Anemia protection and eradication[1].pptx

Anemia

1. SCREENING FOR ANEMIA AND RISK FACTORS AMONG PATIENTS ATTENDING MTM CLINIC IN GCMC BY Team D2

2. Introduction Anemia is a major killer in India. Statistics reveal that every second Indian woman is anemic One in every five maternal deaths is directly due to anemia. Anemia affects both adults and children of both sexes, although pregnant women and adolescent girls are most susceptible and most affected by this disease.

3. Objectives Definition of anemia Classification of anemia Types of anemia Pathophysiology of anemia Risk factors Signs and symptoms Investigation of anemia Treatment of anemia Management of anemia

4. Definition of anemia Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. Haemoglobin is needed to carry oxygen and if you have too few or abnormal red blood cells, or not enough haemoglobin , there will be a decreased capacity of the blood to carry oxygen to the body’s tissues. This results in symptoms such as fatigue, weakness, dizziness and shortness of breath, among others. The optimal haemoglobin concentration required to meet physiologic needs varies by age, sex, elevation of residence, smoking habits and pregnancy status. Anaemia may be caused by several factors: nutrient deficiencies through inadequate diets or inadequate absorption of nutrients, infections (e.g. malaria, parasitic infections, tuberculosis, HIV), inflammation, chronic diseases, gynaecological and obstetric conditions, and inherited red blood cell disorders

5. Anemia occurs when there is a decrease in circulating red blood cells. When this happens, the blood cannot provide enough oxygen to the body. A person with anemia may feel tired or weak.

6. Classification of anemia Anemia is classified into Morphological and Etiological MORPHOLOGICAL CLASSIFICATION Morphological classification depends upon the size and color of RBC. Size of RBC is determined by mean corpus- cular volume (MCV). Color is determined by mean corpus- cular hemoglobin concentration (MCHC). ETIOLOGICAL CLASSIFICATION On the basis of etiology (study of cause or origin).

7. Types of anemia

8. MORPHOLOGICAL CLASSIFICATION OF ANEMIA Normocytic normochromic size mean corpuscle volume and color mean corpuscle haemoglobin count of rbcs are normal but the number of rbc is less . Macrocytic normochromic RBCs are larger in size with normal colour .RBC count is less

9. Macrocytic hypochromic RBCs are larger in size . mean corpuscle hemoglobin count is less so the cells are pale (less coloured ). Microcytic hypochromic RBCs are smaller in size with less coloured

10. Etiological classification Hemorrhagic anaemia CAUSE 1.Acute loss of blood :morphology of rbc Normocytic, normochromic 2.Chronic loss of blood :morphology of rbc Microcytic, hypochromic

11. Haemolytic anemia 1.Extrinsic hemolytic anemia: Liver failure Renal disorder Hypersplenismiv . Burns. Infections – hepatitis, malaria Drugs – Penicillin, antimalarial drugs Morphology of rbc -Normocytic normochromic

12. 2.Intrinsic haemolytic anemia: causes :Hereditary disorder’s morphology of RBC Sickle cell anemia: Sickle shape Thalassemia: Small and irregular

13. Nutrition deficiency anaemia Iron deficiency morphology of rbc -Microcytic, hypochromic Protein deficiency morphology of rbc -Macrocytic, hypochromic Vitamin B12 morphology of rbc -Macrocytic, normo /hypochromic Folic acid morphology of rbc - Megaloblastic, hypo chromic

14. Aplastic anemia cause :- Bone marrow disorder morphology of rbc :-Normocytic, normochromic

15. Pathophysiology of anemia 1. Impaired Red Blood Cell Production ( Hypoproliferative Anemias)In these types of anemia, the bone marrow produces insufficient or defective red blood cells. Several factors can affect RBC production. Iron Deficiency Anemia Pathophysiology : Iron is essential for hemoglobin production. A lack of iron (due to poor diet, chronic blood loss, or malabsorption) leads to decreased hemoglobin synthesis, resulting in smaller (microcytic) and pale (hypochromic) red blood cells Vitamin B12 or Folate Deficiency Anemia Pathophysiology : Both vitamin B12 and folate are essential for DNA synthesis in the bone marrow. A deficiency in either results in impaired DNA replication, leading to large, immature red blood cells (megaloblasts). These cells are often destroyed before they leave the bone marrow (ineffective erythropoiesis), causing anemia.

