Nutritional Anaemia: A Major Health Problem in Assam

Dr Dharmakanta Kumbhakar

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

Health depends to a large extent on a balanced diet that maintains nutritional status. Most of the poor people in Assam are deprived of a balanced diet. Moreover, in today’s age, time has turned out to be more valuable than nutrition. We eat on the run, we grab a bite, pizzas and burgers are becoming lunch options, and a hastily-put-together junk recipe is replacing a traditionally balanced meal. Adding to this poisonous fare, pollution and adulteration are depleting the nutritive value of all food sources, be it vegetables, grains or fruits. The result of all these factors is an avalanche in the prevalence of nutritional deficiencies, the chief among which is nutritional anaemia.

In Assam, nutritional anaemia is classified as a major public health problem as it is widespread among children, adolescent girls and boys, women of reproductive age, pregnant women, and lactating mothers in different districts in the State, mirroring overall high rates of under-nutrition. As per the Fourth National Family Health Survey (NFHS-4) 2015-16, an estimated 35.7% (total), 36.5% (rural) and 27.6% (urban) of 6-59 months old children in Assam are anaemic (Hb<11.0gm/dl). Approximately, 46.0% (total), 46.3% (rural) and 44.2% (urban) of all 15-49 years old adult women are anaemic. The NFHS-4 records that 46.1% (total), 46.3% (rural) and 44.4% (urban) non-pregnant woman of reproductive age (15-49 years) are anaemic (Hb<12.0gm/dl. Approximately, 44.8% (total), 45.7% (rural) and 37.9% (urban) of pregnant women (15-49 years) are anaemic (Hb<11.0gm/dl). The NFHS-4 also records that 25.4% (total), 26.8% (rural) and 17.9% (urban) of 15-49 years old adult men suffer from nutritional anaemia (Hb<11.0gm/dl). These figures are high in all the districts of the State, which has tea gardens.

The most common type of nutritional anaemia in Assam is iron-deficiency anaemia and, less frequently, folic acid-and-vitamin B12-deficiency anaemia due to low dietary intake of iron and folic acid (IFA) and vitamin B12, improper absorption of IFA and vitamin B12, increased demand of IFA during pregnancy and lactation, and other related causes such as hook-worm infestation. Iron-deficiency anaemia occurs when iron reserves in the body get depleted and haemoglobin synthesis is inhibited. Deficiency of folic acid or vitamin B12 is implicated in the aetiology of nutritional anaemia as these are needed for the formation and growth of red blood cells.

Anaemia is a reduction in the oxygen-transporting capacity of blood from lungs to different tissues and organs of the body due to reduction of 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. Nutritional anaemia has detrimental effects on the health of children, adolescent girls, women of reproductive age, and pregnant women. Nutritional 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.

Most of the children, adolescent girls and boys, women of reproductive age, pregnant women, and lactating mothers of Assam are vulnerable to the adverse consequences of anaemia as nutritional anaemia is most prevalent in the State. Forty per cent of all maternal and peri-natal deaths in the State are linked to nutritional anaemia, especially iron-deficiency anaemia. Iron-deficiency anaemia also results in an increased risk of premature delivery, low-birth weights, and infant mortality. Nutritional anaemia in adult men is one of the causes of decreased productivity and per capita income of the State.

The Assam government has been providing free IFA supplement to all pregnant women, lactating mothers, adolescent girls, schoolchildren, and young children to prevent nutritional anaemia and its adverse consequences under the National Anaemia Control Programme for the last two decades. The Central government and the State government often run some special drives to make the country and the State nutritional anaemia-free. Despite the measures taken by the government, there is very slow decline in the prevalence and adverse consequences of nutritional anaemia in Assam, and till date, it is a major public health problem in the State.

The coverage under IFA supplementation is low in Assam as the majority of pregnant women do not receive IFA tablets regularly, only one-third of those who receive the tablets take them regularly, and less than 10% take more than 90 tablets during pregnancy. There has been poor access and intake of IFA syrup by children, inadequate training of frontline health workers, and inadequate counselling of mothers. The free distribution of IFA tablets among the schoolchildren of the State is also poor. The low compliance of 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 that combined food and IFA supplementation can reduce the side effects associated with IFA preparations.

Therefore, redressing nutritional anaemia among the vulnerable groups in Assam requires an urgent attention. The anaemia control programme needs to be implemented more efficiently in the State. New and innovative strategies are the need of the hour to make IFA readily available, apart from the mechanism to motivate the vulnerable groups to regularly take IFA supplements. Combined food and IFA supplementation programme may be the most effective way to address nutritional anaemia.

Of course, only free IFA supplementation programme cannot iron out nutritional anaemia from Assam. It is the time to collectively iron out nutritional anaemia from the State with awareness, balanced diet and proper supplementation. Some important steps along with IFA supplementation to deal with this major public health problem may be dietary diversification ensuring inclusion of iron-folate-vitaminB12 rich food, inclusion of food items that promote iron absorption, food fortification with IFA, health and nutrition education to improve overall dietary intake, promotion of consumption of iron and folate-rich foodstuffs, screening for early detection of nutritional anemia among vulnerable groups, appropriate management of nutritional anaemia, provision of proper antenatal services preferably by doctors, and distribution of free commodities like rice, dal etc on each antenatal visit with a cash award.

The government should provide nutritional support to meet the recommended dietary allowances for vulnerable groups through Aanganwadi programmes. There must be proper implementation of integrated programmes for hookworm eradication, malaria prophylaxis and proper sanitation. Nutritional anaemia among the adult male population in Assam must be corrected to increase productivity and per capita income so that their families get nutritious food and the State becomes nutritional anaemia-free.