India MOH Alert On Iron-Deficiency Anaemia

Union Ministry of Health and Family Welfare gave a high priority to iron-deficiency anaemia. On 23 April 2007 , it issued a notification and guidelines to make iron and folic acid (IFA) distribution across India a success.

Iron deficiency remains a major nutritional problem among infants and young children in India. The recent National Family Health Survey III that more than 74 per cent children between the ages of 6-35 months were anaemic.

Vitamin A deficiency is being addressed through nationwide biannual distribution of vitamin A solution to infants, young children, and fortification of foods.

However, little progress was made to eliminate iron deficiency. The Iron continued to remain as most "neglected micronutrient" in spite of its higher magnitude of problem and more serious health consequences.

Regular use of Iron-Folic Acid (IFA) supplements protects a woman's health by helping her body store iron, and preventing a plunge into iron deficiency anaemia (IDA) during pregnancy and delivery. IDA results in low birth-weight babies, morbidity, and maternal mortality. In addition, IFA provides a woman with sufficient folic acid before pregnancy, preventing neural tube defects that can occur during the first few weeks of fetal gestation.

The World Health Organization estimates that 43% of all women of reproductive age living in the developing world have IDA. IDA during pregnancy results in more than 60,000 maternal deaths each year. Folic acid deficiency during pregnancy causes more than 200,000 neural tube defects. Many countries' attempts to combat iron deficiencies during pregnancy with the distribution of iron folate through prenatal clinics has proved less than successful because many women in developing countries do not seek prenatal treatment or do so too late to take advantage of iron folate.

There is strong scientific evidence from community-based studies that iron deficiency anaemia is associated with impaired performance on a range of mental and physical functions in children like mental development, physical coordination and capacity, cognitive abilities, social and emotional development, and loss of intelligence quotient similar to iodine deficiency. The other health consequences are i) poor scholastic performance; ii) reduced immunity; iii) increased morbidity; iv) increased susceptibility to heavy metal (including lead) poisoning. The precise effects vary with the age groups studied. Recent studies have documented that the iron supplementation at a later age may not reverse the effects of moderate to severe iron deficiency anaemia that occurred during the first 18 months after birth.

The recent notification of Union Ministry of Health and Family Welfare gives a high priority to the problem of Nutritional anaemia by including all children and young people for Iron and Folic acid distribution falling in the age-bracket 6 - 60 months, 6- 10 years and 11 to 18 years.

The policy regarding IFA (Iron Folic Acid) supplementation which was approved is as follows:

1) The infants between 6-12 months should also be included in the programme as there is sufficient evidence that IFA deficiency also affects this age group

2) Children between 6 months to 60 months should be given 20 mg elemental iron and 100 micro gm folic acid per day per child as this is considered safe and effective

3) National IMNCI (Integrated Management of Neonatal and Childhood Illnesses) guidelines to be followed

4) For children (6 to 60 months) ferrous sulphate and folic acid should be provided in a liquid formulation containing 20 mg elemental iron and 100 micro gm folic acid per ml of the liquid formulation. For safety reasons the liquid formulation should be dispensed in bottles so designed that only 1 ml can be dispensed each time.

5) Dispersible tablets have an advantage over liquid formulations in programmatic conditions. These have been used effectively in other parts of the world, and in large scale Indian studies. The logistics of introducing dispersible formulation of iron and folic acid should be expedited under the programme.

6) The current programme recommendations for pregnant and lactating women should be continued

7) School children (6-10 years old) and young adolescents (11-18 years old) should also be included in National Nutritional Anaemia Prophylaxis Programme (NNAPP)

8) Children 6 - 10 years old should be provided 30 mg elemental Iron and 250 micro gm folic acid per child per day for 100 days in a year

9) Adolescents 11-18 years old will be supplemented at the same doses and duration as adults. The adolescent girls will be given a priority.

10) Multiple channels and strategies are required to address the problem of iron deficiency anaemia. The newer products such as double fortified salts, sprinklers, ultra rice and other micro nutrient candidates or fortified candidates should be explored as an adjunct or alternate supplementation strategy.

Dr Umesh Kapil, Professor Public Health Nutrition, (email: umeshkapil@yahoo.com ) is compiling comments on the recently issued notification of the Health Ministry. So readers are requested to send in their responses.

Bobby Ramakant

(The author is a senior health and development journalist, writing for newspapers in Asia, Africa and Middle East. He can be contacted at: bobbyramakant@yahoo.com)

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