Anemia Mukt Bharat - 6x6x6 strategy

Video lecture link : https://www.youtube.com/watch?v=Zh0ndif3iTc

1. Marching towards anemia mukt bharat Dr Venkatesh Karthikeyan Community and Family Medicine Resident AIIMS Patna 1 Dr Venkatesh Karthikeyan - [email protected]

2. Index 1 2 3 4 Introduction Timeline Objectives 6 Beneficiaries 5 6 7 8 6 Interventions 6 Institutional mechanisms What’s New? Take Home Message 2 Dr Venkatesh Karthikeyan - [email protected]

3. 3 Definition : Anemia is a condition in which the number of red blood cells or their oxygen carrying capacity is insufficient to meet the body’s physiological requirements, which vary by age, sex, altitude, smoking habits and during pregnancy. Dr Venkatesh Karthikeyan - [email protected] INTRODUCTION

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15. Dr Venkatesh Karthikeyan - [email protected] 15 INTRODUCTION

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17. Low Iron Stores Pregnancy Vicious Cycle Dietary Inappropriate IYCF Iron Inhibitors vs Iron enhancers Low bioavailability of dietary iron RDA Iron Loss Due to parasitic load Maternal Anemia Increased iron requirement PPH Teenage pregnancy Inadequate spacing Causes of High Burden of Anemia v

18. Diminished concentration, disturbance in perception, delayed psychomotor development Impaired language and motor skills, Diminished IQ equivalent to a 5–10 point About 20 % of maternal deaths are caused by Anemia worldwide Neural tube defects, infants of low birth weight and still births Anemic pregnant women are more prone to increased morbidity and ; there is a three times greater incidence of premature delivery in severely anemic women Decreased work output and work capacity Physical and cognitive losses due to IDA in South Asia are staggering: close to $ 4.2 billion annually in Bangladesh, India and Pakistan In the WHO/World Bank rankings, Iron Deficiency Anemia is the third leading cause of DALYs lost for females aged 15–44 years and 1.18 % of Gross Domestic Product (GDP) loss . Public Health Implications of Anemia v

19. National Nutritional Anemia Prophylaxis Programme (NNAPP) TIMELINE 1970 National Nutritional Anemia Control Programme 1991 12 by 12 initiative 2007 National Iron Plus Initiative (NIPI) 2013 Anemia Mukt Bharat (Intensified NIPI) 2018 19 Source: Bhatia V, Sahoo DP, Parida SP. India steps ahead to curb anemia : Anemia Mukt Bharat Indian J Comm Health. 2018; 30, 4: 312-316. Dr Venkatesh Karthikeyan - [email protected]

20. 20 INTENSIFIED NATIONAL IRON PLUS INITIATIVE Launched in 2018 Complying with the targets of POSHAN ABHIYAAN and National Nutrition Strategy set by NITI Aayog The strategy is estimated to reach out to 450 million beneficiaries Government of India is also committed to the World Health Assembly target of 50 percent reduction of anemia among women of reproductive age by 2025 Based on life-cycle approach Dr Venkatesh Karthikeyan - [email protected]

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22. OBJECTIVE AND TARGETS To reduce the prevalence of anemia by 3% per year in children, adolescents and women of reproductive age group (15-49 years) between 2018-2022. Dr Venkatesh Karthikeyan - [email protected] 22

23. 6 x 6 × 6 STRATEGY 23 Dr Venkatesh Karthikeyan - [email protected]

24. 6 BENEFICIARIES 24 Dr Venkatesh Karthikeyan - [email protected]

25. Deworming Intensified Year Round BCC Campaign Testing and Treatment of Anemia Mandatory provision of Iron and Folic Acid fortified foods Prophylactic IFA Supplementation Intensifying awareness, screening and treatment of non-nutritional causes of anemia in endemic pockets 6 INTERVENTIONS 25 Dr Venkatesh Karthikeyan - [email protected]

26. Prophylactic IFA Supplementation Dr Venkatesh Karthikeyan - [email protected] 26 6 INTERVENTIONS

27. Deworming Dr Venkatesh Karthikeyan - [email protected] 27 6 INTERVENTIONS

28. Dr Venkatesh Karthikeyan - [email protected] 28 Solid Body, Smart Mind

29. INTENSIFIED YEAR ROUND BCC CAMPAIGN Compliance to IFA supplement and deworming Appropriate Infant and Young Child Feeding practices Increased intake of nutritious food Promoting practice of Delayed cord clamping Early initiation of Breast feeding 29 Dr Venkatesh Karthikeyan - [email protected] 6 INTERVENTIONS

