"Anemia may be common, but it's not inevitable - take action today.”
Introduction:
Anaemia is a serious global public health problem that particularly affects young children and pregnant women with more than 2 billion people worldwide suffering from it. WHO estimates that 42% of children less than 5 years of age and 40% of pregnant women worldwide are anaemic (1)
The World Health Organization (WHO) has defined anaemia as a haemoglobin level below 13 g/dL in men, below 12 g/dL in non-pregnant women and below 11 g/dL in pregnant women. It is diagnosed with checking a complete blood panel, serum iron, vitamin B12, folic acid and ferritin levels.
Symptoms of anaemia :
People suffering from anaemia experience fatigue, weakness, difficulty concentrating, memory
problems, depression, anxiety, decreased attention span, sleep disturbances, restless leg syndrome and in serious cases, heart failure and heart attacks. Anaemia can weaken the immune system making women more susceptible to infections such as malaria, tuberculosis, and HIV. It can lead to adverse pregnancy outcomes such as preterm delivery, low birth weight, and perinatal problems.
Poverty and anemia, ‘a silent vicious cycle’:
Poverty can exacerbate anaemia due to limited access to healthcare facilities and services, making it challenging to diagnose and treat anemia. Low socioeconomic population can’t afford to purchase iron-rich foods or supplements, resulting in poor dietary intake of iron. In addition, living conditions in impoverished areas may increase the risk of parasitic infections, which can also contribute to anemia.
Anemia, in turn, can exacerbate poverty, due to decreased physical performance and productivity such individual's ability to work, attend school, and care for themselves and their families, perpetuating the cycle of poverty. The effects of poverty and anemia on children are particularly severe, resulting in developmental delays, poor school performance, and long-term health problems. In pregnant women, anemia can result in adverse pregnancy outcomes, including preterm delivery, low birth weight, and maternal mortality, further perpetuating the cycle of poverty.
Breaking the vicious cycle of poverty and anemia requires a multi-faceted approach that focus and address the underlying social, economic, and health-related factors. As untreated anemia over a period will lead to reduced physical, mental, and cognitive performance limiting daily activities, economic productivity and affecting overall quality of life, approach should include measures to improve access to healthcare services, education, and nutritious food, as well as interventions to prevent and treat anemia. These measures would not only improve the health and well-being of individuals, but also have long-term economic benefits by improving productivity and reducing healthcare costs.
Anaemia burden in India:
Anaemia is a common health problem in India. Per National Family Health Survey 5 (2019-21),
prevalence of anaemia across age groups is as follows (2): Children age 6-59 months: 67%, Adolescent girls: 59%, Women age 15-49 years: 57%, Adolescent boys age 15-19 years: 31.1%, Men age 15-49 years: 15-25% Nutritional deficiencies (iron, B12 and folic acid) due to poor dietary intake, blood loss (menstruation), and parasitic infestations are some of the leading causes. Moreover, the prevalence of anemia is higher among pregnant women due to increased demand for iron and folic acid during pregnancy.
"In 2018, the Government of India launched the Anaemia Mukt Bharat (AMB) strategy with the target to reduce anaemia in the vulnerable age groups such as women, children and adolescents in life cycle approach providing preventive and curative mechanisms through a 6X6X6 strategy - six target age groups, six interventions and six institutional mechanisms for all stakeholders".
Identify, approach, and treat target Population:
Counseling about the effects of anemia is essential to raise awareness and encourage adherence to treatment. Non-adherence to treatment is a common problem in rural areas and can have serious consequences for individuals and the community. Lack of access to health care, cost of treatment, lack of education, beliefs and attitude and lack of support being some of the many factors contributing to non-compliance of the treatment. Moreover, anemia during pregnancy can increase the risk of complications, such as preterm birth and low birth weight. Counseling should also emphasize the importance of seeking medical attention for symptoms of anemia. Dietary interventions such as eating iron-rich foods as green leafy vegetables, nuts, and dried fruits, is a low-cost way to prevent anemia. Additionally, fortification of staple foods, such as wheat flour and salt, with iron and folic acid can be a cost-effective strategy for prevention.
In India, community health workers, such as Accredited Social Health Activists (ASHAs), can play a crucial role in identifying and approaching the target population. ASHAs can visit households and screen women for anemia using a portable hemoglobinometer. Additionally, community-based campaigns, such as health fairs and mobile clinics, can be effective in reaching a larger population.
Community-based interventions, such as the prophylactic distribution of iron-folic acid, vitamin B12 tablets to pregnant women and the provision of deworming treatment, have also been successful in reducing the prevalence of anemia. Increasing awareness in women that anemia can cause fatigue, weakness, and other symptoms that can significantly impact their daily lives and the importance of taking medications as prescribed, attending follow-up appointments, and maintaining a healthy diet to prevent recurrence of anemia. Early diagnostic/clinical testing can also curb the disease at a very early stage thus reducing its immediate and long-term sequela.