16. Aplastic Anemia Pathophysiology : Aplastic anemia is caused by the failure of the bone marrow to produce sufficient red blood cells, white blood cells, and platelets. This may result from autoimmune damage, toxic exposure (e.g., radiation, chemotherapy), infections, or genetic disorders. It leads to pancytopenia (low levels of all blood cells).

17. Increased Red Blood Cell Destruction ( Hemolytic Anemias )In hemolytic anemia, red blood cells are destroyed faster than they are produced. This destruction may occur within the blood vessels (intravascular hemolysis ) or within organs like the spleen (extravascular hemolysis ). Sickle Cell Anemia Pathosiology : This is a genetic disorder in which a mutation in the hemoglobin gene (HBB) causes red blood cells to form an abnormal crescent (sickle) shape under low oxygen conditions. These sickle-shaped cells are rigid and prone to causing blockages in small blood vessels, leading to hemolysis and vaso -occlusive crises. Chronic hemolysis leads to anemia and other complications such as organ damage

18. Thalassemia Pathosiology : Thalassemia is caused by genetic mutations that impair the production of one or more globin chains of hemoglobin. The imbalance in globin chain production leads to the destruction of red blood cell precursors in the bone marrow (ineffective erythropoiesis) and early destruction of circulating RBCs (hemolysis).

19. Blood Loss (Hemorrhagic Anemias) Anemia due to blood loss can be acute or chronic:Acute Blood Loss Pathophysiology : Significant blood loss from trauma, surgery, or gastrointestinal bleeding leads to an immediate reduction in circulating blood volume and red blood cells. The body responds by activating compensatory mechanisms, such as vasoconstriction and increased heart rate, but anemia can develop if the loss is not quickly corrected. If iron stores are depleted due to chronic blood loss, iron deficiency anemia can develop. Chronic Blood Loss Pathophysiology : Repeated small blood loss over time (e.g., from peptic ulcers, heavy menstrual bleeding, or colon cancer) can gradually deplete iron stores. As a result, the bone marrow cannot produce enough hemoglobin , leading to microcytic, hypochromic anemia (iron deficiency anemia).

20. Risk factors

21. Modifiable risk factors Major modifiable risk factors are: high cholesterol, high blood pressure, smoking, diabetes, obesity, physical inactivity and poor nutrition. These includes Diet: A diet that lacks iron, vitamin B12, and folic acid can increase the risk of anemia. Menstrual periods: Heavy menstrual bleeding can cause anemia because it leads to a loss of red blood cells Pregnancy: Pregnant people who don't take a multivitamin with iron and folic acid are at a higher risk of anemia.

22. Cardiovascular Disease Risk Factors Risk factors for cardiovascular disease (heart disease and stroke) are classified as nonmodifiable or modifiable. Nonmodifiable risk factors cannot be controlled. These include gender, race, family history and advancing age. Risk factors that can be controlled, or changed, are called modifiable. The more risk factors a person has, the greater the chance of heart disease and stroke. Major modifiable risk factors are: high cholesterol, high blood pressure, smoking, diabetes, obesity, physical inactivity and poor nutrition.

23. High Cholesterol As blood cholesterol levels rise, so does the risk for cardiovascular disease. Too much LDL cholesterol clogs arteries, increasing the risk of heart attack and stroke.Likewise , as the income level increases, the proportion of those with high cholesterol decreases

24. High Blood Pressure Hypertension, or high blood pressure, is the chronic state of elevated pressure in the arteries. High blood pressure is a major risk factor for heart disease, congestive heart failure, stroke, impaired vision and kidney disease. Generally, the higher the blood pressure, the greater the risk. Rates of high blood pressure increase with age. While there is little difference by race, the prevalence of high blood pressure rates among non-Hispanics is 81 percent higher than among Hispanics.

25. Smoking Cigarette smoking is a major cause of coronary heart disease and is a major risk factor for sudden

26. Diabetes People with diabetes, due to the many complications caused by this disease, suffer greater morbidity and mortality than the general population.Heart disease and stroke are the most common causes of morbidity and mortality among people with diabetes.

27. Obesity Obesity, a major risk factor for heart disease and stroke, is associated with many other risk factors including high blood pressure, diabetes and high cholesterol, and is usually the result or poor nutrition and lack of adequate physical activity.

