Prof. (Dr.) Dharmakanta Kumbhakar
(drkdharmakanta1@gmail.com)
Health depends to a large extent on a balanced diet, which maintains nutritional status. Most children and women in Assam, including Dhubri district, are deprived of a balanced diet. Moreover, today, time has become more valuable than nutrition. We eat on the run; we grab a bite; pizzas and burgers are becoming lunch options; and a junk recipe hastily put together is replacing a traditional balanced meal. Adding to this poisonous fare, pollution and adulteration are depleting the nutritive value of all food sources: vegetables, grains, milk and milk products, fish, meat, and fruits. The result is an avalanche of nutritional deficiencies, the chief among which is nutritional anaemia.
Dhubri is an administrative district in the Indian state of Assam, covering a 2176-square-kilometre area. The district headquarters of Dhubri district is Dhubri town, which is situated 290 kilometres from the state capital, Dispur. The population in Dhubri district in the year 2022 has no correct answer. The last census of Dhubri district was done in 2011, and the next census in 2021 has been postponed due to the COVID-19 pandemic. As per the 2011 Census, Dhubri district had a population of 19,49,258 (6.25% of the Assam population), of which 9,97,848 (51 percent of the total population) were male and 9,51,410 (49 percent of the total population) were female. But on the basis of population growth in Dhubri district, the projected population of Dhubri district in 2022 can be considered as 23,90,000. As per the 2011 Census, it is the second-most populous district of Assam, after Nagaon. In Dhubri, 11 percent of the population is under 6 years of age. The demography of Dhubri district is non-homogenous, with several linguistic, religious, and ethnic communities. Most of the people are of Muslim Bengali, Hindu Bengali, Koch-Rajbongshi, Goalpariya, and tea garden communities. With close to 75 percent of its population being Muslims, it is one of the most minority-concentrated districts in India. Assamese, Goalpariya, and Bengali are the major languages spoken in the district. The majority of the population of Dhubri district lives in rural areas; 90 percent lives in urban areas.
In all the districts of Assam, including Dhubri district, nutritional anaemia is classified as a major public health problem as it is widespread among children, adolescent girls, women of reproductive age, pregnant women, and lactating mothers, mirroring overall high rates of ndernutrition. The problem of nutritional anaemia is high in Dhubri district.
According to the fifth National Family Health Survey (NFHS-5) 2019–21, an estimated 73.1 percent of 6–59-month-old children in Dhubri district are anaemic Hb11.0 gm/dl). The corresponding figure in Assam is 68.4 percent (68.6 percent in rural areas and 66.4 percent in urban areas). It is 67.1 percent (68.3 percent in rural areas and 64.2 percent in urban areas) in India.
The NFHS-5 records that 65.2 percent of 15- to 19-year-old girls in Dhubri district are anaemic Hb12.0 gm/dl). The corresponding figure in Assam is 67.0 percent (67.0 percent in rural areas and 67.4 percent in urban areas). It is 59.1 percent (60.2 percent in rural areas and 56.5 percent in urban areas) in India.
The NFHS-5 records that 63.2 percent of all women of reproductive age (15–49 years) (Hb12.0 g/dl), 63.0 percent of non-pregnant women in the 15–49 age group (Hb12.0 g/dl), and 69.7 percent of pregnant women in the 15–49 age group (Hb11.0 g/dl) are anaemic in Dhubri district. The corresponding figure in Assam is 65.9 percent (66.0 percent in rural areas and 65.2 percent in urban areas) for all women of reproductive age (15-49 years), 66.4 percent (66.4 percent in rural areas and 66.0 percent in urban areas) for non-pregnant women in the 15-49 age group, and 54.2 percent (55.9 percent in rural areas and 41.4 percent in urban areas) for pregnant women in the 15-49 age group. It is 57.0 percent (58.5 percent in rural areas and 53.8 percent in urban areas) for all women of reproductive age (15-49 years), 57.2 percent (58.7 percent in rural areas and 54.1 percent in urban areas) for non-pregnant women in the 15-49 age group, and 52.2 percent (54.3 percent in rural areas and 45.7 percent in urban areas) for pregnant women in the 15-49 age group in India. Almost all of them suffer from nutritional anaemia.
