Iron deficiency has been categorised by the World Health Organization (WHO) as one of the top ten most serious health problems in the modern world. Iron deficiency anemia has assumed even greater importance as evidence accumulates linking iron deficiency with premature births, low birth weight babies and delayed growth and development. Iron deficiency can result in poor memory or poor cognitive skills and can result in poor performance in school, and at work. Iron deficiency can be the result of several issues including insufficient iron intake – very common in people with vegetarian diets, or difficulty absorbing iron in the gut.
Iron deficiency has been found to be widely prevalent amongst adolescents. Iron requirement of an adolescent’s body increases many fold during a period of rapid growth and development. However the awareness about anemia and corrective steps is very low among this age group. Even with national guidelines to include 11-18 years old adolescent girls in place, the focus on this age group is missing. Without adequate iron, anaemic adolescents then tend to grow into anaemic adult women with inadequate iron stores, which, when coupled with low pre-pregnancy weight, a condition seen often in undernourished populations, can lead, in its most serious case, to maternal mortality. [Read: Treatment Options for Anaemia]
Iron Deficiency Anemia (IDA) is one of the most prevalent nutritional deficiencies in the world, and more than half of the population in India is anemic, making it one of the worst countries in the world with respect to rates of anemia. The National Family Health Survey (NFHS-3), an India wide study of health and nutrition, revealed the prevalence of anemia to be about 79% in children 6-35 months, 58% in pregnant women and 24% in adult men.
For every 100,000 births in India, over 250 women die and anemia is the underlying cause of 20 percent of these preventable maternal deaths. The National Nutritional Anaemia Prophylaxis Programme (NNAPP) aims at decreasing rates of anaemia in women of reproductive age, especially adolescent girls 11-18 years of age, pregnant and breastfeeding women as well as preschool children. Despite the fact that the programme has been operational for over four decades, the problem of anaemia continues unabated, a fact which is true for other countries in South Asia. Even with good intentions and some successes, overall anaemia rates remain far too high. [Read: Who is at Risk for Anaemia]
In addition to encouraging the eating of iron rich foods wherever possible, provision of iron and folic acid through capsules or pills, coupled with a program to counsel women on taking these pills with food to avoid common side effects such as cramps or nausea have been shown to improve outcomes for maternal health and births. Many States in India have been successful in getting capsules out to women but not in getting them to take them regularly. This is the challenge.
In a country where eating a varied diet can be a challenge for many households, fortifying common staples such as wheat flour or salt can also provide a consistent daily intake of iron and possibly folic acid and other vitamins and minerals depending on the food. There is very encouraging movement in producing wheat flour fortified with iron, and very recently, salt as well. These will have a significant effect on rates of anemia as they roll out throughout India, in particular using the Public Distribution System to ensure the widest reach to those who need these most.
As reflected in the recently revised Nutritional Anemia Prophylaxis Programme, a combination of dietary changes, supplementation and fortification, coupled with education, starting at adolescence offers the best hope of finally seeing reductions in anemia in India. India can and will lead the way in this region in demonstrating its commitment to the health of women and children.
The writer is Melanie Galvin, Regional Director - Asia, the Micronutrient Initiative.
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