28. Non-modifiable risk factors These include: Age: People over 65 are at a higher risk of anemia. Young children also require more iron for growth and development Family history: Family history is a non-modifiable risk factor for anemia. Sex: Anemia is twice as common in women than in men, especially during childbearing years. Menstruation: Excessive bleeding during menstruation can increase the risk of anemia Pregnancy: Pregnant women are more likely to develop anemia due to blood loss and the increased demand for blood

29. Other risk factors for anemia include: Inflammation in the stomach or bowels Surgery Serious injury Donating blood too often Chronic conditions like cancer, kidney failure, or diabetes Infections Blood diseases Autoimmune conditions Exposure to toxic chemicals Medication

30. Signs and symptoms Signs: Pallor (Pale Skin, Mucous Membranes, and Nail Beds) This is the most common and easily observed sign of anemia. It occurs due to reduced blood flow or decreased red blood cell mass, which makes the skin and mucous membranes appear less pink Tachycardia (Increased Heart Rate ) The heart compensates for the decreased oxygen-carrying capacity of the blood by pumping faster to circulate more oxygen to the tissues

31. Hypotension (Low Blood Pressure) In severe cases, particularly with blood loss, the volume of circulating blood decreases, leading to a drop in blood pressure. Shortness of Breath ( Dyspnea ) Reduced oxygen delivery to tissues makes it difficult to breathe, especially during physical exertion, leading to increased respiratory rate. Fatigue and Weaknes This is a common sign of anemia, as insufficient oxygen in the muscles and organs causes reduced physical strength and stamina.

32. Spoon-Shaped Nails (Koilonychia) This is a sign of severe, long-standing iron deficiency anemia. The nails become thin, concave, and brittle Jaundice (Yellowing of the Skin and Eyes ) Seen in hemolytic anemias, where red blood cells are destroyed at a high rate, leading to increased bilirubin levels in the blood. Enlarged Spleen (Splenomegaly) The spleen may become enlarged in conditions like hemolytic anemia or thalassemia due to the increased workload of clearing damaged red blood cells.

33. Symptoms The most common symptom of anemia is fatigue. Other common symptoms include: pallid complexion a fast or irregular heartbeat shortness of breath chest pain Headache lightheadedness

34. Iron deficiency anemia symptoms This is the most common type of anemia and occurs when your body doesn’t have enough iron to produce hemoglobin Symptoms: Fatigue and weakness Pale skin Shortness of breath Dizziness or lightheadedness Cold hands and feet Brittle nails Cravings for non-nutritive substances (e.g., dirt, ice) Headaches

35. Vitamin B12 Deficiency Anemia (Pernicious Anemia) symptoms Fatigue Shortness of breath Pale or jaundiced skin Numbness or tingling in the hands and feet (nerve damage) Balance problems or difficulty walking Cognitive difficulties, memory loss, or confusion Sore, swollen tongue (glossitis) Mood changes, irritability, or depression

36. Folate Deficiency Anemia symptoms Fatigue Weakness Pale skin Shortness of breath Irritability Difficulty concentrating Sore mouth or tongue

37. Aplastic Anemia symptoms This is a rare but serious condition where the bone marrow doesn’t produce enough red blood cells, white blood cells, and platelets. Extreme fatigue Shortness of breath Rapid or irregular heartbeat Frequent infections Prolonged bleeding from cuts Easy bruising Dizziness or lightheadedness Nosebleeds or gum bleeding

38. Hemolytic Anemia symptoms This type occurs when red blood cells are destroyed faster than the body can replace them Fatigue Shortness of breath Dark urine Jaundice (yellowing of the skin and eyes) Fever Pain in the abdomen, back, or legs Pale or cold hands and feet Enlarged spleen

39. Investigation of anemia For different types of anemias there are considerable variations in the count of blood cells and characteristics of the cell.

40. Anemia can be investigated through the following variety of tests: Blood Test CBC Hemoglobin level Hematocrit level MCV,MCH,MCHC Iron profile

41. 2. Physical Exam : Pallor Asks for symptoms Looks for signs 3. Imaging: Eg. Abdominal Sonogram Others: Reticulocyte count Peripheral blood smear Serum Creatinine Thyroid function tests Liver function test Coagulation screening Bone marrow analysis.

