Iron deficiency anaemia

iron deficiency anaemia is the commonest nutritional anaemia in India as well as other developing countries. till an effective supplementation is implemented right from the age of 4 months the problem can not be solved. there is an urgent need to develop effective strategy to reach every infant in the country and give iron supplementation to every infant irrespective of class, creed, caste and society.

1. IRON DEFICIENCY ANAEMIA DR.HARIVANSH CHOPRA M.D.,DCH PROFESSOR DEPT. OF COMMUNITY MEDICINE L.L.R.M.MEDICAL COLLEGE,MEERUT [email protected]

2. Anaemia is the most common public health problem in India as well as in other developing countries. INTRODUCTION

3. Although there are a number of causes of anaemia in young children but commonly anaemia is classified as : INTRODUCTION

4. MICROCYTIC HYPOCHROMIC ANAEMIA

5. NORMOCHROMIC NORMOCYTIC ANAEMIA

6. MEGALOBLASTIC ANAEMIA

7. By far the commonest anaemia is iron deficiency anaemia and despite of having a national program for the control of anaemia it is not been able to make a dent on the prevalence in India INTRODUCTION

8. The main reason for failure of this program is lack of life cycle approach in the prevention of iron deficiency anaemia. As per various N ational Family Health Surveys, the prevalence of anemia has been staggering around 70% among the children below 3 years of age. INTRODUCTION

9. The main cause of this high prevalence of anaemia in young children is failure to provide supplementary iron right from the age of 4 months of life and this results in child becoming anaemic by the end of first year and then this anemia remain persistent in pre school, school going and adolescent age group. INTRODUCTION

10. INTRODUCTION Especially it becomes more profound in adolescent females again due to lack of therapeutic approach in this particular age group. the failure to treat anaemia in adolescent results in propagation of anaemia in pregnancy.

11. DR.HARIVANSH CHOPRA OBJECTIVES

12. DR.HARIVANSH CHOPRA OBJECTIVES

13. DR.HARIVANSH CHOPRA HIDDEN HUNGER The term was coined by WHO in 1986 & refers to the problems associated with the deficiency of 3 essential micronutrients:

14. DR.HARIVANSH CHOPRA IRON IN NATURE Iron is among the abundant minerals on earth . Of the 87 elements in the earth’s crust, Iron constitutes 5.6% and ranks fourth behind Oxygen (46.4%), Silicon (28.4%) and Aluminum (8.3 %).

15. DR.HARIVANSH CHOPRA What is Iron? Iron is vital to the health of the human body, and is found in every human cell .

16. DR.HARIVANSH CHOPRA What is Iron? The human body contains approximately 4 grams of iron .

17. DR.HARIVANSH CHOPRA What is Iron? Iron is an integral part of many proteins and enzymes that maintain good health.

18. DR.HARIVANSH CHOPRA What is Iron? In humans, iron is an essential component of proteins involved in oxygen transport .

19. DR.HARIVANSH CHOPRA What is Iron? It is also essential for the regulation of cell growth and differentiation It helps cells to "breathe." Iron works with protein to make the hemoglobin in red blood cells .

20. DR.HARIVANSH CHOPRA What is Iron? Dietary iron comes in two forms: Heme iron Non-heme iron

21. DR.HARIVANSH CHOPRA What is Iron? Heme iron is found only in animal flesh, as it is derived from the hemoglobin and myoglobin in animal tissues . Non-heme iron is found in plant foods and dairy products .

22. DR.HARIVANSH CHOPRA Oxygen Distribution Iron serves as the core of the hemoglobin molecule, which is the oxygen-carrying component of the red blood cell. How it Functions?

23. DR.HARIVANSH CHOPRA Red blood cells pick up oxygen from lungs and distribute the oxygen to tissues throughout the body How it Functions?

24. DR.HARIVANSH CHOPRA The ability of red blood cells to carry oxygen is attributed to the presence of iron in hemoglobin molecule . How it Functions?

25. DR.HARIVANSH CHOPRA If we lack iron, we will produce less hemoglobin, and therefore supply less oxygen to our tissues. How it Functions?