30. INTERPERSONAL COMMUNICATION MATERIAL FOR WORKERS 30 Dr Venkatesh Karthikeyan - [email protected]

31. 31 MASS AND SOCIAL MEDIA Dr Venkatesh Karthikeyan - [email protected]

32. 32 TESTING AND TREATMENT OF ANAEMIA Dr Venkatesh Karthikeyan - [email protected] 6 INTERVENTIONS

33. TESTING AND TREATMENT OF ANAEMIA Target Group A : Children 6-59 months Dose 3mg/kg/day for 2 months Target Group B : Children 5-9 yrs Dose 3mg/kg/day for 2 months Target Group C : Adolescents 10-19 yrs Dose 2 tablets of IFA /day for 3 months Target Group D :Pregnant woman Dose 2 tablets of IFA /day . 33 Dr Venkatesh Karthikeyan - [email protected] 6 INTERVENTIONS

34. Severe anemia Moderate anemia in second or third trimester of pregnancy Postpartum if oral iron is not suitable or effective Contraindications to oral iron, or compliance or tolerance (side effect) issues Comorbidities which may impact iron absorption ( eg. Intestinal mucosal disorders), Chronic renal impairment receiving erythropoiesis-stimulating agent Ongoing iron losses that exceed absorptive capacity PARENTERAL IRON TREATMENT 34 Dr Venkatesh Karthikeyan - [email protected] 6 INTERVENTIONS

35. Types of Dextran free iron supplement Parenteral Iron Formulations: Iron Sucrose Ferric Carboxy Maltose (FCM) Advantages of Parenteral Iron overcoming the challenges of oral supplementation such as: Adherence Behaviour change Poor absorption Restores the body iron store in a short period PARENTERAL IRON TREATMENT 35 Dr Venkatesh Karthikeyan - [email protected] 6 INTERVENTIONS

36. fortified foods Iron Fortified Whole Wheat Flour/Rice Iron fortified Salt/Double Fortified Salt Dr Venkatesh Karthikeyan - [email protected] 36 6 INTERVENTIONS

37. MALARIA : Testing of malaria and anemia - malaria endemic regions Utilization of Long Lasting Insectidal Nets HAEMOGLOBINOPATHIES : Comprehensive prevention, screening and management of haemoglobinopathies Pre-marital and pre-conception screening and counselling services non-nutritional causes of anemia 37 Dr Venkatesh Karthikeyan - [email protected] 6 INTERVENTIONS

38. FLUOROSIS : NPPCF programme recognizes the linkages of fluoride, anemia and malnutrition Interventions : Identification of fluoride affected inhabitations Anemia control for Fluorosis – BCC and combined approach of safe drinking water and nutritional improvement Capacity building 38 Dr Venkatesh Karthikeyan - [email protected] 6 INTERVENTIONS non-nutritional causes of anemia

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40. 6 INSTITUTIONAL MECHANISMS Intra Ministerial Co-ordination * AMB Steering committee included in RKSK * Biannual Meetings with MoHFW , MoTW , MoWCD , MoRD and others 2. Anaemia Mukt Bharat Unit * National AMBU - supports and monitor states for strategy implementation * State AMBU – ensures accountability and effective implementation * District level – Day to Day implementation 40 Dr Venkatesh Karthikeyan - [email protected]

41. 6 INSTITUTIONAL MECHANISMS 3. National Centre for Excellence and Advanced Research on Anemia Control Apex national laboratory for anemia screening and diagnosis Will provide technical inputs regarding policy making , program guidelines and implementation Will facilitate periodic program reviews and capacity building of anemia control program Will support sample chain monitoring 4. Convergence with other ministries 41 Dr Venkatesh Karthikeyan - [email protected]

42. 5. Strengthening of supply chain and logistics Introducing auto indents at district levels Centralized procurement at state level IFA and Albendazole as a part of essential drug list 6. Anemia Mukt Bharat Dash board and Digital portal ONE STOP SHOP FOR ANAEMIA 42 6 INSTITUTIONAL MECHANISMS Dr Venkatesh Karthikeyan - [email protected]

43. Coordinated management efforts – intra & inter ministerial Target based monitoring and KPI reviews and awards; 60 mg instead of 100 mg prophylactic dose, sugar coated. Communication materials for extensive awareness, intensive 360 degree communication campaigns - Creating a Jan Andolan Use of digital methods of hemoglobin estimation and point of care treatment, newer treatment strategies Linkage with Malaria Mandating use of fortified food in public health programmes , specially double fortified salt (iron and iodine) What’s New? v

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45. Thank You! Dr Venkatesh Karthikeyan AIIMS Patna [email protected] Dr Venkatesh Karthikeyan - [email protected] 45