Dr Sangamitra Das, Obstetrician, Infertility Specialist, Gynaecologist – Cuttack, talks about the need to draft a national public health programme to tackle anaemia

In the modern world, few public health concerns are as widespread as anaemia. The World Health Organization (WHO) has conducted extensive studies to determine the prevalence of anaemia and in 2008 found that nearly one in four people around the world were affected by anaemia[1]. However, it is pertinent to note that a disproportionate number of those affected by anaemia belong to the developing world.

Anaemia is widespread in India and the numbers are rather grim. Studies have shown that 58.6 per cent of all children, 53.2 per cent of non-pregnant women, and 50.4 per cent of pregnant women were found to be anaemic[2]. These figures were recorded as recently as in 2016 and there aren’t any indications that much has changed in the last few years. That this continues to be the state of affairs when central governments have carried out an anaemia control programme for over 50 years is an unflattering indictment of our public health programmes. While the battle against polio has been won and there is a lot of progress when it comes to the battle against tuberculosis, we are not even close to taming anaemia.

As is commonly the case in India, the challenges rural India faces are very different compared to those that urban India faces. While it is understood that these battles need to be fought on multiple flanks, it must also be remembered that the strategy and infrastructure needed to combat anaemia are also vastly different in various parts of the country.

Despite several decades of public health and awareness campaigns, malnourishment is still a major challenge in rural India. Worm infestation remains a significant cause of anaemia in the villages, even though free deworming treatment has been made available by the government. These two causes are primarily responsible for the fact a massive proportion of women suffer from acute iron deficiencies. When anaemic women bear children, the anaemia is passed on the infant as the mother’s milk is deficient of iron. Another large area of concern in rural India is the blood loss women face due to the improper administration of contraceptive practices. This is found to happen, especially in the case of copper IUDs.

In urban centres, while some of the causes for anaemia overlap, there are a different set of challenges that need to be dealt with. While malnourishment is not as significant a challenge as it is in rural India, dietary inadequacies are still a primary cause of anaemia, as for large parts of the population, a high-calorie, fast food-based diet is a culprit. Often unhealthy and ill-conceived diets followed by the younger population are a direct cause of the iron deficiency. Furthermore, smoking, alcohol abuse, and drug use are far more prevalent in urban centres and this is a significant contributing factor when it comes to anaemia.

Drafting a national public health programme to tackle such a widespread ailment sure is intimidating. The programme must start by focussing on creating awareness, as a battle against an invisible enemy can never be won. After identifying the causal factors, targeted measures such as providing subsidized iron and vitamin supplements must be pursued. Further emphasis needs to be placed on existing programmes that aim to carry out periodic deworming. Drives to encourage safe use of contraception must also be carried out. While altering the dietary choices of a country as vast as India is a monstrous challenge, reinforcing healthy dietary choices must be a priority. 

By Dr Sangamitra Das

Obstetrician, Infertility Specialist, Gynaecologist - Cuttack

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