Hari Dev JJ

WHO DEFINITION

• A condition in which the haemoglobin content of blood is lower than normal as a result of deficiency of one or more essential nutrients regardless of the cause of such deficiency

WHO cut off points for diagnosis of Nutritional Anemia

Haemoglobin [ g/dl] MCHC [ per cent]

Adult males 13 34

Adult females, non pregnant

12 34

Adult females , pregnant 11 34

Children, 6 months to 6 years

11 34

Children, 6-14 years 12 34

Causes of Anaemia• Most frequent cause – Iron deficiency other causes - Folate deficiency Vitamin B12 deficiency

• Groups mainly affected Women of child bearing age [ 4-12 percent in

India ] Young children During pregnancy [ 2/3 of pregnant woman and ½ of

non pregnant woman in developing countries]

During lactation

• Prevalence of anaemia in adolescent girls is very high [ 72.6%]

PATHOGENESIS

• Inadequate intake • Poor bioavailability of dietary iron [ impt.]• Excessive losses of iron from body.

[ menstruation , malaria , hook worm infestations]

• Megaloblastic anaemia – poor socioeconomic groups.

Detrimental Effects

• During pregnancy- abortions, premature births, PPH, LBW babies, increased maternal and foetal mortality and morbidity.

• Infection - can be caused or be aggravated by diseases, increase susceptibility to infection

• Work capacity – great reduction in work performance

• Hb Less than 10g/dl – SEVERE – High dose of iron or blood transfusion. - REFERRAL

• If Hb 10 – 12 g/dl

Iron and folic acid supplementation Iron fortification Other strategies

1.Iron and Folic Acid supplementationNational Nutritional Anaemia Prophylaxis Programme

• Launched during 4th five year plan-1970

• Programme is based on daily supplementation with iron,folic acid –to prevent mild, moderate cases of anaemia, to double the quantity if pallor (+)

• Beneficiaries – pregnant women , lactating mothers and children under 12 years

• DOSAGE

1.CHILDREN [ 6m – 5yrs]• If suspected , screening test done at 6

months, 1 year , 2 years.• 20mg iron + 100mcg FA X 100 days

• Liquid formulation – 1ml at a time

2. SCHOOL CHILDREN 6 – 10 yrs

• 30mg iron + 250 mcg FA X 100 days

3. ADULT & Adolescents

• 100mg iron + 500 mcg FA X 100 days

4. MOTHERS

• 100mg elemental Fe + 500 mcg FA daily until 2-3 months after the Hb level has returned to normal.

2.Iron Fortification• Developed by National Institute of Nutrition,

Hyderabad

• Addition of ferric ortho phoshapte or ferrous sulphate with sodium bisulphate was enough to fortify salt with iron.

• When consumed for 12-18 months – reduce prevalence of anaemia.

• Commercial production since 1985.

3.Other Strategies

• Changing dietary habits

• Control of parasites

• Nutrition education