National nutritional anemia prophylaxis programme

1. National nutritional anemia prophylaxis programme POOJA CHETAL M.SC 1 ST YEAR

2. Anemia as a serious concern: Because it adversely effect Cognitive performance Behavioral development Motor development Coordination language development Scholastic achievement Increase morbidity from infection

3. Hemoglobin classification Mild: 10.0- 10.9g/dl Moderate: 8.0-9.9g/dl Severe: <8.0g/dl

4. Programme was launched in 1970 during the 4 th 5 year plan to prevent nutritional anemia in mothers and children .

5. Beneficiaries: Beneficiaries are “at risk groups” Pregnant woman Lactating mothers Children under 12years of age

6. Eligibility criteria: They are determined by the hemoglobin level of the patient. If the hemoglobin is between 10-12g, daily supplement with iron and folic acid tab is prescribed. If it is less than 10g , the patient is referred to the nearest health centre.

7. Interventions/focus: Iron and folic acid supplementation Iron fortification Other strategies

8. Iron and folic acid supplementation Mothers: expected and nursing mothers One tab of iron and folic acid containing 60mg of elementary iron (300mg of ferrous sulphate) which was raised to 100mg of elementary iron, however folic acid content remained same (.5mg of folic acid) Daily administration should be continued until 2-3months after Hb level has returned to normal so that iron stores are replenished. Estimation of Hb repeated at 3-4 months interval .

9. Contd … Children: Screening done at 6 months , 1 and 2 years of age. One tablet of iron and folic acid containing 20 mg of elemental iron ( 60 mg of ferrous sulphate) and . 1mg of folic acid daily for 100 days . For children 6-60 months of age ferrous sulphate and folic acid should be provided in a liquid formulations containing 20mg of elemental iron and .1mg of folic acid per ml of the liquid formulation .

10. Contd …. For safety reason the liquid formulation should be dispatched in bottles designed that only ml is dispensed each time.

11. Contd …. School children 6-10 years 30 mg of elemental iron and 250micrograms of folic acid /day for 100 days . Adolescents 11-19 years Same dosage and duration as adults girls given priority.

12. Iron fortification The WHO experts did not recommend iron fortification strategy for control of anemia in the regions where its prevalence is high. However studies in India at the national institute of nutrition , Hyderabad showed that simple addition of ferrous sulphate was enough to fortify salt with iron. When consumed over a period of 12-18months , iron fortified salt was found to reduce prevalence of anemia significantly.

13. Other strategies Dietary habits Control of parasites and nutrition education

14. 12-by-12 initiative for anemia control Pooja chetal m.Sc nursing 1 st year

15. 12-by- 12initiative for anemia control A 12-by -12 initiative was launched at aiims on april 24 ,2007 with a view to ensure that every child should have hemoglobin of 12grams by the age of 12. this initiative is jointly taken by ministry of health and family welfare , Govt of India , who, and UNICEF.

16. objectives Ensure that every child by the age of 12years has a healthy Hb level.

17. All the partner agencies will work in their areas like adoption of a few schools and creating public awareness by giving advice on dietary pattern. Workshops will be conducted in rural and slum areas . Children between age group of 10-14 will be screened and if the H b levels are found to be below 12grams , iron supplement will be given . FOCUS

18. CONTD… In adopted schools , an iron day has been declared where students will be educated about the issue and their dietary patterns will be corrected Focus on increasing iron intake of children , controlling worm infestation and other infections and improving overall nutritional status by changing the dietary pattern in such a way as to make iron more bio-available.

19. Thank you