42. Microcytic Hypochromic Low RBC count Low MCHC Supplementary Test: Ferretin level:- Heamoglobin electrophoresis( HPLC) Low ferretin :-Iron deficiency anemia High Hb A2:-beta thalassemia Normal ferretin and Hb A2:-Secondary Anemia and alpha thalassemia

43. Normocytic Normochromic Low hemoglobin Low hematocrit Normal MCV Supplementary Test : Reticulocyte count 1.High reticulocyte If spherocytes are present=DAT If DAT is positive then Immune hemolysis If DAT is negative then Burns. If spherocytes are absent= Enzyme deficiency anemia

44. 2. Low reticulocyte: Bone marrow failure= Aplastic anemia Macrocytic: Megaloblastic anemia- Hypersegmented neutrophils Other cyptopenias Supplementary tests :-B 12 level Folate Thyroid function tests Liver function test Bone marrow analysis Decreased B12 and folate levels observed

45. Treatment and management of anemia Treatment and management of IDA National Nutritional Anemia Prophylaxis Programme . NNAPP was launched in 1970 with the objective of preventing anemia in pregnant and lactating mothers and children. Under NNAPP, expectant and nursing mothers as well as acceptors of family planning are given one tablet of iron and folic acid containing 100 mg elementary iron and 500 μg of folic acid. Children, from the age of 6 mo to 5 y, receive iron supplements in a liquid form in doses of 20 mg/d elemental iron and 100 μg /d folic acid for 100 d/y.

46. Food fortification (with iron, folate and B12) seems the most likely means to add value to the existing programs. In addition, food diversification needs to be included in regular school curriculum to bring about community awareness and change in food habits.

47. Key interventions required to combat IDA There are certain fundamental elements that are needed to be addressed in any program aimed at improving general well-being, and the improvement of iron status in particular. These include The reduction of poverty. Improvement of access to diversified diets. Improvement of health services and sanitation. Promotion of better care and feeding practices.

48. Treatment and management of anemia due to blood loss menorrhagia was the leading cause of anemia in adolescent girls. Anemia due to antepartum hemorrhage was specifically found in women of child bearing age Blood loss 🩸 from GI tract was commonly found in patients who were either taking NSAIDS as a part of their medication or who had hemorrhoids. Dilated internal and external venous plexuses in the anal canal are known as hemorrhoids. They result from Inadequate intake of fiber in diet . In case of hemorrhoids, blood in stools leads to long term iron deficiency anemia. For external hemorrhoids firstly fiber and liquids are added to the diet of patient. Patient is made aware of self-care techniques.

49. For the treatment of internal hemorrhoids, blood supply to the hemorrhoids is cut off. As a result hemorrhoids fall off within seven days of treatment. Injections (sclerotherapy) are also available for the treatment of internal hemorrhoids. Surgery is done when none of the treatments explained above, is effective. In case of the patients with anemia due to operative blood loss, anemia due to child birth was due to loss of a large volume of blood during a caesarean section whereas anemia due to blood loss in surgery was found in case of patients who had undergone a hepatic surgery. Blood transfusion, being the most preferred treatment for anemia due to operative blood loss, was carried out

50. Management and treatment of other anemias 1 Aplastic anemia Bone marrow transplantation Immunosuppressive treatment Androgens to stimulate bone marrow regeneration Platelet transfusion 2 Pernicious anemia Parental replacement with hydroxycobalamine Or cyanocobalamine is necessary by I'M injection every month. 3 Sickle cell anemia Promote adequate oxygenation Blood transfusion Spleenectomy Butyrate and hydroxyurea

51. Anemia severity is classified based on hemoglobin Mild: Hb level of 10.0 g/dL to the lower limit of normal Moderate: Hb level of 8.0 to 10.0 g/dL Severe: Hb level of 6.5 to 7.9 g/dL Life-threatening: Hb level of less than 6.5 g/dL Anemia can be caused by a number of factors, including: hemorrhage (acute or chronic), hemolysis, sequestration, and impaired erythropoiesis. A complete blood count (CBC) can help evaluate the severity of anemia by providing insights into a patient's RBC count, hemoglobin, and hematocrit levels.

