Anemia mukth bharath

Session overview
• Speaker : DR.Sivaharivelan.T
• Topic : Anemia mukt bharat
• Date : 24/12/2020
• Time : 2.30 pm
• Duration : 30 – 45 mins
• Method : seminar
• Audience : Faculty of Community medicine
• A-v aids : LCD projects
2

Specific learning objectives
• To describe what is anaemia
• To recollect the past government interventions for anaemia
• To describe the importance of Anaemia Mukt Bharat
• To review 6*6*6 strategy of Anaemia Mukt Bharat
• To explain the treatment plan for anaemia
3

What is anaemia?
• Anaemia is a condition in which the number of red blood cells
or the haemoglobin concentration within them is lower than
normal.
• Male: 14 to 17 gm/dL
• Female: 12 to 15 gm/dL
6

Anemia in world
• All ages anemia prevalence was 22.8% globally in 2019, a
decrease from 27.0% in 1990. While prevalence decreased
over this time, total cases of anemia increased from 1.42
billion in 1990 to 1.74 billion in 2019.
• Prevalence was highest among children under five years, with a
combined prevalence of 39.7% in 2019. Globally, 54.1% of
anemia cases were mild, 42.5% were moderate, and 3.4%
were severe.
7

Why Anemia Mukt Bharat needed?
• Anemia is a silent epidemic impacting our physical growth, mental and work
capacity, and lives of future generations. All population groups in India are
affected by anemia and, hence, intensified efforts are needed to tackle this
problem.
• 18th September, 2018
• Ministry of Health and Family Welfare Government of India
11

ANEMIA MUKT BHARAT
• Intensified National Iron Plus Initiative Program
• Target for accelerating the annual rate of decline of
anemia from one to three percentage points.
12

6*6*6 STRATEGY
6
beneficiaries
6
interventio
ns
6X6X6
strategy
6
institutional
mechanisms
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6 Beneficiaries:
1.Children 6-59 months
2.Children 5-9 years
3.Adolescent girls and boys (10-19 years)
4.Women of reproductive age (15-49 years)
5.Pregnant women
6.Lactating mothers
15

Population NoAnemia (gm/dL) Mild Anemia
(gm/dL)
Moderate Anemia
(gm/dL)
SevereAnemia
(gm/dL)
Children 6-59
months of age
11.0 10-10.9 7.0-9.9 <7.0
Children 5-11
years of age
11.5 11.0-11.4 8.0-10.9 <8.0
Children 12-14
years of age
12.0 11.0-11.9 8.0-10.9 <8.0
Non-pregnant
women (15 years
of age and above)
12.0 11.0-11.9 8.0-10.9 <8.0
Pregnant women 11.0 10.0-10.9 7.0- 9.9 <7.0
Men (15 years of
age and above)
13.0 11.0-12.9 8.0-10.9 <8.0
16

6 Interventions
1. Prophylactic Iron Folic Acid Supplementation
2. Deworming
3. Intensified year-round Behavior Change Communication Campaign including
assured delayed cord clamping
4. Testing of anemia using hospital digital methods and point of care treatment
5. Mandatory provision of iron folic acid fortified food in public health
programes
6. Addressing non-nutritional causes of anemia in endemic pockets, with
special focus on malaria, hemoglobinopathies and fluorosis
17

6 Institutional mechanisms:
1. Intra-ministerial coordination
2. National Centre of Excellence and Advanced Research on Anemia
Control
3. Strengthening supply chain and logistics
4. National Anemia Mukt Bharat Unit
5. Convergence with other Ministries
6. Anemia Mukt Bharat Dashboard and digital portal—one-stop shop
for anemia
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Population group Dose and regime for deworming
Children 12-59 months of age Bi-annual dose of 400 mg
albendazole (½ tablet to
children 12–24 months and 1
tablet to children 24–59
months)
Children 5-9 years of age Bi-annual dose of 400 mg
albendazole (1tablet)
School-going adolescent girls and boys (10-
19 years) and out-of- school adolescent
girls 10-19 years of age
Bi-annual dose of 400 mg
Women of reproductive age (non-
pregnant, non-lactating) 20-49 years
Biannual dose of 400 mg
Pregnant women One dose of 400 mg
albendazole (1 tablet), after
the first trimester,
preferably during the second
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Dose and regime for deworming

