anaemia_in_pregnancy_1.pptx

anaemia , pregnancy

1. Anaemia is still a menace – Disease burden

2. 76 years after independence Anaemia - s till widespread in India - causing a significant percentage of maternal deaths in the country V arious reasons G eneral disregard to health issues P overty Educational backwardness According to National Family Health Survey-V 2019-21 data 52.2 percent pregnant women in the age group 15-49 years are estimated to be anaemic in the country.

3. Prevalence of anaemia among six groups As per the National Family Health Survey 5 (2019-21) 25.0 percent - men (15-49 years) 57.0 percent - women (15-49 years) 31.1 percent - adolescent boys (15-19 yrs ) 59.1 percent - adolescent girls 52.2 percent - pregnant women (15-49 years) 67.1percent - children (6-59 months)

4. WHO estimated prevalence of anaemia worldwide in 2019 39.8 % among children aged 6 to 59 months 36.5 % among pregnant women 29.9 % of the women of reproductive age According to WHO’s dashboard Prevalence of anaemia in women of reproductive age in India 53 % in 2019- the fifth-highest globally, after Yemen, Mali, Benin, and Nigeria Children (6 to 59 months )- 53.4%

5. Gujarat, Assam, and West Bengal significant increase in prevalence in anaemia among children and women respectively, compared to NFHS-4 Kerala and some north-eastern states - low prevalence across categories but increase in prevalence since NFHS-4 Uttarakhand, Jharkhand, and Haryana a decline in prevalence or only a marginal increase in prevalence in certain categories Jharkhand , the Health Department of the state rolled out an action plan covering pregnant women, lactating women, infants and children in order to tackle anaemia in the state

6. ANAEMIA MUKT BHARAT Anaemia Mukt Bharat was launched by Government of India in 2018 target to reduce anaemia in the vulnerable age groups such as women, children and adolescents in life cycle approach providing preventive and curative mechanisms focusing on reducing anemia from 50% in 2016 to 32% by 2022 estimated to reach 450 million beneficiaries. focuses on “six target beneficiary groups through six interventions and six institutional mechanisms” to achieve the envisaged target under the POSHAN Abhiyaan 6X6X6 strategy six target beneficiaries six interventions six institutional mechanisms for all stakeholders to implement the strategy

7. S ix Beneficiary Groups children aged 6–59 months children aged 5–9 years, adolescent girls and boys women of reproductive age pregnant women lactating women

8. Six institutional mechanisms Intra-Ministerial Coordination National Anemia Mukt Bharat Unit National Centre of Excellence and Advanced Research on Anemia Control (NCEAR-A ) at AIIMS Convergence with other Ministries Strengthening Supply Chain and Logistics Anemia Mukt Bharat Dashboard and Digital Portal – One-Stop Shop on Anemia

9. Testing of anaemia using digital methods and point of care treatment Addressing non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis Management of severe anaemia in pregnant women undertaken by administration of IV Iron Sucrose/Blood transfusion Providing incentives to the ANM for identification and follow-up of pregnant women with severe anaemia in high priority districts (HPDs) Training and orientation of Medical Officers and front line-workers on newer Maternal Health and Anaemia Mukt Bharat guidelines Field level awareness by ASHAs through community mobilization activities and IEC and BCC activities focused on anaemia in pregnant women Six Interventions

10. Programmes launched by GOI till now The National Nutritional Anaemia Prophylaxis Programme (NNAPP) - 1970 assess the baseline prevalence of nutritional anaemia 1970 as a measure to prevent anaemia in the country specific mothers and young children through the estimation of Hb levels give prophylaxis and treatment doses of IFA to mothers and children monitor the quality of the tablets, distribution and consumption of the IFA supplements continuously assess the Hb levels of the beneficiaries periodically motivate the mothers to consume tablets through relevant nutritional education (and also to give the appropriate dose to their children