The most common type of nutritional anaemia in Dhubri district is iron deficiency anaemia and less frequently folic acid and vitamin B12 deficiency anaemia due to low dietary intake of iron, folic acid, and vitamin B12, improper absorption of iron, folic acid, and vitamin B12, increased demand for iron and folic acid during pregnancy and lactation, and other related causes such as hookworm infestation. Iron deficiency anaemia occurs when iron stores in the body are depleted and haemoglobin synthesis is inhibited. Folic acid or vitamin B12 deficiency is implicated in the aetiology of nutritional anaemia, as these are needed for the formation and growth of red blood cells.
Anaemia is a reduction in the oxygen-transporting capacity of blood from the lungs to different tissues and organs of the body due to a fall in haemoglobin concentration in the red blood cell mass to below-normal amounts. Anaemia can lead to reduced productivity, increased susceptibility to infections, and a slow recovery from illnesses. Nutritional anaemia affects the health of children, adolescent girls, women of reproductive age, and pregnant women. Nutritional anaemia in children can result in impaired cognitive performance, behavioural and loco-motor development, coordination, language development, and scholastic achievement, thereby severely implicating human development and increasing morbidity from infectious diseases. Adolescent girls need extra iron and folic acid for physiological and biological changes associated with age to prepare them for childbearing in due course. Extra iron and folic acid are also needed to reduce nutritional anaemia in older women of reproductive age. The incidence of nutritional anaemia in adolescent girls and women can result in weakness, diminished physical and mental capacity, and increased morbidity from infectious diseases. Most children, adolescent girls, women of reproductive age, pregnant women, and lactating mothers in Dhubri district are vulnerable to these adverse consequences of nutritional anaemia, as it is most prevalent in the district. In pregnant women, nutritional anaemia may become the underlying cause of premature delivery, low birth weights, maternal mortality, perinatal mortality, and infant mortality. Forty percent of all maternal and perinatal deaths in Dhubri district are linked to nutritional anaemia, especially iron deficiency anaemia.
Under the National Anaemia Control Programme, the Dhubri district authority has been providing free iron and folic acid (IFA) supplements to pregnant women, lactating mothers, adolescent girls, and children to prevent nutritional anaemia and its adverse consequences, for the last two decades. The Central Government and State Government often run special drives to make India and Assam nutritionally anaemia-free. As a part of the government programmeme, the Dhubri district authority also runs such a programmeme to make Dhubri district nutritionally Despite the measures taken by the district authority, there has been no decline in the prevalence and adverse consequences of nutritional anaemia in the district, and to date, it is a major public health problem in the district.
The coverage under IFA supplementation is low in Dhubri district as the majority of pregnant women don’t receive IFA tablets always; only one-third of those who receive the tablets take them regularly, and less than 10 percent take more than 90 tablets of IFA during pregnancy. There has been poor access to and intake of IFA syrup by children, inadequate training of frontline health workers, and inadequate counselling of mothers. The free distribution of IFA tablets among schoolchildren in the district is also poor.
Therefore, redressing nutritional anaemia among the vulnerable groups in Dhubri district requires urgent attention. The anaemia control programme needs to be implemented more efficiently in the district. New innovative strategies are the need of the hour to make IFA readily available, as well as a mechanism to motivate the vulnerable groups of the district to regularly take IFA supplements. The low compliance with IFA supplementation is particularly due to the side effects associated with IFA preparations. Taking IFA preparations on an empty stomach can cause gastritis, abdominal cramps, vomiting, and the passage of black stool. The good news is that a combined food and IFA supplementation programme would be most effective to address nutritional anaemia in Dhubri district.
But only a free IFA supplementation programme can eradicate nutritional anaemia in Dhubri district. This can be done with awareness, a balanced diet, and proper supplementation. Important steps along with IFA supplementation to deal with this major public health problem may be dietary diversification, ensuring inclusion of iron-folate-vitamin B12-rich foods, inclusion of food items that promote iron absorption, food fortification with iron and folic acid, screening for early detection of nutritional anaemia among vulnerable groups, appropriate management of nutritional anaemia, providing proper antenatal services, preferably a doctor, a and distribution of free commodities like rice and dal on each antenatal visit with a cash award. The Dhubri district authority should provide nutritional support to meet the recommended dietary allowances for vulnerable groups through Anganwadi programmes. In the district, an integrated programme for hookworm eradication and proper sanitation, among other things, must be properly implemented.