% respectively in NFHS-4 (2015-16)).
- The Health Ministry has noted that anaemia is a public health challenge.
What prompted the change?
- WHO cut-offs for haemoglobin may not be suited to India
- The WHO defines:
- anaemia in children aged under five years and pregnant women as a haemoglobin concentration <110 g/L at sea level, and
- anaemia in non-pregnant women as a haemoglobin concentration <120 g/L.
- Experts had cautioned that there is a danger of anaemia being over-diagnosed in India as it follows WHO cut-offs for haemoglobin.
- This may not be suited to India, because the cut-off point depends on the age, gender, physiological status, altitude and other factors.
Differences in the way blood is drawn for sampling in NFHS
- Various studies also pointed to differences in the way blood is drawn for sampling in NFHS.
- The NFHS survey measured haemoglobin in a drop of capillary blood that oozes from a finger prick.
- This, as per the report, can dilute the blood and give a falsely lower value.
- The recommended method of venous blood sampling, as per the report, gives a more accurate value.
Shift in assessment of anaemia in India
- According to the Health Ministry, assessment of anaemia in India is being shifted to the new Diet and Biomarkers Survey in India (DABS-I).
- DABS-I was launched in December 2022 to map diet, nutrition and health status and provide the correct estimate of anaemia among the rural and urban population.
- The survey will define food and nutrient adequacy by collecting individual dietary intake data of different age groups of people.
- The study will also provide nutrient composition data on cooked and uncooked foods from various regions of the country for the first time.
- India launched a programme under the POSHAN Abhiyaan aiming to make the country ‘anaemia-free’ and set a target of reducing anaemia in WRA to below 35% by 2022.
- Because an iron-deficient diet is the primary cause of the large burden of anaemia, the Ministry of Health and Family Welfare is engaged in increasing the iron intake of the population.
The Government of India implements Anaemia Mukt Bharat (AMB) strategy under POSHAN Abhiyaan with the target for reducing anaemia in the six population groups – Children (6-59 months), Children (5-9 years), Adolescents girls and boys (10-19 years), Pregnant women, Lactating women and Women of Reproductive Age (WRA) group (15-49 years) in life cycle approach. Some of the major interventions by Ministry of Health and Family Welfare (MoHFW) to address anaemia under AMB include:
- Prophylactic Iron and Folic Acid Supplementation.
- Intensified year-round Behaviour Change Communication (BCC) Campaign and delayed cord clamping.
- Testing of anaemia using digital methods and point of care treatment.
- Addressing non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis.
- Convergence and coordination with line department and other ministries.
- Engaging National Centre of Excellence and Advanced research on Anaemia Control for capacity building of health care providers.
- Monitoring progress in States/UTs using Anaemia Mukt Bharat Dashboard.