National iron plus_initiative_guidelines_for_control_of_ida

Iron deficiency management guidelines-MoHFW

1. Guidelines for Control of
Iron Deficiency Anaemia

2. Adolescent Division
Ministry of Health and Family Welfare
Government of India

4. Acknowledgements

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List of Contributors
Ms. Anuradha Gupta
Additional Secretary & Mission Director, NRHM
Dr. Rakesh Kumar
Joint Secretary, RCH
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Deputy Commissioner, Adolescent Health
Ms. Anshu Mohan
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Dr. Sheetal Rahi
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Technical Experts
Professor Umesh Kapil, Department of Community Medicine, AIIMS
Dr. HPS Sachdev, Paediatrician, Sita Ram Bhartia Institute of Science & Research
Dr. PV Kotecha, Professor, Preventive and Social Medicine,
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Dr. Prema Ramachandran, Director, Nutrition Foundation of India
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Dr. Vartika Saxena, Deptt. of Community Medicine, AIIMS, Rishikesh
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6. Message
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8. P.K. PRADHAN
Secretary
Department of Health & FW
Tel.: [phone] Fax : [phone]
e-mail : [email protected]
National Rural Health Mission
GOVERNMENT OF INDIA
MINISTRY OF HEALTH & FAMILY WELFARE
NIRMAN BHAVAN, NEW DELHI - 110108
-110108
Message
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(P.K. Pradhan)
Place: New Delhi
15
th
January, 2013

10. A G, IAS
Additional Secretary &
Mission Director, NRHM
Telefax : 23062157
E-mail : anuradha&[email protected]
G I
M H & F W
N B , N D - 110108
110108
Preface
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supervision. For children of class I to class V in Government/Government aided schools,
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and economic productivity of individuals and populations
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Anuradha Gupta

12. Foreword
Anaemia, a manifestation of under-nutrition and poor dietary intake of iron is
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levels of care.
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and control anaemia. I call upon all stakeholders and partners for their continued support
in this respect.
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(Dr. Rakesh Kumar)
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D . RAKESH K MAR, I.A.S
INT SE RETAR
Telefax : 23061723
E-mail : r umar [email protected]
G I
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M H & F W
N B , N D - 110108

14. Contents
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1.1. What is Anaemia? 1
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15. Acronyms
AG Adolescent Girl
ANC Antenatal Care
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ASHA Accredited Social Health Activist
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CHC Community Health Centre
CNS Central Nervous System
5q 75 q
DH District Hospital
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FRU First Referral Unit
GDP Gross Domestic Product
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IFA Iron and Folic Acid
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ITBN Insecticide Treated Bed Nets
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MCP Card Mother Child Protection Card
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MoHFW Ministry of Health and Family Welfare
MUAC Mid Upper Arm Circumference
MWCD Ministry of Women and Child Development
NFHS National Family Health Survey
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PHC Primary Health Centre
PNC Postnatal care
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RBC Red Blood Cells
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WIFS Weekly Iron and Folic Acid Supplementation
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16. 1
Anaemia ? $
1.1. What is Anaemia?
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function of the RBCs is to deliver oxygen from the lungs to the tissues and carbon
dioxide from the tissues to the lungs. This is accomplished by using haemoglobin
(Hb), a tetramer protein composed of haem and globin. Anaemia impairs the body’s
ability for gas exchange by decreasing the number of RBCs transporting oxygen and
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Fig. 1.1: Adverse effects of anaemia
ANAEMIA
Reduced
physical
development
Impaired
sexual and
reproductive
development
Reduced
cognitive
development
Decreased work output
Decreased work capacity
Diminished concentration
Disturbance in perception
Poor learning ability
Irregular menstruation
Low pre-pregnancy iron stores
LBW babies and preterm delivery
1

17.
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Table 1.1: Haemoglobin levels to diagnose anaemia (g/dl)
Age groups No Anaemia Mild Moderate Severe
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Source: Haemoglobin concentration for the diagnosis of anaemia and assessment of severity. WHO
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causative factor.
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Storage iron
Transport iron
RBC iron
Normal Iron depletion
Iron deficient
erythropoiesis
Iron deficiency
anaemia
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1.2.4 Malaria
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Certain chronic diseases, such as cancer, HIV/AIDS, rheumatoid arthritis, Crohn’s disease ? ) ! *|) in chronic anaemia. Kidney failure can also cause anaemia.