Service delivery platforms for testing and treatment
of anemia
20

Target group A Children 6–59 months
Who will screen?
Place of screening
• ANM: VHND/sub-centre/sessionsite
• RBSK team: AWC/school
• Medical officer: health facility
Periodicity • RBSK/ANM: as per scheduled microplan
• Medical officer: opportunistic
21
RBSK : Rashtriya Bal Swasthya Karyakram

Intervention-target A
• Bi-weekly, 1 ml of iron and folic acid syrup.
• Each ml of iron and folic acid syrup containing 20 mg of elemental iron + 100
mcg of folicacid.
• Bottle (50 ml) to have an ‘auto-dispenser’ and information leaflet as per
MoHFW guidelines in the mono-carton.
• Prophylaxis with iron and folic acid should be withheld in case of acute illnesses
(fever, diarrhoea, pneumonia, etc.), and in a known case of thalassemia major/
history of repeated blood transfusion
22

Target group B Children 5–9 years
Who will screen?
place of screening
• RBSK teams will screen in-school and out-
of-school children for anemia
• All children with clinical signs and symptoms
of anemia will be referred to SC/PHC for Hb
estimation and further management
Periodicity • Once a year
• Opportunistic screening, e.g., routine Hb
assessment of sick children presenting to
health facility
23

• Weekly, 1 iron and folic acid tablet.
• Each tablet containing 45 mg of elemental iron + 400 mcg of folic acid sugar-
coated, pink-colour.
24
Intervention-target B

Target group C All school going adolescents
10–19 years in government/
government-aided schools
Who will screen and place of
screening
In school premises by RBSK team
Periodicity Annual
25

• Each tablet containing 60 mg of elemental iron + 500 mcg of folic acid sugar-
coated, blue-colour
• All women in the reproductive age group (15-49 years) are advised to have 400
mcg of folic acid tablets, daily during the period of pre-conception up to the first
trimester of the pregnancy, to reduce the incidence of neural tube defects in the
foetus.
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Intervention-target C

Target group D Pregnant women registered for antenatal
care
Who will screen and place of screening Health service provider at any ANC
contact,
All pregnant women will be tested
for anemia using digital
hemoglobinometers at any ANC
contact point
Periodicity At every ANC contact
28

• Daily, one iron and folic acid tablet starting from the fourth month of
pregnancy (that is from the second trimester)
• Continued throughout pregnancy (minimum 180 days during pregnancy).
• Each tablet containing 60 mg of elemental iron + 500 mcg of folic acid, sugar-
coated, red-colour.
30
Intervention-target D

Women of reproductive age
(non-pregnant, non- lactating) 20-49 years
• Each tablet containing 60 mg of elemental iron + 500 mcg of folic acid Sugar-
coated, red-colour
• All women in the reproductive age group (15-49 years) are advised to have 400
mcg of Folic Acid tablets, daily during the period of pre-conception up to the first
trimester of the pregnancy, to reduce the incidence of neural tube defects in the
foetus.
31

Consumption of IFA supplementation: Things to
remember
• IFA tablets to be taken preferably about one hour after major meals to prevent
side effects such as nausea.
• Beneficiaries complaining of side effects are advised to take the IFA
supplements after dinner and before sleeping.
• IFA supplement should be consumed along with foods rich in vitamin C such as
lemon in the form of nimbu-paani, amla (Indian gooseberry) etc. for improving
the absorption of iron.
32

• Drinking of tea or coffee within an hour of consuming IFA should be
discouraged, as it may reduce the iron absorption.
• Iron and calcium tablets should not be consumed together, as calcium
interferes in iron absorption. At least two hours of interval should be there
between calcium and iron tablet consumption.
33

Why parenteral iron therapy
• Oral IFA supplementation is often associated with poor compliance
mainly due to side effects such as vomiting, nausea, constipation,
indigestion, etc.
• Parenteral iron treatment circumvents the natural gastrointestinal
regulatory mechanisms to deliver non-protein bound iron to the red blood
cells. Intra-venous (IV) iron helps in achieving rapid correction of
hemoglobin and iron stores, and is better tolerated than oral iron in
treating iron deficiency anemia.
36