26. DR.HARIVANSH CHOPRA Iron is also an important constituent of another protein called myoglobin . How it Functions?

27. DR.HARIVANSH CHOPRA Myoglobin, like hemoglobin, is an oxygen-carrying molecule, which distributes oxygen to muscles cells, especially to skeletal muscles and to the heart . How it Functions?

28. DR.HARIVANSH CHOPRA Energy Production Iron also plays a vital role in the production of energy as a constituent of several enzymes, including iron catalase, iron peroxidase, and the cytochrome enzymes How it Functions?

29. DR.HARIVANSH CHOPRA How it Functions? It is also involved in the production of carnitine , a nonessential amino acid important for the proper utilization of fat. The function of the immune system is also dependent on sufficient iron .

30. DR.HARIVANSH CHOPRA MAGNITUDE OF PROBLEM Iron deficiency is the most common micronutrient deficiency in the world affecting 1.3 billion people i.e. 24% of the world population.

31. DR.HARIVANSH CHOPRA In developing countries, about 50 percent of women and young children are anemic. MAGNITUDE OF PROBLEM

32. DR.HARIVANSH CHOPRA MAGNITUDE OF PROBLEM The highest overall rates of anemia are reported in southern Asia and certain regions of Africa

33. DR.HARIVANSH CHOPRA PREVALENCE IN WORLD REGION 6 – 59 MONTHS PREGNANT WOMEN NON PREGNANT WOMEN AFRICA 60.2 % 44.6 % 37.6 % LATIN AMERICA AND CARIBBEAN 29.1 % 28.6 % 19.1 % NORTH AMERICA 07.0 % 17.1 % 12.4 % ASIA 42.0 % 39.3 % 31.9 % EUROPE 19.3 % 24.5 % 20.1 % OCENIA 26.2 % 29.0 % 20.0 % GLOBAL 42.6 % 38.2 % 29.4 %

34. DR.HARIVANSH CHOPRA PREVALENCE IN INDIA ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA AGE GROUP PREVALENCE 6 – 59 MONTHS 58.4 % PREGNANT WOMEN (15 – 49 YEARS) 53.1 % NON PREGNANT WOMEN (15 – 49 YEARS) 50.3 % ALL WOMEN 15 – 49 YEARS 53.0 % MEN 22.7 %

35. DR.HARIVANSH CHOPRA PREVALENCE IN UTTAR PRADESH ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA AGE GROUP PREVALENCE 6 – 59 MONTHS 63.2 % PREGNANT WOMEN (15 – 49 YEARS) 52.5 % NON PREGNANT WOMEN (15 – 49 YEARS) 51.0 % ALL WOMEN 15 – 49 YEARS 52.4 % MEN 23.7 %

36. DR.HARIVANSH CHOPRA ANEMIA IN CHILDREN < 5 YEARS

37. Percent 10/5/2017 37 Anaemia among Children Age 6-35 Months

38. DR.HARIVANSH CHOPRA According to the epidemiological data collected from multiple countries by the WHO , Some 35 % of women and 43 % of young children in the world are affected by anemia. MAGNITUDE OF PROBLEM

39. DR.HARIVANSH CHOPRA FOOD SOURCE

40. DR.HARIVANSH CHOPRA FOOD SOURCE

41. DR.HARIVANSH CHOPRA The amount of iron needed depends on age, gender, & activity level. Iron needs increase during periods of rapid growth, such as during pregnancy, childhood, & adolescence when new tissue is being built. DAILY REQUIREMENT

42. DR.HARIVANSH CHOPRA Women and teenage girls need more iron than men because of menstrual losses . Competitive athletes may also experience an increased need for iron. DAILY REQUIREMENT

43. DR.HARIVANSH CHOPRA DAILY REQUIREMENT

44. DR.HARIVANSH CHOPRA IMPACT OF COOKING, STORAGE AND PROCESSING Much of the iron in whole grains is found in the bran and germ.