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Fig. 2.1: Global picture – Anaemia as a public health problem in preschool children by country
Category of Public
Health Significance
Normal (<5.0%)
Mild (5.0-19.9%)
Moderate (20.0-39.9%)
Se
vere (>40.0%)
No Data
Source: WHO Global Database on Anaemia
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21.
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Table 2.1: Prevalence of anaemia in India and neighbouring countries
Country
Proportion of population with
anaemia (Hb <11 g/dl)
Public health problem
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Bhutan [\^ Severe
India ?_ Severe
Nepal ?[\ Severe
Pakistan Z\? Severe
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Source: WHO Global Database on Anaemia
2.2. Indian Scenario
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Age groups Prevalence of anaemia (%)
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22. |-
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2.2.1 Trends in anaemia prevalence
Anaemia prevalence in under-5 children
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Table 2.3: Prevalence of anaemia among children aged 6 to 35 months (per cent)
Anaemia level
NFHS-2 NFHS-3
Urban Rural Total Urban Rural Total
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Fig. 2.2: Prevalence of anaemia among adolescent girls (12–19 years) and young women
(20–29 years) in India
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Source: NFHS-3, 2005-06 and the National Nutrition Monitoring Bureau Survey (NNMBS), 2006
Prevalence of anaemia among pregnant women, men and women of reproductive
age (WRA)
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Fig. 2.3: Prevalence of anaemia among pregnant women
Percentage
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24. |-
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Children: Causes of Nutritional Anaemia
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26. 11
Impact of Anaemia on
Health Outcomes
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Managers; WHO 2001- WHO/NHD/01.3
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39.
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Table 7.1: Management of anaemia on the basis of haemoglobin levels in children
6 months–5 years
Level of Hb Treatment Follow-up Referral
No Anaemia
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2 months
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treatment to document
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for 2 months, refer the child to the
%*8?$ %]# #4?
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"
Severe Anaemia
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Refer

DH/FRU
Table 7.2: Dose of IFA syrup for anaemic children 6 months–5 years
Age of child Dose Frequency
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Follow-up of children undergoing treatment of anaemia to be done by ANM
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ay for a erio of onth
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f chil continue to ha e anae ia Hb e ti ation at
ub centre after onth of yru refer the
chil to PHC for further anage ent

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– Dehydration
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$"!?_
Table 7.3: Management of anaemia on the basis of haemoglobin levels in children
5–10 years
Level of Hb Treatment Follow-up Referral
Mild Anaemia
(11–11.4
gm/dl)
_ ?/?
day for
2 months
%]!"}
$
! ~
$
?}}Z?
In case the child has not responded

dose of iron for 2 months, refer the
%*8?$ %]#
trained MO/Paediatrician/Physician
"
Moderate
Anaemia
(8–10.9 gm/dl)
_ ?/?
day for
2 months
%]!"}
$
! ~
$
?}}Z?
In case the child has not responded

dose of iron for 2 months, refer the
%*8?$ %]#
trained MO/Paediatrician/Physician
"
Severe
Anaemia
(<8 gm/dl)
*
to DH/FRU
Note:
? ! $ " ?}}Z ?) %
!!
? ) "
- !
! ) ! )!
the individual case.

42. ! !!5
27
Management of severe anaemia at FRU/DH in children 5–10 years
History taking for Examination for
? symptoms
?8 < =
?% < +
-=
?"
?&
?|
?!
?" od transfusions
?' < =
?'"!ar pallor
?'- <! ?!! !=
?5!!
?$!]!
?' <!) ,3)
! )! =
Investigations
Indication for blood
transfusion
Blood transfusion
?%
`
!
?|
parasites
?'` ")

? $??
? $]^?
6
– Dehydration
– Shock
– Impaired consciousness
– Heart failure
? !

– 3 !
<?}\?*|=
!-" )
"}\?-"_]
!) "
~\?-"_]
Indications for further investigations and referral for management:
? $!]!?'!)
`!
? < =
? !!)
? ? - !
or pancytopenia on smear examination
? ! 9 ? "~-
?_ !}\?}?q
Screening
' - ]
&&]]!)
! ! $?#
$

43.
28
Facility level management of anaemia in adolescents
$ ! $"
" )"
$" !?
Table 7.4: Management of anaemia on the basis of haemoglobin levels among
adolescents 10–19 years
Level of Hb Treatment Follow-up Indication for referral
Mild Anaemia
(11–11.9 gm/dl)
^\
elemental iron
daily for
_
%]!"
$ !
_
$ ?}~?
In case of no improvement
$"
_)

to DH/FRU for further
"
Moderate Anaemia
(8–10.9 gm/dl)
^\
elemental iron
daily for
_
"
%]!"}
$ !
_
$ ?}~?
In case of no improvement
$"
_)

to DH/FRU for further
"
Severe Anaemia
(<8 gm/dl)
Referurgently
to DH/FRU
Severely anaemic adolescents
#
? ]!_
" 6
?!
??` ! !
?|` ! <! -=
?'` ")
Table 7.5: Management of severely anaemic adolescents at FRU/DH
Investigations
Indication for blood
transfusion
Blood transfusion
?%
`
!
?|
parasites
?'` ")
and occult
?& $??
?& $]^?
6
– Dehydration
– Shock
– Impaired consciousness
– Heart failure
? !

– Very h !
<?}\?*|=
!-" )
"}\?-"_?
!
) "~\?-
"_?