Indications
• Intra-venous Iron Sucrose (IVIS) may be considered as the first line of
management in individuals identified with the following conditions:
I. Moderate anemia during pregnancy (after the first trimester of pregnancy) and
during
II. postpartum period if:
• Oral iron is not tolerated
• Non-compliance to oral iron
• No improvement in hemoglobin level or improvement less than 1gm/dL after
one month of oral IFAtreatment
III.Severe anemia (Hb 6.9 to 5 gm/dL) during 13 to 34 weeks of pregnancy`
37

Contraindication
I.Patients with evidence of iron overload
II.Patients with known hypersensitivity to iron preparation or any of its
component
III.Patients with anemia not caused by iron deficiency
IV.Liver disorder like jaundice, cirrhosis or renal failure
V.Acute cardiac failure
VI.Known case of thalassemia, sickle cell anemia or hemolytic anemia
38

Iron sucrose administration: Dos and don’ts
• Iron sucrose is available in 5 ml vial, with 20 mg of elemental iron per
ml of iron sucrose.
• IV iron sucrose should be administered as a slow infusion of 200
mg/dose in 100 ml 0.9% saline administered over 20-30 minutes.
• During the first five minutes, infusion should be given at the rate of
20-30 drops/minute and then increased to 80-90 drops/minute.
• Subsequent doses can be given over a period of 20 to 25 minutes
39

• Maximum dose should not exceed 600 mg (3 doses of 200 mg each) of iron
sucrose in a week.
• Iron sucrose should be administered at primary health care or higher level of
health care under the supervision of the medicalofficer.
• Vital signs such as blood pressure, heart rate, respiratory rate, temperature and
foetalheart rate should be monitored before, during (every 5 minutes after
initiation of infusion) and at the end of theinfusion.
• The expected increase in hemoglobin level for pregnant women with severe and
moderate anemia is approximately 2.5 gm/dL and 1.6 gm/dL, respectively after
3 weeks of complete dose of IV iron sucrosetreatment.
• To avoid permanent discolouration of the skin due to extravasation of IVIS,
patency of the cannula has to be checked by flushing normal saline before
initiation of treatment.
40

Treatment of anemia using intravenous iron
sucrose during pregnancy
41

Indication
• Parenteral therapy using intravenous iron sucrose during pregnancy is
indicated in:
• Moderate anemia during pregnancy (after the first trimester of
pregnancy) and during postpartum period if:
• Oral iron is not tolerated
• No improvement in hemoglobin level or improvement less than 1gm/dL after
one month of oral IFA treatment
42

Dosage calculation
• Iron requirement for intravenous administration of iron sucrose
can be calculated using Ganzoni’s formula.
• Total iron deficit (mg) = Body weight* (kg) x (target Hb in gm/dL**–
actual Hb in gm/
• dL) x 2.4 + 500***
43

• *Pre-pregnancy weight. If pre-pregnancy weight is not
available, weight recorded during the first visit of first
trimester can be used
• **Target Hb for pregnant women = 11.0 gm/dL
• ***500 mg for replenishing iron stores in the body of women
weighing 35 kg
•If the pregnant women’s weight is less than 35
kg, allowance for iron store = 15mg/kg body
weight)
44

SWOT analysis
• Strengths:
covered all the age groups
door step diagnosis and treatment
IV iron therapy/Calculation
deworming
colored and sugar coated tablet
100mg to 60 mg
46

Weakness :
•Poor follow up of patients
•For pregnant women IFA duration 180 days, so
there is a chance of withdrawal
•No geriatrics age group coverage
•No repeat Hb check up
•Blood transfusion
47

• Opportunities :
• Other vitamins included like Vitamin A & C
• Reproductive health education
• Since it focus on school children , government
may conduct awareness through school children
48

• Threats :
• TABOO
• There is high chance of withdrawal of IFA tablets
because of the following causes
• GIT discomfort ,
• nausea ,
• constipation ,
• diarrhea ,
• dark stools.
49

References:
• https://www.who.int/health-topics/anaemia#tab=tab_1
• https://www.nhp.gov.in/disease/blood-lymphatic/anaemia
• https://anemiamuktbharat.info/
• https://academic.oup.com/cdn/article/4/Supplement_2/830/584505
1
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Anemia mukth bharath

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