ANEMIA PROPHYLAXIS ANEMIA PROPHYLAXIS PROGRAMMEPROGRAMME

DefinitionDefinition

Anemia - insufficient Hb to carry out O2 requirement

by tissues.

WHO definition : Hb conc. 11 gm %

CDC definition : Hb conc. < 11gm % in 1st and 3rd trimesters and < 10.5 gm% in 2nd trimester

For developing countries : cut off level suggested is 10 gm %

Anemia - insufficient Hb to carry out O2 requirement

by tissues.

WHO definition : Hb conc. 11 gm %

CDC definition : Hb conc. < 11gm % in 1st and 3rd trimesters and < 10.5 gm% in 2nd trimester

For developing countries : cut off level suggested is 10 gm %

Degree Hb% Haematocrit (%)

Moderate 7-10.9 24-37%

Severe 4-6.9 13-23%

Very Severe <4 <13%

Degree Hb% Haematocrit (%)

Moderate 7-10.9 24-37%

Severe 4-6.9 13-23%

Very Severe <4 <13%

WHO Classification of Anaemia WHO Classification of Anaemia

Magnitude of ProblemMagnitude of ProblemMagnitude of ProblemMagnitude of Problem

Globally, is about 30 %Globally, is about 30 %

In developing countries & In developing countries & India, incidence is around India, incidence is around 40 – 90%.40 – 90%.

Responsible for 40% of Responsible for 40% of maternal deaths in third world maternal deaths in third world countries.countries.

Important cause of direct and Important cause of direct and indirect maternal deathsindirect maternal deaths

Globally, is about 30 %Globally, is about 30 %

In developing countries & In developing countries & India, incidence is around India, incidence is around 40 – 90%.40 – 90%.

Responsible for 40% of Responsible for 40% of maternal deaths in third world maternal deaths in third world countries.countries.

Important cause of direct and Important cause of direct and indirect maternal deathsindirect maternal deaths

Reason For Increased Reason For Increased Incidence Of AnemiaIncidence Of Anemia

Reason For Increased Reason For Increased Incidence Of AnemiaIncidence Of Anemia

Poor pre-pregnancy iron balance due to – Poor pre-pregnancy iron balance due to – untreated systemic diseases & menstrual untreated systemic diseases & menstrual disorders disorders

Improper supplementation of iron in pregnancy Improper supplementation of iron in pregnancy ( late registration and poor follow up)( late registration and poor follow up)

Repeated childbearingRepeated childbearing

Lack of awareness and illiteracyLack of awareness and illiteracy

Poor pre-pregnancy iron balance due to – Poor pre-pregnancy iron balance due to – untreated systemic diseases & menstrual untreated systemic diseases & menstrual disorders disorders

Improper supplementation of iron in pregnancy Improper supplementation of iron in pregnancy ( late registration and poor follow up)( late registration and poor follow up)

Repeated childbearingRepeated childbearing

Lack of awareness and illiteracyLack of awareness and illiteracy

Low socioeconomic status and poor hygieneLow socioeconomic status and poor hygiene

Chronic malnutritionChronic malnutrition

Poor availability of iron due to predominantly Poor availability of iron due to predominantly veg diet, diet low in calories but rich in phytates. veg diet, diet low in calories but rich in phytates. Food and religious taboosFood and religious taboos

GI infections and infestations GI infections and infestations (e.g. Kala azar, worm infestations)(e.g. Kala azar, worm infestations)

Low socioeconomic status and poor hygieneLow socioeconomic status and poor hygiene

Chronic malnutritionChronic malnutrition

Poor availability of iron due to predominantly Poor availability of iron due to predominantly veg diet, diet low in calories but rich in phytates. veg diet, diet low in calories but rich in phytates. Food and religious taboosFood and religious taboos

GI infections and infestations GI infections and infestations (e.g. Kala azar, worm infestations)(e.g. Kala azar, worm infestations)

Reason For Increased Reason For Increased Incidence Of AnemiaIncidence Of Anemia

Reason For Increased Reason For Increased Incidence Of AnemiaIncidence Of Anemia

IUGR

IUD IUH

CCFCCF

INFECTIONINFECTION

PRETERM LABOUR

PRETERM LABOUR

PIHPIH

Medical DisorderMedical Disorder

Complications - PregnancyComplications - PregnancyComplications - PregnancyComplications - Pregnancy

Instrumental delivery

PPH

FoetalDistressCCF

MATERNALPERINATAL

MorbidityMortality

Complications - LabourComplications - LabourComplications - LabourComplications - Labour

Available studies on prevalence of nutritional anemia in India show that 65% infant and toddlers, 60% 1-6 years of age, 88% adolescent girls (3.3% has hemoglobin <7 gm./dl; severe anemia) and 85% pregnant women (9.9% having severe anemia. The prevalence of anemia was marginally higher in lactating women as compared to pregnancy. The commonest is iron deficiency anemia.

launched in 1970

to prevent nutritional anemia in mothers and children.

1 tablet of iron and folic acid daily for a period of 100 days.

taken up by Maternal and Child Health (MCH), Division of Ministry of Health and Family Welfare. Now it is part of RCH programme.

The Ministry of Health and Family Welfare has revised the guidelines on IFA supplementation related to the National Nutritional anaemia Prophylaxis programme.

The infants between 6-12 months should also be included in the programme as there is sufficient evidence that iron deficiency affects this age also. Children between 6 months to 60 months should be given 20mg elemental iron and 100 mcg folic acid per day per child as this regimen is considered safe and effective. National IMNCI guidelines for this supplementation to be followed. 

For children (6-60 months), ferrous sulphate and folic acid should be provided in a liquid formulation containing 20 mg elemental iron and 100mcg folic acid per ml of the liquid formulation. For safety reason, the liquid formulation should be dispensed in bottles so designed that only 1 ml cab be dispensed each time. The current programme recommendations for pregnant and lactating women should be continued.

 School children, 6-10 year old, and adolescents, 11-18 year olds, should also be included in the National Nutritional Anaemia Prophylaxis Programme  (NNAPP). Children 6-10 year old 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 duration as adults. The adolescent girls will be given priority. Multiple channels and strategies are required to address the problem of iron deficiency anaemia. The newer products such as double fortified salts / sprinkles/ ultra rice and other micro nutrient candidates or fortified candidates should be explored as an adjunct or alternate supplementation strategy.

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