11. Programmes launched by GOI till now IFA interventions provided under NNAPP Pregnant women - one big (adult) tablet (each tablet containing 60 mg of elemental iron and 500 μg folic acid) daily for 100 days lactating women and intrauterine device acceptors - one big (adult) tablet (containing 60 mg of elemental iron and 500 μg folic acid) daily for 100 days preschool children (1-5 yr ) - one small ( paediatric ) tablet (containing 20 mg elemental iron and 100 μg folic acid) daily for 100 days Women with severe anaemia (<7 g/dl) were administered with one big (adult) tablet twice daily for 100 days The programme was implemented through the network of primary health centres (PHCs) and subcentres . The paramedical staff was responsible for the distribution of IFA tablets

12. NNAPP in 1989 recommended that the dose of iron in the adult -100 mg elemental iron MoHFW in 1991 revied the policy guidelines for the prevention and control of anaemia NNAPP programme renamed as National Nutritional Anaemia Control Programme (NNACP) emphasis was shifted from prevention to the management of anaemia Objectives and service components essentially remained the same Increased emphasis - on the health and nutrition education activities

13. Provision of liquid formulation of ferrous sulphate and folic acid containing 20 mg elemental iron and 100 μg folic acid per millilitre for children (6-60 months) Inclusion of School children aged 6-10 yr Inclusion of Adolescents aged 11-18 yr under NNAPP Children aged 6-10 yr were provided with 30 mg elemental iron and 250 μg folic acid daily for 100 days in a year Adolescents aged 11-18 yr were given priority supplemented at the same doses and duration as adults Importance of multiple channels and strategies to address the problem of iron deficiency anaemia were suggested Use of newer products such as double-fortified salts/sprinklers/ultra rice and other micronutrient candidates were suggested to possibly be explored as an adjunct or alternative supplementation strategy. 2007 – Revision of national policy of iron supplementation

14. In 2013, MoHFW expanded the NNACP R enamed National Iron Plus Initiative (NIPI) programme . The dose of iron, frequency and duration of iron and roles and responsibilities of functionaries

15. Age groups covered and related interventions Under National Iron+ Initiative, the following age groups are covered for lifelong supplementation of Iron from the age of 6 month onwards: Bi-weekly 20 mg elemental iron and 100 microgram (mcg) folic acid per ml of liquid formulation and age appropriate de-worming for preschool children of 6-59 months. Weekly supplementation of 45 mg elemental iron and 400 mcg folic acid per child per day for children from 1st to 5th grade in Govt. & Govt. Aided schools, and at AWC for out of school children (6 to 10 years). Weekly dose of 100 mg elemental iron and 500 mcg folic acid with biannual de-worming in adolescents (10–19 years) under Weekly Iron and Folic Acid Supplementation (WIFS) Programme. Weekly supplementation of 100mg elemental iron & 500mcg of folic acid for women in reproductive age Pregnant and lactating women - 100mg elemental iron & 500mcg of folic acid - 1 tablet daily for 180 days, starting after the first trimester, at 14 - 16 weeks of gestation. To be repeated for 180 days post - partum.

16. Supplementation for Children 6–60 months as per GoI guidelines One ml of IFA syrup containing 20 mg of elemental iron and 100 mcg of folic acid biweekly for 100 doses in a year. Iron folic acid supplements be supplied in bottles of 100 ml each and composition, preparation, dose and duration of IFA supplementation will remain same as the existing guidelines. The bottles should have an auto-dispenser so that only 1 ml of syrup will be dispensed at a time. Albendazole tablets will be provided to children for biannual de-worming, with dose half tablet between 1-2 years age and full tablet from the age of 2 years onwards. For implementation among all children aged 6 to 60 months it is proposed that IFA supplement will be administered under the direct supervision of ANM/ASHA on fixed days on a biweekly basis. The micro plan for reaching out to these children can be worked out at village level. It is recommended that a particular child should receive the supplement on the fixed day (Monday and Thursday), though it can vary for the groups of children depending on the home visits schedule prepared at block/district level. The nutritional status of children should be assessed by MUAC (Mid Upper Arm Circumference less than 11.5 cm) to ensure that IFA syrup is not given to children with Severe Acute Malnutrition (SAM). ANM/ASHA would give IFA syrup bottles to mothers for safe storage and to lessen the logistic hurdle of carrying bottles around, but the IFA syrup will be administered under her direct supervision only. During the visits, the ANM/ASHA will also advise/inform the caregiver about the following issues:

