Anemia as a public health problem Adolescent Girls Anemia Control Program Baroda Experience and Scal

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Anemia as a public health problemAdolescent
Girls Anemia Control ProgramBaroda Experience
and Scaling up..

• For Food Nutrition Security Vision Workshop
• Prakash V Kotecha
• Department of Preventive Social Medicine
• Medical College Vadodara, Gujarat, India
• Technical Support UNICEF Gujarat

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Iron Deficiency

• Iron deficiency is the most common nutritional
  disorder in the world. 4-5 billion people
  (66-80) of the global population is iron
  deficit.
• 2 Billion anemic people (30 of global
  population) in the world are anemic
• ID affects more people than any other condition
  in the world.. And remains silent despite severe
  consequences than other common conditions

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What is Anemia?

• Less of hemoglobin in blood, so blood is pale or
  less red. This occurs because in the blood there
  is less iron.
• Iron is a vital ingredient in our blood that
  helps oxygen be carried throughout our bodies
• So in anemia, not enough oxygen going to parts of
  the bodies, they will not function as they should.

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Hemoglobin - Work Capacity
work capacity
Anemic
Normal
Hemoglobin
Adopted from MI Website
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Population, anemia prevalence in risk groups, and
death and disability attributable to
iron-deficiency anemia in the world and in
selected developing regions of the world
GBD 2000 WHO estimates Southeast Asia
contributes 1/5th of the population But
contributes to more than 40 of the deaths due
to anaemia and almost 1/3rd of the DALY lost due
to anaemia!

• Source Stoltzfus et al
• DALY disability-adjusted life year
• Excluding Egypt, Morocco, Somalia, Sudan and
  Tunisia
• Excluding Cuba
• Afghanistan, Djibouti, Egypt,Iraq,Morocco,
  Pakistan, Somalia, Sudan, Yemen

• Indonesia, Srilanka, Thailand (I)
• Bandladesh, Bhutan, Democratic Peoples Republic
  of Korea, India, Maldives, Myanmar, Nepal (II)
• Including Cuba
• Because anemia cutoffs are defined as the 5th
  percentile of normative distribution, this
  represents the theoretical minimum population
  prevalence of anemia

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Prevalence of Anemia in Children NFHS II
Large proportion anemia More than 2/3 of them are
moderate to severe
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Prevalence of Anemia in Children India based on
published books 1950-2002  
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Prevalence of Anemia in Women ICMR Mutli Centric
Districts Study
Large proportion anemia More than 5/6 of them are
moderate to severe
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Other Groups

• Infants thumb rule it is as high as anemia
  among pregnant mothers.which is 85-90..
• Adolescents Very High..60-80 different
  studieseven among boys it is high
• ICMR study (11 districts) 90.1
• Adolescent Boys 66 in Vadodara Urban
• School going younger children it remains high

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Anemia-Iron Deficiency Realities
Total Population
50-70 of the population or more have Iron
Deficiency Anemia
Iron Deficiency
40 or more ID develop IDA
Anemia
Iron Deficiency Anemia
50-85 of Total Anemia is IDA
Adapted from Yip, 1989
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For anemia control what is required

• Requirements of Effective Prevention/Control of
  Iron Deficiency are
• A well defined goal
• Enabling policy
• Effective program strategy
• These elements are in turn supported by three
  major program components
• Research and development
• Communications
• Program operations

Adopted from Yip, 2002
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Anemia strategy in India

• Magnitude of the problem and its effects are well
  appreciated in the programs..!
• Tenth five year plan 2002-2007 goal
• To reduce prevalence of anemia by 25 and
  moderate and severe anemia by 50 in children,
  pregnant and lactating women and adolescents!
• Screening of children for anemia whenever
  required and appropriate treatment of those found
  anemic!
• Universal screening of pregnant women for anemia
  and appropriate treatment!

Tenth Five Year Plan Volume II Sectoral
policies and Programs Nutrition
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So what should we do?

