Nutritional Anemia- from a public health point of view

1. NUTRITIONAL ANEMIA
Dr. Moumita Pal
MBBS, DPH, MD
Dept. of Community
Medicine
College of Medicine and
Sagar Dutta Hospital
1

2. Iron
Group Requirement (mg) / day RDA(mg)
Male 0.84 17
Female 1.65 21
Pregnancy 2.80 35
Lactation 1.65 21
•Micro element- mineral
•Adult body contains- 4 gm iron; >2/3rd i.e. 2.4 gm
present in haemoglobin
2

3. Iron- sources
• Haem-iron: Non vegetarian sources- meat,
fish, poultry, liver. Help in absorption of
Non haem iron. Milk is poor source but iron
in breast milk is well utilized.
• Non haem iron: vegetarian sources like
cereals, green leafy vegetables, pulses,
nuts, dry fruits, jaggery. Bioavailability is
poor.
• Decrease absorption- Phytic acid( cereals,
fibre), polyphenols( in plants), tannins
( tea), phosphates ( milk, eggs), calcium
• Enhance non haem iron absorption- haem
iron, ascorbic acid, low pH ( vit C ).
3

4. Absorption and Loss
• Mostly from duodenum and upper small intestine in
ferrous state according to body need.
• Absorption from habitual Indian diet is <5%
• Transported as Plasma Ferritin
• Stored in liver, spleen, bone marrow and kidney.
• Lost by-1. hemorrhages- physiological(menstruation,
childbirth)
• Pathological( hookworm, malaria, hemorrhoids, peptic
ulcers)
• 2. Basal loss- through urine, sweat, bile and
desquamation of surface cells.
4

5. Functions
• Formation of haemoglobin and Myoglobin.
• Constituents of enzymes like cytochromes,
catalase, peroxidase,
• Oxygen transport and cellular respiration.
• Cellular immune response and functioning of
phagocytes.
• Brain development and function
• Regulation of body temperature and muscle
activity.
5

6. Iron deficiency
Decreased storage but no S/S
Latent iron deficiency – serum Ferritin n
Transferrin saturation( falls to <15%)
Overt iron deficiency- fall down HB
conc.
6

7. Evaluation of iron status
• Haemoglobin concentration-
• Serum iron concentration- 0.80-1.80 mg/L
• Serum ferritin- < 10mcg/L absence of store.
• Serum transferrin saturation-30%
7

8. Definition
• Disease syndrome by malnutrition
• A condition in which the hemoglobin content
of blood is lower than normal as a result of a
deficiency of one or more essential nutrients
regardless of the cause of such deficiency.
(WHO)
• Most common- IDA ( Microcytic)
• Less common- Vit B12 and Folic acid Deficiency
( Macro/,megaloblastic Anemia)
8

9. WHO CUT OFF CRITERIA OF HB%
(IN VENOUS BLOOD)
Age/gender group HB ( g/dl)
Adult man 13
Adult woman (non
pregnant)
12
Adult woman (pregnant) 11
Child above 6 yrs 12
Child below 6 yrs 11
9

10. The problem Statement
• World wide problem specially for developing
countries.
• More prevalent in women of child baring age,
young children, pregnancy, lactation.
• In India >50% of women, 70% of children are
anemic.
• Adolescent girls- 72.6% anemic ( DLHS)
• Megaloblastic anemia masked by IDA. 30% in
pregnant women
10

11. Causes -IDA
Inadequate intake of iron Poor diet
Poverty
Ignorance
Inadequate folate/vit C
intake
Poor absorption and bioavailability of iron Absorption-5%
Poor absorption- Non heame iron
Inhibitors- phosphates, phytates, oxalates,
fibre, tea(tannin), calcium
Excessive loss of iron Normal man (1mg/dl)
Menstruation( 2 mg/dl)
IUDs
Intestinal worms
Malaria
Repeated pregnancies
Increased demand of iron Pregnancy
Growth
11

12. Increased risk of Iron deficiency
women
Growing children and adolescents
Pregnancy and lactation
Heavy menstruation
Chronis bleed- hemorrhoids, peptic ulcers, acute gastritis
Iron deficient diet
Strict vegetarians
Heavy tae coffee drinkers
Reduced gastric acid secretion
Atrophic gastritis
Chronic antacid use
Reduced transport due to deficiency of- Vit-A, Vit B6, Copper
12

13. Prevention and control
(Integrated approach)
• Breastfeeding and appropriate weaning.
• Dietary modification
• De-worming
• Control of infection
• Supplementation
• Iron fortification
• Nutrition education
• Home gardening
• Care of pregnant and lactating women.
13

14. Iron fortification
• By National Institute of Nutrition, Hyderabad
• Addition of ferric ortho-phosphate or ferrous
sulphate with sodium bisulphate to fortify
common salt
• Consumed over 12-18 months-reduced
prevalence
• Advantages- universally consumed by all
sections, no special delivery system needed.
14

15. National nutritional anemia
prophylaxis program
• Launched in 1972
• Beneficiaries : pregnant and lactating women,
children 1-5 years and women acceptors of
family planning.
• Currently operating as a part of RMNCH+A.
• Target group includes infants(6-12 months),
School children 5-10 years and adolescents
10-19 years.
15

16. 1
16

17. 17

18. New strategies under
RMNCH+A
18

19. NATIONAL IRON + INITIATIVE
• Continuum of care- management of anemia across all life
stages.
• Use of folic acid in planned pregnancies-3 months before
and 3 months after conception to prevent Neural tube
defect.
• For 6-60months- ASHA are key person to visit home to
provide 1 dose under direct observation and educate
mother about importance of IFA.
• IFA tablets for adolescent is colored blue- IRON KI NILI GOLI
to distinguish it from red IFA for pregnant and lactating
women.
19

20. The weekly Iron and Folic Acid
supplementation (WIFS)
• Community based intervention
• address IDA amongst adolescents( boys and
girls) for both Urban and Rural areas.
• Covers adolescent enrolled in class VI-XII of
Govt., Govt. aided and Municipal schools.
• Includes out of school girls too through
anganwadis.
20

21. Cont. Key features of WIFS
• Supervised administration of weekly IFA
• Screening of target groups for mod and severe
anemia and referral to appropriate facility
• Bi annual de worming
• IEC for improve diet and prevention of worm
infestation.
21

22. Causes of poor out come of the
program
• Poor perception of the problem by population
• Poor compliance
• Medicine supply and stock inadequate and
poor quality
• Knowledge of functionaries and beneficiaries
poor
• Evaluation system not implimented
22

23. 23