India’s great anaemia mystery

What is Anaemia?

• The WHO defines anaemia as a condition in which the number of red blood cells or the concentration of haemoglobin within them is lower than normal. This compromises immunity and impedes cognitive development.
• More than half of all women and children in India are anaemic, and that number has increased in the last three years. Between 2005 and 2015, anaemia decreased in India, albeit marginally.
• But recent data from the National Family Health Survey (NFHS-5) shows a reversal of those gains: Anaemia rates increased from 53% to 57% in women and from 58% to 67% in children in 2019-21.

What could be causing this dire result?

• The breadth of the NFHS survey allows us to investigate factors traditionally used to explain the prevalence of micronutrient outcomes such as anaemia.
• Grain-focused diets, with relatively lower consumption of iron-rich food groups such as meat, fish, eggs, and dark green leafy vegetables (DGLF), may be associated with higher levels of anaemia.
• However, the percentages of children and women consuming iron-rich food groups have increased from NFHS-4 to NFHS-5.
• High levels of anaemia are also often associated with underlying factors such as poor water quality and sanitation conditions that can negatively affect iron absorption in the body.
  • However, both factors improved from NFHS-4 to NFHS-5. The percentage of the population living in households using improved sanitation facilities increased from 48.5% to 70.2%, while the percentage of households with access to improved sources of drinking water improved from 94.4% to 95, 9%.
• Women’s empowerment is another factor that can play an important role in determining the quantity and quality of food intake within the household.
  • Women’s ownership of assets (such as land or a house), the ability to make decisions about the use of income, access to resources such as savings or credit, and participation in key household decisions can translate into increased awareness of and access to diverse, nutritious diets.
  • But women’s empowerment in such domains has also improved from NFHS-4 to NFHS-5, suggesting that women’s decision-making alone cannot explain the increase in anaemia.
• Finally, the provision of health and nutrition interventions plays an important role in the prevalence of anaemia.
  • But women’s folic acid intake during pregnancy and access to prenatal care has improved in the last five years. It is surprising, then, how anaemia rates have increased not only in mothers but also in children under the age of five.
• The NFHS anaemia data is an anomaly for several reasons.

It is also pertinent to invest in a better understanding of the various causes behind this increase in anaemia. At a minimum, we should go beyond haemoglobin to include other iron-specific biomarkers, such as serum ferritin, as well as markers of inflammation, to identify the role of iron deficiency as a driver of anaemia.

Conclusion:

• Rising numbers of anaemia make it almost impossible to meet the targets of the Anaemia Mukta Bharat programme: a reduction of 3% per year in all age groups from 2015-16 to 2022.
• India is also behind in achieving the global nutrition target for anaemia in women of reproductive age: a 50 percent decrease from the 2012 baseline by 2030.
• Thus, need of the hour is for rigorous research and informed policymaking that engages diverse stakeholders such as public health professionals, program implementers, policymakers, and other experts in this field. The data on anaemia tells us that something has gone wrong. It is critical that we find out what has changed and move quickly to address it.

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Source:  Indian Express