17. Time of administration – half an hour after food if the child has been breastfed (in LBW infants)/fed semisolid/solid food Benefits of regular intake of IFA syrup in physical and cognitive development of the child e.g. improvement in well-being, attentiveness in studies and intelligence etc. Minor side effects associated with IFA administration such as black discolouration of stools. Preservation of IFA bottle – in a cool and dark place, away from reach of children, keeping the lid of the bottle tightly closed each time after administration, etc.

18. Age group Intervention/ Dose Regime Service delivery 6–60 months 1ml of IFA syrup containing 20 mg of elemental iron and 100 mcg of folic acid Biweekly throughout the period 6–60 months of age and de-worming for children 12 months and above. Inclusion in MCP card Through ASHA/ ANM 5–10 years Tablets of 45 mg elemental iron and 400 mcg of folic acid Weekly throughout the period 5–10 years of age and biannual de-worming In school through teachers and for out- of school children through Anganwadi centre (AWC) 10–19 years 100 mg elemental iron and 500 mcg of folic acid Weekly throughout the period 10–19 years of age and biannual de-worming In school through teachers and for those out-of- school through AWC Pregnant and lactating women 100 mg elemental iron and 500 mcg of folic acid 1 tablet daily for 100 days, starting after the first trimester, at 14–16 weeks of gestation. To be repeated for 100 days post-partum. ANC/ ANM /ASHA                   Inclusion in MCP card Women in reproductive age (WRA) group 100 mg elemental iron and 500 mcg of folic acid Weekly throughout the reproductive period Through FHW during house visit for contraceptive distribution Details of IFA supplementation will be included in the Mother and Child Protection (MCP) Card. IFA supplementation programme and service delivery

19. Initiatives to Tackle Anaemia in Pregnant Women Surakshit Matritva Aashwasan (SUMAN) provides assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting public health facilities to end all preventable maternal and newborn deaths. Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme for promoting institutional delivery

20. Janani Shishu Suraksha Karyakram (JSSK), every pregnant woman is entitled to free delivery, including caesarean section, in public health institutions along with the provision of free transport, diagnostics, medicines, other consumables & diet Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides pregnant women a fixed day, free of cost assured and quality antenatal check up by a Specialist/Medical Officer on the 9th day of every month.

21. LaQshya improves the quality of care in labour room and maternity operation theatres to ensure that pregnant women receive respectful and quality care during delivery and immediate post-partum Monthly Village Health, Sanitation and Nutrition Day (VHSND) is an outreach activity at Anganwadi centers for provision of maternal and child care including nutrition in convergence with the ICDS

22. Delivery Points- Over 25,000 ‘Delivery Points’ across the country have been strengthened in terms of infrastructure,equipment , and trained manpower for provision of comprehensive RMNCAH+N services MCP Card and Safe Motherhood Booklet are distributed to the pregnant women for educating them on diet, rest, danger signs of pregnancy, benefit schemes and institutional deliveries

23. Centre’s Anaemia Mukt Bharath program that was launched in 2018 under National Health Mission as part of Intensified National Iron Plus Initiative (NIPI) Program. The action plan aimed to provide micronutrient drugs like IFA, Calcium, Vitamin A and Albendazole, to the last mile.  Haryana launched the Anaemia Mukt Haryana program under state scheme ‘Atal Abhiyaan’ (Assuring total Anaemia Limit Abhiyaan) to reduce anaemia in all age group across Haryana, in line with the Centre’s Anaemia Mukt Bharat program in 2019. 

24. six primary interventions Providing prophylactic iron and folic acid supplements deworming intensifying the year-round behaviour change communication (BCC) campaign ensuring delayed cord clamping in new- borns increasing testing and treatment of anemia mandating the provision of iron and folic acid-fortified foods in government-funded health programs, and intensifying the awareness, screening, and treatment of non nutritional causes of anemia focusing on malaria, hemoglobinopathies, and fluorosis