45. DR.HARIVANSH CHOPRA As a result, the milling of grain, which removes the bran and germ, eliminates about 75% of the naturally occurring iron in whole grains. IMPACT OF COOKING, STORAGE AND PROCESSING

46. DR.HARIVANSH CHOPRA Impact of Cooking, Storage and Processing Refined grains are often fortified with iron, but the added iron is less absorbable than the iron that naturally occurs in the grain. IMPACT OF COOKING, STORAGE AND PROCESSING

47. DR.HARIVANSH CHOPRA Cooking with iron cookware will add iron to food, a practice that can eventually lead to iron toxicity. IMPACT OF COOKING, STORAGE AND PROCESSING

48. DR.HARIVANSH CHOPRA Iron absorption is increased when there is an increased physiological need for iron, as occurs in children during rapid growth periods and during pregnancy and lactation. Predisposing factors for Deficiency

49. DR.HARIVANSH CHOPRA Iron absorption is decreased in people with low stomach acid (hypochlorhydria ), Iron absorption is decreased by caffeine and tannic acid found in coffee and tea and by phosphates found in carbonated soft drinks. Predisposing factors for Deficiency

50. DR.HARIVANSH CHOPRA Phytates , found in whole grains, and oxalates, found in spinach and chocolate, may also decrease iron absorption by forming complexes with the mineral that cannot be absorbed through the digestive tract. Predisposing factors for Deficiency

51. DR.HARIVANSH CHOPRA elderly teenager female aborigine immigrant widower DEMOGRAPHIC FACTORS

52. DR.HARIVANSH CHOPRA low iron,haem iron low vitamin C excess phytates excess tea/coffee fad diets DIETARY FACTORS

53. DR.HARIVANSH CHOPRA Social/physical factors poor detention poverty alcohol abuse GIT disease depression

54. DR.HARIVANSH CHOPRA Use of the following medications may increase the amount of iron needed : Aspirin and NSAIDS (for eg , ibuprofen) Histamine blockers Neomycin Stanozolol , Warfarin (Coumadin) DRUG -NUTRIENT INTERACTIONS

55. DR.HARIVANSH CHOPRA Dietary iron may impact the absorption of the following medications: Iron binds with sulfasalazine, decreasing sulfasalazine absorption. Iron decreases the absorption of tetracycline . Iron supplements may decrease absorption of thyroid hormone medications. DRUG -NUTRIENT INTERACTIONS

56. DR.HARIVANSH CHOPRA Iron supplements may interfere with the action of carbidopa , a drug used in the treatment of Parkinson's disease. Iron supplements decrease the absorption of methyldopa, a drug used to lower blood pressure in people with high blood pressure. DRUG -NUTRIENT INTERACTIONS

57. DR.HARIVANSH CHOPRA How do other nutrients interact with iron? Several nutrients increase iron absorption including ascorbic acid (vitamin C), copper, cobalt, and manganese . NUTRIENT INTERACTIONS

58. DR.HARIVANSH CHOPRA Amino acids also improve iron absorption by stimulating the secretion of hydrochloric acid in the stomach . High dietary intake of calcium may decrease absorption of dietary iron. NUTRIENT INTERACTIONS

59. DR.HARIVANSH CHOPRA What health conditions require special emphasis on iron? HEALTH CONDITIONS

60. DR.HARIVANSH CHOPRA HEALTH CONDITIONS

61. DR.HARIVANSH CHOPRA HEALTH CONDITIONS

62. DR.HARIVANSH CHOPRA HEALTH CONDITIONS

63. DR.HARIVANSH CHOPRA Many people with iron deficiency don't have any signs and symptoms because the body's iron stores are depleted slowly. As anemia progresses , following symptoms maybe recognized: Fatigue and weakness Pale skin and mucous membranes CLINICAL FEATURES

64. DR.HARIVANSH CHOPRA CLINICAL FEATURES

65. DR.HARIVANSH CHOPRA CLINICAL FEATURES

66. DR.HARIVANSH CHOPRA Also known as Paterson Kelly syndrome . Characterized by : Iron-deficiency anaemia, Atrophic changes in buccal, glossopharyngeal, and esophageal mucous membranes, Plummer-Vinson Syndrome

67. DR.HARIVANSH CHOPRA Plummer-Vinson Syndrome Koilonychia (spoon-shaped finger nails) , Dysphagia. The dysphagia is due to a web formed in the post cricoid region.