• Not just know anemia but UNDERSTAND anemia, its
  wide spread consequences in the field much beyond
  health
• Effectively communicate that to those who DECIDE
  POLICY AND ALLOCATE RESOURCES
• Come with technically sound, practically feasible
  and realistically targeted program

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Why Anemia Control?

• Reduction of anemia means
• Less morbidity and mortality of mothers
• Less blood loss
• Less chances of deaths..
• Faster recovery to normalcy
• More birth weight of the child
• Better survival of child..
• Less infection
• Better growth potential
• More appetite

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Why Anemia Control?
The World Health Organizations (WHO) 2002 Report
titled Preventing Risk, Promoting Healthy Life,
mentioned iron deficiency as the 9th of 26
preventable risks to disease disability and death
in the world today It is social and economic
problem and not medical one
Life is much more Meaningful.
Quality of life Improves.
Ability to Care for Family and Self
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Gujarat Experience
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Why Adolescent Girls?

• Anemia in pregnancy has not been controlled
  ever.and anywhere.
• Quality of life matters.
• Adolescent age group is 1/6th of the total
  population and important one
• Half of them adolescent girls
• 40 marriage by age of 18 years among all married
  women including young women (MICS 1999, 2001)

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Background for the Project

• Baseline prevalence of anemia 75 in adolescent
  school girls
• Similar among rural, tribal and urban areas
• Readiness to take IFA tablets to 98 level
• Technical and Administrative Assistance available
• All 426 schools covered under the program

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Adolescent Anemia Control Program
UNICEF Gujarat (Technical Financial Help)
Medical College Vadodara Project Support
unit (Technical Guidance and Documentation)
More than 4000 Teachers
Beneficiaries in the schools More than 65000
Adolescent Girls
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State Ministers Health, Education UNICEF Chief
Inaugurating
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Project Inputs

• Once a week supervised IFA tablet to 65000 school
  girls by teachers/monitors
• IEC- brochures, posters, self monitoring card and
  20 question booklet - 100 schools covered.
• Training Logistics - one day, interactive,
  linked with PHCs, synchronized with supplies -
  gt95 coverage
• Monitoring- individual, class (weekly), school ,
  cluster and district level (monthly) and state
  level six monthly

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Hemoglobin Curve
Mean Rise in Hb 6.4 gm/L (0.64 g/dL)
Change in Anemia Prevalence from 74.7 to 53.2
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Prevalence of Anemia at Different Hb. Cut off
Points Before and After Intervention
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Positive Lessons

• Easy, doable and successful program. Replicable
  and effective to control anemia
• Effective in reducing anemia by 20 with
  improvement in hemoglobin for 82 of girls in 17
  months of the intervention period
• Compliance for the schoolgirls to 90 has already
  been achieved.

Dr. Prakash V Kotecha
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Progress based on Vadodara Project lessons

• Program extended to ALL 25 districts, supported
  by UNICEF and MI owned by Government of Gujarat
  jointly education and health departments
• Currently covers over one million adolescent
  girls in the schools
• Internalized with education and health program
  with minimum extra input

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Lessons Learnt for Future

• For out of the schoolgirls, limited success
  achieved.
• IEC material use has not been satisfactory and
  needs to be strengthened more for its
  application then for its content.
• Dietary practices improvement based on IEC
  material has largely eluded us..

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Out of school girls

• Out of school girls are about 70 of adolescent
  girls and they are not effectively covered
• Reach Out of school girls through ICDS,
  Panchayat, NGO etc.
• Through ICDS AWW by involving them in urban area.
• Over 10,000 girls covered under urban
  areasstaring in rural areas too..
• Solution exchange network suggested options..

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What next?

• Expand Intervention beyond Iron e.g. Family Life
  Education e.g. Menstrual hygiene etc..
• Supporting School Adolescent Education Program
  including HIV/AIDS

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Questions?
Thank You..