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Anemia Mukt Bharat

Anemia Mukt Bharat. -An Intensified National. Iron Plus Initiative. 18th September, 2018. Ministry of Health and Family Welfare. Government of India. A Snapshot of Anemia in India. High Prevalence across all ages Slow progress in most of the States.

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Anemia Mukt Bharat

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  1. Anemia Mukt Bharat • -An Intensified National • Iron Plus Initiative • 18th September, 2018 • Ministry of Health and Family Welfare • Government of India

  2. A Snapshot of Anemia in India High Prevalence across all ages Slow progress in most of the States Trend in Prevalence of Anemia among Children and Women v 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 age 50%of pregnant women 58%of breastfeeding mothers

  3. Anemia Prevalence among Pregnant Women (NFHS-4) v

  4. Causes of High Burden of Anemia Low Iron Stores Dietary Maternal Anemia Iron Loss • During pregnancy in anemic mothers • Poor iron stores from infancy, childhood deficiencies and adolescent Anemia • 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 • Due to parasitic load (malaria, intestinal worms) • Poor environmental sanitation, unsafe drinking water and inadequate personal hygiene • Increased 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 v

  5. Public Health Implications of Anemia • Decreased work output and work capacity • Physical and cognitive losses due to IDA in South Asia are staggering: close to $ 4.2 billion annually in Bangladesh, India and Pakistan • About 20 % of maternal deaths are caused by Anemia worldwide • tube defects, infants of low birth weight and still births • AnemiNeuralc pregnant women are more prone to increased morbidity and ; there is a three times greater incidence of premature delivery in severely anemic women v • Diminished concentration, disturbance in perception, delayed psychomotor development • Impaired language and motor skills, • Diminished IQ equivalent to a 5–10 point • 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.

  6. Improvements enhance human capital Contribute to a virtuous cycle by fostering economic development • Why Should We Address Anemia? Short term, Long term and Intergenerational benefits Enhances health & nutrition of women and children Contribute to a virtuous cycle by fostering economic development v Improvements enhance human capital World 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 Current – close to 1% Committed to achieve target – 3%

  7. Milestones in Control of Anemia in India • Anemia control efforts in India started in 1970 with supplementation of Iron and folic acid across age groups • Anemia level in various population groups remained high • IFA coverages remained less than 30% • More than 50% cases of anemiaattributed to Iron deficiency v 2013 2018 2007 1991 1970 5-10 yrs age group added Wkly and biwkly supplementation. Test and treat (NIPI) Life cycle approach I-NIPI Program intensification (Anemia Mukt Bharat) PLW 60mgX180 days, IFS for WRA 6X6X6 strategy Life cycle approach 60 mg Iron changed to 100mg 60 mg Iron supplementation for PW and 20 mg for 1-5 yr X100 days

  8. Learning from Best Performing States/ Districts v

  9. States with >=30% Anemia DeclineWhat Did They Do? v

  10. Anemia Mukt Bharat AnemiaMukt Bharat will use a 6x6x6 strategy to combat anemia 6 v 6X6X6 strategy 6 6 institutional interventions mechanisms

  11. Six Beneficiaries Estimated 450 millionbeneficiaries v Reaching nearly 50% of the country’s population

  12. Beneficiary-wise Targets To reduce the prevalence of anemia by 3 percentage points per annum v

  13. 2 1 Prop h ylactic iron folic acid P eriodic deworming of children, supplementation adolescents, pregnant women 4 3 Intensified year-round Behavior • Change Communication Campaign Solid Body Smart Mind ,delayed cord clamping T esting of anemia using digital HOSPI T AL methods and point of care treatment 6 5 Mandatory pr o vision of iron ANGAN W ADI public health prog r ammes • Six Interventions v Addressing non-nutritional causes of anemia in endemic pockets, with special focus on malaria, haemoglobinopathies and fluorosis

  14. Intervention- 1 • Prophylactic IFA supplementation- Regime v

  15. Cont... • Prophylactic IFA Supplementation- Regime v

  16. Intervention 3 Intensified 360 Degree IEC/ BCC for Anemia Prevention & BehaviourChange Focus on Social mobilization and behaviour change: 4 key behaviours • Compliance to Iron Folic Acid supplements and deworming • Appropriate 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 v Solid Body, Smart Mind

  17. Intervention 4 • Test and Treat Strategy Testing: • Use of digital hemoglobinometers • In two age groups- to begin with • School-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 Analyzers • This may be extended to all age groups, later v

  18. Anemia Management Protocol for Adolescents v

  19. Anemia Management Protocol forPregnantWomen v Management protocol for severe anemia contraindicated for patients of thalassemia major and sickle cell disease.

  20. Six Institutional Mechanisms v

  21. Target based monitoring • SIX performance indicators v

  22. What’s New? 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 FCM Linkage 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 v

  23. LET US MAKE INDIA ANEMIA-FREE

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