68. DR.HARIVANSH CHOPRA CUT OFF POINTS FOR DIAGNOSIS OF ANAEMIA (WHO)

69. DR.HARIVANSH CHOPRA Hb in IDA

70. DR.HARIVANSH CHOPRA A complete blood count (CBC) may reveal low Hb levels and low hematocrit. The CBC gives information about the size of the red blood cells (RBCs). DIAGNOSIS

71. DR.HARIVANSH CHOPRA RBCs with low hemoglobin tend to be smaller and less pigmented. DIAGNOSIS

72. DR.HARIVANSH CHOPRA The reticulocyte count measures the number of immature red blood cells being produced. This is a useful test because it can indicate a problem before anemia develops. DIAGNOSIS

73. DR.HARIVANSH CHOPRA Serum iron directly measures the amount of iron in the blood, but may not accurately reflect how much iron is concentrated in the body's cells. DIAGNOSIS

74. DR.HARIVANSH CHOPRA Serum ferritin reflects total body iron stores. It's one of the earliest indicators of depleted iron levels, especially when used in conjunction with other tests, such as a CBC. Stool test to detect occult blood loss and to detect presence of eggs of any worms. DIAGNOSIS

75. DR.HARIVANSH CHOPRA A low MCV (normal-85±8 fl ) Low MCH (normal-30±2.5 pg ) L ow MCHC (normal-33±2.5g/dl), indicate microcytic anemia. DIAGNOSIS

76. DR.HARIVANSH CHOPRA DIAGNOSIS

77. DR.HARIVANSH CHOPRA Elevated serum transferrin and High total iron binding capacity (TIBC) (normal 250-450 µg/dl). DIAGNOSIS

78. DR.HARIVANSH CHOPRA A definitive diagnosis requires a bone marrow aspiration, with the marrow stained for iron. DIAGNOSIS

79. DR.HARIVANSH CHOPRA Normal bone marrow is shown here. Note the erythroid islands where erythropoiesis is occurring. DIAGNOSIS

80. DR.HARIVANSH CHOPRA The diagnosis of iron deficiency anemia requires further investigation as to its cause. It can be a sign of other disease, such as DIAGNOSIS

81. DR.HARIVANSH CHOPRA DIAGNOSIS

82. DR.HARIVANSH CHOPRA Treatment for underlying problem- Deworming of patients Change in dietary habits Wearing of shoes TREATMENT

83. DR.HARIVANSH CHOPRA Iron-rich foods are encouraged. Causes of persistent blood loss if any (polyps, chronic dysentery, ulcerative colitis etc.) need to be treated. TREATMENT

84. DR.HARIVANSH CHOPRA ORAL IRON THERAPY : The optimal dose of iron is 3-6mg/kg body weight given orally in 3 doses . With this, hemoglobin level should rise by 0.4g/dl / day . TREATMENT

85. DR.HARIVANSH CHOPRA Oral therapy should be continued for at-least 8 – 12 weeks . Vitamin C should be included in diet and phytate avoided. TREATMENT

86. DR.HARIVANSH CHOPRA If malabsorption is present, it may be necessary to administer iron parenterally (e.g ., iron dextran) . TREATMENT

87. DR.HARIVANSH CHOPRA Iron requirement is determined from the following equation : IRON (mg) = Wt (kg) X Hb deficit (g/dl) X 80 100 X 3.4 X 1.5 Or, Wt (kg) X Hb deficit (g/dl) X 4 TREATMENT

88. DR.HARIVANSH CHOPRA Follow up evaluation with CBC is essential to demonstrate whether the treatment has been effective. TREATMENT

89. Children 6 – 60 months SUPPLEMENTATION 20 mg of elemental iron and 100 mcg of folic acid in biweekly regimen DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE

90. Children 6 – 60 months MILD ANEMIA ( Hb 10 – 10.9 gm/dl ) 3mg of iron/Kg/day for 2 months In case the child has not responded to treatment of anemia for 2 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE

91. Children 6 – 60 months MODERATE ANEMIA ( Hb 7 – 9.9 gm/dl) 3mg of iron/Kg/day for 2 months In case the child has not responded to treatment of anemia for 2 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE

92. Children 6 – 60 months SEVERE ANEMIA ( Hb < 7 ) Refer urgently to DH/FRU DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE

93. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN CHILDREN 6 MONTHS – 5 YEARS HISTORY TO BE TAKEN FOR 93

94. EXAMINATION FOR DR.HARIVANSH CHOPRA MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN CHILDREN 6 MONTHS – 5 YEARS