52. Anemia treatment varies depending on severity of the condition Mild Anemia Dietary Changes: Increase intake of iron-rich foods (red meat, spinach, lentils, fortified cereals). Include foods rich in vitamin C (oranges, strawberries) to enhance iron absorption Oral Iron Supplements : Ferrous sulfate or other iron supplements are commonly prescribed. These are taken over a period of weeks or months Vitamin B12 and folate supplements may also be recommended, especially in cases of megaloblastic anemia

53. Address Underlying Conditions: If mild anemia is due to a chronic condition, addressing that disease (e.g., controlling heavy menstrual bleeding or treating minor infections) is crucial. Moderate Anemia Iron Supplements: Oral supplements are typically the first line of treatment, but dosages may be increased. Erythropoiesis-Stimulating Agents (ESAs): For patients with anemia due to chronic diseases (like chronic kidney disease), ESAs can stimulate the production of red blood cells. IV Iron Therapy: If oral iron supplements are insufficient or cause side effects (like gastrointestinal issues), intravenous iron may be administered

54. Blood Transfusions (if necessary): Although typically reserved for more severe cases, transfusions may be considered in cases of moderate anemia that is not responsive to other treatments, especially if the symptoms are significant Treat Underlying Causes: This may include addressing conditions such as gastrointestinal bleeding, infections, or inflammatory diseases. Severe Anemia : Blood Transfusions: This is often the first step in treating severe anemia, especially if the hemoglobin levels are dangerously low or if there are signs of hypoxia (oxygen deficiency) Intravenous Iron: IV iron is frequently administered in cases where rapid correction of iron deficiency is needed

55. Bone Marrow Stimulation: In cases of severe anemia related to bone marrow problems (e.g., aplastic anemia), treatments like bone marrow-stimulating drugs (such as erythropoietin) or even bone marrow transplants may be considered. Steroids or Immunosuppressive Drugs: For autoimmune hemolytic anemia (where the body's immune system attacks red blood cells), steroids or other immune-modulating treatments may be needed. Surgical Interventions: In cases where bleeding (e.g., from a peptic ulcer or fibroids) is the cause, surgery may be necessary to stop the source of blood loss. Oxygen Therapy: In very severe cases, especially where tissue oxygenation is compromised, supplemental oxygen may be administered.

56. The cut off value for diagnosis of anemia The cut-off value defining anemia has been determined by convention as the value at −2 sd from the mean or the 2.5th percentile of the normal distribution of a healthy iron-replete population. Because iron deficiency is often the most common cause of anemia, the presence of anemia is also used as a screening tool for iron deficiency. Although other iron-related tests are required for the confirmation of iron deficiency, it is reasonable to assume that a population with a high anemia prevalence is likely to also have a high prevalence of iron deficiency.

57. Reference from ResearchGate.com

58. To assess the proportion of anemia among patients attending MTM clinic in GCMC To assess the association between anemia and its risk factors OBJECTIVES

59. Review of literature

60. Anemia Among School Children in Ernakulam District, Kerala, India by P . S. Rakesh1,2 Leyanna Susan George1 • Teena Mary Joy1 • Sobha George1 •B. A. Renjini1 • K. V. Beena2 The prevalence of anemia was estimated to be 44% (95% CI 40.67–47.33). Among them 0.8% had severe anemia , 3.5% had moderate anemia and 39.7% had mild anemia . Among them 21.3% and 52.6% reported not in the habit of consuming green leafy vegetables and citrus fruits respectively, at least three times on a usual week. Anemia among children was associated with female gender (adjusted OR 1.53, 95% CI 1.16–2.04), higher age group (adjusted OR 2.24, 95% CI 1.69–2.91) and regular intake of Tea coffee along with regular meal.

61. Differences in Risk Factors for Anemia Between Adolescent and Adult Women Deepa L. Sekhar , MD, MSc,1 Laura E. Murray-Kolb, PhD,2 Allen R. Kunselman , MA,3 Carol S. Weisman, PhD,3,4 and Ian M. Paul, MD, MSc The prevalence of IDA was 2.4% and 5.5% among younger and older women, respectively. Among younger women, contraceptive use was marginally protective from IDA (risk ratio 0.50, 95% confidence interval [CI] 0.25–1.00). Among older women, significant variables included Black race (risk ratio 2.31, 95% CI 1.33–4.02) and increased years menstruating (‡25 years vs. <25 years; risk ratio 1.93, 95% CI 0.99–3.76). Conclusions: Risk factors for IDA among older reproductive-age women do not apply to adolescent women.To better inform the timing and frequency of screening recommendations, further research must identify adolescent-specific IDA risk factors.

