Seeking an anaemia-free Assam

Dr. Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)

Anaemia is most prevalent in Assam. The most common type of anaemia in Assam is iron deficiency anaemia and less frequently folic acid and vitamin B12 deficiency anaemia due to low dietary intake of iron, folic acid and vitamin B12, improper absorption of iron, folic acid and vitamin B12, increased demand for iron and folic acid during pregnancy and lactation and other related causes such as hookworm infestation. Anaemia associated with iron and folic acid deficiency is widespread among children, adolescent girls, women of reproductive age, pregnant women and lactating mothers in different districts of Assam; mirroring overall high rates of under-nutrition.

According to the fifth National Family Health Survey (NFHS-5) 2019-20, an estimated 68.4 per cent (66.4 per cent in urban areas and 68.6 per cent in rural areas) of 6 to 59-month-old children in Assam are anaemic. Approximately 67.0 per cent (67.4 per cent in urban areas and 67.0 per cent in rural areas) of 15 to19-year-old girls and 39.6 per cent (34.6 per cent in urban areas and 40.4 per cent in rural areas) of 15 to19-year-old boys are anaemic. The NFHS-5 records that 65.9 per cent (65.2 per cent in urban areas and 66.0 per cent in rural areas) of all women of reproductive age (15-49 years), 66.4 per cent (66.0 per cent in urban areas and 66.4 per cent in rural areas) non-pregnant woman in the 15-49 age group and 54.2 per cent (41.4 per cent in urban areas and 55.9 per cent in rural areas) of pregnant women in the 15-49 age group are anaemic. The NFHS-5 also records that 36.0 per cent (27.6 per cent in urban areas and 37.5 per cent in rural areas) of old adult men in the 15-49 age group suffer from anaemia. These figures are high in the districts with tea gardens, indicating that anaemia is worse among the tea garden population than others.

Anaemia is a reduction in the oxygen-transporting capacity of blood from the lungs to different tissues and organs of the body due to a fall in haemoglobin concentration in the red blood cell mass to below-normal amounts. Anaemia can lead to reduced productivity, increased susceptibility to infections and slow recovery from illnesses. Anaemia has detrimental effects on the health of children, adolescent girls, women of reproductive age and pregnant women. Anaemia in children can result in impaired cognitive performance, behavioural and loco-motor development, coordination, language development and scholastic achievement thereby severely implicating human development besides increasing morbidity from infectious diseases. Adolescent girls need extra iron and folic acid for physiological and biological changes associated with age to prepare them for childbearing in due course of time and, in the longer term to reduce anaemia in older women of reproductive age. Extra iron and folic acid are also needed to reduce anaemia in older women of reproductive age. Incidence of anaemia in adolescent girls and women can result in weakness, diminished physical and mental capacity and increased morbidity from infectious diseases. Most children, adolescent girls and boys, women of reproductive age, pregnant women and lactating mothers of Assam are vulnerable to these adverse consequences of anaemia. In pregnant women, anaemia may become the underlying cause of premature delivery, low birth weights, maternal mortality, perinatal mortality and infant mortality. Forty per cent of all maternal and perinatal deaths in Assam are linked to anaemia, especially iron deficiency anaemia. Anaemia in adult men decreases the productivity and per capita income of the State.

Under the National Anaemia Control Programme, the Assam Government has been providing free iron and folic acid (IFA) supplements to pregnant women, lactating mothers, adolescent girls and children to prevent anaemia and its adverse consequences, for the last two decades. They often run some special drives to make Assam anaemia-free. Still, there is no decline in the prevalence and adverse consequences of anaemia in Assam.

The coverage under IFA supplementation is low in Assam as the majority of pregnant women don't receive IFA tablets always; only one-third of those who receive the tablets take them regularly, and less than 10 per cent take more than 90 tablets of IFA during pregnancy. There has been poor access to and intake of IFA syrup by children, inadequate training of frontline health workers and inadequate counselling of mothers.

Therefore, redressing anaemia among the vulnerable groups in the State requires urgent attention. The anaemia control programme needs to be implemented more efficiently in Assam. New innovative strategies are the need of the hour to make IFA readily available as well as the mechanism to motivate vulnerable groups to regularly take IFA supplements. The low compliance with IFA supplementation is particularly due to the side effects associated with IFA preparations. Taking IFA preparations on empty stomach can cause gastritis, abdominal cramp, vomiting and passage of black stool. The good news is combined food and IFA supplementation programme would be most effective to address anaemia in Assam.

But, only a free IFA supplementation programme cannot make Assam anaemia free. This can be done with awareness, a balanced diet and proper supplementation. Important steps along with IFA supplementation to make Assam anaemia free may be dietary diversification ensuring the inclusion of iron-folate-vitamin B12 rich food, the inclusion of food items that promote iron absorption, food fortification with iron and folic acid, screening for early detection of anaemia among vulnerable groups and appropriate management of anaemia. The Government should provide nutritional support to meet the recommended dietary allowances for vulnerable groups through Anganwadi programmes. Integrated programmes for hookworm eradication and proper sanitation, etc., must be properly implemented.