95. Investigations Indication for blood transfusion Blood transfusion Full blood count and examination of a thin film for cell morphology Blood films for malaria parasites Stool Examination for ova, cyst, and occult blood All children with Hb ≤4gm/dl Children with Hb 4-6 gm/dl with any of the following : Dehydration Shock Impaired Consciousness Heart Failure Deep and labored Breathing Very high parasitemia If packed cells are available, give 10ml/kg over 3-4 hours preferably. If not, give whole blood 20ml/kg over 3-4 hours 95

96. DOSE OF IFA SYRUP FOR ANEMIC CHILDREN 6 MONTHS – 5 YEARS AGE OF CHILD DOSE FREQUENCY 6 months – 12 months (6-10 kg) 1 ml of IFA syrup Once a day 1 year – 3 years (10 – 14 kg) 1.5 ml of IFA syrup Once a day 3 years – 5 years (14 – 19 kg) 2 ml of IFA syrup Once a day 96

97. SUPPLEMENTATION Tablets of 45mg elemental iron and 400mcg of folic acid DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE CHILDREN 5 – 10 YEARS

98. MILD ANEMIA ( Hb 11 – 11.9 gm/dl ) 3mg of iron/Kg/day for 2 months In case the child has not responded to treatment of anemia for 2 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE CHILDREN 5 – 10 YEARS

99. MODERATE ANEMIA ( Hb 8 – 10.9 gm/dl) 3mg of iron/Kg/day for 2 months In case the child has not responded to treatment of anemia for 2 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE CHILDREN 5 – 10 YEARS

100. SEVERE ANEMIA ( Hb < 8 gm/dl ) Refer urgently to DH/FRU DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE CHILDREN 5 – 10 YEARS

101. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN CHILDREN 5 – 10 YEARS HISTORY TO BE TAKEN FOR 101

102. EXAMINATION FOR DR.HARIVANSH CHOPRA MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN CHILDREN 5 – 10 YEARS

103. Investigations Indication for blood transfusion Blood transfusion Full blood count and examination of a thin film for cell morphology Blood films for malaria parasites Stool Examination for ova, cyst, and occult blood All children with Hb ≤4gm/dl Children with Hb 4-6 gm/dl with any of the following : Dehydration Shock Impaired Consciousness Heart Failure Deep and labored Breathing Very high parasitemia If packed cells are available, give 10ml/kg over 3-4 hours preferably. If not, give whole blood 20ml/kg over 3-4 hours 103

104. ADOLESCENTS 10 – 19 YEARS 104

105. SUPPLEMENTATION 100mg elemental Iron and 500mcg folic acid DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE ADOLESCENTS 10 – 19 YEARS

106. MILD ANEMIA ( Hb 11 – 11.9 gm/dl) 60mg of iron/day for 3months In case the child has not responded to treatment of anemia for 3 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE ADOLESCENTS 10 – 19 YEARS

107. MODERATE ANEMIA ( Hb 8 – 10.9 gm/dl) 60 mg of iron/day for 3 months In case the child has not responded to treatment of anemia for 3 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE ADOLESCENTS 10 – 19 YEARS

108. SEVERE ANEMIA ( Hb < 8 gm/dl ) Refer urgently to DH/FRU DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE ADOLESCENTS 10 – 19 YEARS

109. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN ADOLESCENT HISTORY TO BE TAKEN FOR 109

110. EXAMINATION FOR DR.HARIVANSH CHOPRA MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN ADOLESCENT

111. Investigations Indication for blood transfusion Blood transfusion Full blood count and examination of a thin film for cell morphology Blood films for malaria parasites Stool Examination for ova, cyst, and occult blood All children with Hb ≤4gm/dl Children with Hb 4-6 gm/dl with any of the following : Dehydration Shock Impaired Consciousness Heart Failure Deep and labored Breathing Very high parasitemia If packed cells are available, give 10ml/kg over 3-4 hours preferably. If not, give whole blood 20ml/kg over 3-4 hours 111

112. PREGNANT AND LACTATING WOMEN 112

113. Hb level 9 – 11gm/dl IFA tablets 100mg iron and 500 mcg folic acid 2 IFA tablets per day for at least 100 days DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN

114. Hb 8 – 9 mg/dl Cause of IDA must be investigated 2 tablet IFA to be given daily DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN

115. Hb 7 – 8 mg / dl Before starting the treatment, the women should be investigated to detect the cause of anemia Injectable IM preparations DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN

116. Hb 5 – 7 mg / dl Continue Parenteral iron therapy as for Hb level between 7-8mg/dl. Hb testing to be done after 8 weeks DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN

117. Hb < 5 gm /dl injectable IV sucrose preparations Immediate Hospitalization irrespective of period of gestation in hospitals for blood transfusion DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN

118. 118 LEVEL OF Hb TREATMENT FOLLOW UP REFERRAL MILD ANEMIA (11 -11.9 gm/dl) 60mg of elemental iron daily for 3 months Follow up every month Hb estimation after completing 3 months of treatment to assess if Hb estimates are >12 gm/dl In case the child has no improvement in Hb levels after 3 months of treatment , adolescent will be referred to DH/FRU for further investigation Moderate Anemia (8 – 10.9 gm/dl) 60mg of elemental iron daily for 3 months Investigation Follow up every month Hb estimation after completing 3 months of treatment to assess if Hb estimates are >12 gm/dl In case the child has no improvement in Hb levels after 3 months of treatment , adolescent will be referred to DH/FRU for further investigation SEVERE ANEMIA (<7gm/dl) Refer urgently to DH/FRU Severely Anaemic adolescents would be line listed by ANM

119. DR.HARIVANSH CHOPRA Prevention of iron deficiency can be achieved by following measures : PREVENTION

120. DR.HARIVANSH CHOPRA Iron Supplementation v/s Iron Therapy – Cost

121. DR.HARIVANSH CHOPRA PREVENTION

122. DR.HARIVANSH CHOPRA Launched in 1970 to prevent nutritional anaemia in mother & children . This program is now a part of RCH II program . NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS PROGRAM

123. DR.HARIVANSH CHOPRA NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS PROGRAM Under this program, prophylactic treatment for expected and nursing mothers are given one tablet containing 100 mg elementary iron and 0.5 mg folic acid .

124. DR.HARIVANSH CHOPRA NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS PROGRAM Children are given one tablet containing 20mg elemental iron and 0.1 mg folic acid for a period of 100 days . For therapeutic purpose, number of tablets is increased to 2 daily.

125. NATIONAL IRON + INITIATIVE Launched to bring existing Programmes together and establish new age groups 125

126. Bi weekly iron supplementation for pre school children 6 months to 5 years DR.HARIVANSH CHOPRA Weekly Supplementation for children from 1 st to 5 th grade in Govt. and Govt. aided school NATIONAL IRON + INITIATIVE

127. Weekly supplementation for out of school children (5 – 10 years) at Anganwadi Centers. DR.HARIVANSH CHOPRA Weekly Supplementation for adolescents (10 – 19 years) NATIONAL IRON + INITIATIVE

128. Pregnant and lactating women DR.HARIVANSH CHOPRA Weekly Supplementation for women in reproductive age NATIONAL IRON + INITIATIVE

129. DR.HARIVANSH CHOPRA CONCLUSION

130. DR.HARIVANSH CHOPRA Normal requirement of iron in children is- 0.1mg/kg/day 0.5mg/kg/day 1mg/kg/day 5mg/kg/day ANS. 3 MCQ's

131. DR.HARIVANSH CHOPRA The prevalence of anaemia in pregnancy in India is – 10-20% 20-30% 30-40% 40-50% ANS. 4 MCQ's

132. DR.HARIVANSH CHOPRA WHO Cut off point for diagnosis of anaemia for children (6month-6year) is : 11g/dl 12g/dl 13g/dl 10g/dl ANS. 1 MCQ's

133. DR.HARIVANSH CHOPRA Normal serum iron level is : 30-80 µg/dl 80-180 µg/dl 150-250 µg/dl 250-450 µg/dl ANS. 2 MCQ's

134. DR.HARIVANSH CHOPRA The content of a tablet used for prevention of Nutritional Anaemia in Pregnant female is : 50mg iron, 0.1mg folic acid 50mg iron, 0.5mg folic acid 100mg iron, 0.1mg folic acid 100mg iron, 0.5mg folic acid MCQ's ANS. 4

135. DR.HARIVANSH CHOPRA THANK YOU