62. Adolescent anaemia its prevalence and determinants: a cross-sectional study from south Kerala, India by Sajith Kumar Soman , Binu Areekal *, Asha Joan Murali , Rosin George Varghese The prevalence of anaemia in the whole population was 53.5% (C.I-51.64-55.34%). The anaemia prevalence in females was 62.0% (C.I -59.33-64.6) and in males was 46.1% (C.I -43.55-48.61). Out of the total population 0.4% were severely anaemic [male 0.3% (5) and female 0.5% (6)]. The prevalence of moderate anaemia was 3.4% [male 2.8% (41) and female 4.2% (54)] and that of mild anaemia was 49.7[male 43% (640) and female 57.4% (746)]. The factors that were found to be significantly associated with adolescent anaemia were female gender (62% vs. 46.1%), being overweight (59.7% vs. 53.2), not taking WIFS regularly (56.5% vs. 51.8% and 28.6% among irregularly taking WIFS and regular takers) and children coming from families with monthly income less than INR 1000. Conclusions: On comparing the academic performance of anaemic and non- anaemic children it was found that the aggregate marks was significantly lower in the anaemic group. compared to the non- anaemic group .

63. Study design: A Cross sectional study Study population: Patients above 18 years of age attending MTM clinic in GCMC Study setting: MTM clinic, Govt. Cuddalore Medical College And Hospital Study period: days Sample size: Sampling technique: Simple Random Sampling METHODOLOGY

64. INCLUSION CRITERIA: Patients more than 18 years of age attending MTM clinic Patients who have acute and chronic illness and those who are on long term treatment Patients who have undergone surgical procedures in the recent past EXCLUSION CRITERIA: Patients less than 18 years of age

65. A cross sectional study will be conducted in MTM clinic in GCMCH, among patients above 18 years of age The participants will be selected using simple random sampling Data collection will be done by using pre tested proforma containing socio demographic details, Height, weight and BMI will be checked Clinical assessment for anemia will be done including pallor, nail changes, knuckle pigmentation Participants haemoglobin levels would be assessed using haemoglobinometer STUDY PROCEDURE

66. Patients who are attending MTM clinic will be

67. After obtaining ethical committee approval, the study will be conducted in MTM clinic, GCMCH. Before collecting the data, all the participants will be briefed about the details of the study, study procedure and the importance of the study and informed consent will be obtained All the participants will be personally interviewed and their identity and information will not be revealed at any point of time ETHICAL CONSIDERATION

68. The collected data will be entered in Microsoft excel and analysis will be made using SPSS software DATA ENTRY AND ANALYSIS

69. PROFORMA SOCIO DEMOGRAPHIC CHARACTERISTICS: Name Age Gender Address Religion Education occupation Marital status Type of family Annual income of the family

70. Questionnaire

71. Reference Source : Indian journal of medical research Author : Tanu anandh , Manju rahi World Health Organization (2011) Anaemia prevention and control [Internet] WHO, Geneva. Available at www.who.int / medical_devices /initiatives/ anaemia_control / en . Accessed 20Aug 2017 WHO, UNICEF. Iron Deficiency Anaemia Assessment, Prevention, and Control A guide for programme managers. 2001. Friedman AJ, Chen Z, Ford P, et al. Iron deficiency anemia in women across the life span. J Womens Health 2012;21:12 82–1289.

72. Prevalence of Anaemia and Its Associated Risk Factors Among Adolescent Girls of Central Kerala P.M. SIVA1, A. SobhA2, V.D. MANJULA Prevalence and risk factor analysis of iron deficiency and iron-deficiency anaemia among female adolescents in the Gaza Strip, Palestine Marwan O Jalambo1, Norimah A Karim2, Ihab A Naser3 and Razinah Sharif2,4,* 1Academic Department, Palestine Technical College, Gaza, Palestine: 2Nutritional Science Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia: 3Clinical Nutrition Department, Faculty of Applied Science, Al-Azhar University, Gaza, Palestine: 4Centre of Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

73. Prevalence and predictors of anaemia among adolescents in Bihar and Uttar Pradesh, India Shekhar Chauhan Ratna Patel 1, Pradeep Kumar 2, Strong P. Marbaniang3,4, Shobhit Srivastava 3* 2 Prevalence of iron deficiency anaemia and risk factors in 1,010 adolescent girls from rural Maharashtra, India: a cross-sectional survey Ahankari AS 1,2, Myles PR 2, Fogarty AW 2, Dixit JV 3 and Tata LJ 2

74. THANK YOU