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Test and Treat Strategy for Point of Care Management Of Anemia

“ Anemia Mukt Bharat and Home-based Young Child Care” National Dissemination Workshop for State Programme Managers, 18 & 19 September, 2018. Test and Treat Strategy for Point of Care Management Of Anemia. Dr . Kapil Yadav, Associate Professor , and

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Test and Treat Strategy for Point of Care Management Of Anemia

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  1. “Anemia Mukt Bharat and Home-based Young Child Care”National Dissemination Workshop for State Programme Managers, 18 &19 September, 2018 Test and Treat Strategy for Point of Care Management Of Anemia Dr. Kapil Yadav, Associate Professor, and Dr Shashi Kant, Professor and Head, Centre for Community Medicine and National Centre of Excellence and Advanced Research on Anemia Control (NCEAR-A), All India Institute of Medical Sciences (AIIMS), New Delhi

  2. Take Home Message • Hb estimation essential for management & follow up • Test and Treat strategy -key paradigm shift for AMB • POCT by digital hemoglobinometer a feasible option • Need for scaling up & universalising “Test and Treat” • Future research for validating non-invasive hemoglobinometer

  3. High prevalence across all age groups Prevalence of Anemia in India Source: NFHS 4 2015-16

  4. State-wise burden of anemia amongst Pregnant women in India

  5. INTENSIFIED NATIONAL IRON PLUS INITIATIVE April, 2018 Ministry of Health and Family WelfareGovernment of India

  6. Objectives of Anemia Mukt Bharat To reducein morbidity and mortality due to anemia 2. To reduce anemia prevalence by 3 percent per annum in all age groups (children, adolescents, pregnant women and WRA) 3. To increase the proportion of eligible target beneficiaries who consumed IFA tablet as per protocol by 50% (by NFHS-5) 4.To increase community knowledge and risk perception through improved social support 5. To ensure that state governments have enhanced capacity to deliver services and supplies for prevention and management of anemia

  7. Targets of Anemia Mukt Bharat • To reduce the prevalence of anemia by 3 percentage points per annum as per POSHAN Abhiyaan targets

  8. How will this be done? 6 6X6X6 strategy 6 6 institutional interventions mechanisms

  9. NCEAR-A ‘National Centre of Excellence and Advanced Research on Anemia Control (NCEAR-A)’ established at Centre of Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.

  10. Vision ofNCEAR-A “To develop and provide technical support to the Ministry of Health and Family Welfare, Government of India, for incorporating scientific, policy and community perspective in policy and programmatic decisions for control of anemia.”

  11. Objectives of NCEAR

  12. 6 Interventions Point of Care Testing of anemia and Treatment and fluorosis

  13. Why Point of Care Test and Treatment Strategy? • Equipped laboratory may not be available / accessible • Enables screening in outreach and community setting • Beneficiary may be lost to follow up if called again for laboratory tests • Paradigm shift from earlier clinical examination or laboratory based tests

  14. Hemoglobin Estimation included in WHO Essential Diagnostic List

  15. Other Advantages of POCT • Small volume of blood sample required • Rapid turnover time, more beneficiaries covered • Overcomes need for health facility visit • No loss to follow up • Ease of obtaining the sample (capillary vs venous) • Laboratory technicians & phlebotomists not required

  16. Invasive methods: Indirect cyanmethemoglobin method Sahli’s method Hb color scale method Copper sulphate method Vanzetti’s method and modifications (HemoCue 201, HemoControl, TrueHb) Invasive methods with reagent free cuvettes: HemoCue 301 DiaSpect Non-invasive methods: Occlusion spectroscopy (NBM 200) Pulse co-oximetry Trancutaneous Reflection Spectroscopy (HemoSpect) POCT for Hemoglobin Estimation

  17. Poor sensitivity and specificity of Sahli’sand WHO Colour Scale Anand H, Mir R, Saxena R. Hemoglobin color scale a diagnostic dilemma. Indian Journal of Pathology and Microbiology. 2009 Jul 1;52(3):360.

  18. Validation of Digital Hemoglobinometer as compared to gold standard • AIIMS, New Delhi assessed validity of two digital hemoglobinometer devices (Device A and Device B) compared with autoanalyzer • Device B: Reagent free microcuvettes, not affected by moisture, temperature , no specific storage conditions Device B is being used for “Test and Treat” camps during PoshanMaah

  19. Validation of Digital Hemoglobinometer as compared to gold standard Agreement between Device B and Gold Standard Scatter plot between Device B and Gold Standard

  20. Adolescent girls and boys of 10-19 years in government and government aided schools Pregnant women registered for ANC check-up To be extended to other beneficiary groups subsequently Target group for Test and Treat intervention under Anemia Mukt Bharat

  21. Test and Treat intervention for anemia amongst Adolescent

  22. Management of Mild and Moderate Anemia amongst Adolescent

  23. Management of Severe Anemia amongst Adolescent

  24. Test and Treat intervention for anemia amongst Pregnant women

  25. Prophylactic IFA supplementation during Pregnancy – No anemia • Daily One IFA tablet • Each tablet containing 100 (60) mg elemental iron + 500 mcg folic acid, sugar-coated, red-colour. • Starting from the 4th month of pregnancy/from the second trimester /at 14th week of gestation) • Continued throughout pregnancy • Minimum 180 days during pregnancy

  26. Testing and treating of anemia in pregnant women under AMB – Mild anemia

  27. Testing and treating of anemia in pregnant women under AMB – Moderate anemia

  28. Testing and treating of anemia in pregnant women under AMB – Severe anemia

  29. Testing and treating of anemia in pregnant women under AMB – Severe anemia

  30. Take Home Message • Hb estimation essential for management & follow up • Test and Treat strategy -key paradigm shift for AMB • POCT by digital hemoglobinometer a feasible option • Need for scaling up & universalising “Test and Treat” • Future research for validating non-invasive hemoglobinometer

  31. THANK YOU NCEAR-A Team, AIIMS, New Delhi

  32. Test and treat interventionforanemia in Adolescent Screening for anemia No anemia > 12 g/dl Mild / moderate anemia 8-11.9 g/dl Severe anemia <8g/dl 60 gm elemental Fe tablet – twice daily orally for 3 months (under observation by school teacher) Weekly, 1 IFA tablet (100 mg elemental Fe + 500 mcg folic Acid) Sugar coated blue colour Management by MO at FRU 1st follow-up*: after 45 days 2nd: follow-up*: after 90 days Hb ≤ 12g/dl Hb > 12g/dl *Follow up by RBSK team / ANM based on the feasibility of the state

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