Nutritional anaemia: A major health problem in Assam

Prof. (Dr.) Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com)

Health depends to a large extent on a balanced diet, which maintains nutritional status. Most poor people in Assam 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.

In Assam, nutritional anaemia is a major public health problem as it is widespread among children, adolescent girls and boys, women of reproductive age, pregnant women, and lactating mothers. According to the fifth National Family Health Survey (NFHS-5) 2019–20, an estimated 68.4 percent (66.4 percent in urban areas and 68.6 percent in rural areas) of 6–59-month-old children in Assam are anaemic. Approximately 67.0 percent (67.4 percent in urban areas and 67.0 percent in rural areas) of 15- to 19-year-old girls and 39.6 percent (34.6 percent in urban areas and 40.4 percent in rural areas) of 15- to 19-year-old boys are anaemic. The NFHS-5 records that 65.9 percent (65.2 percent in urban areas and 66.0 percent in rural areas) of all women of reproductive age (15–49 years), 66.4 percent (66.0 percent in urban areas and 66.4 percent in rural areas) of non-pregnant women in the 15–49 age group, and 54.2 percent (41.4 percent in urban areas and 55.9 percent in rural areas) of pregnant women in the 15–49 age group are anaemic. Almost all of them suffer from nutritional anaemia. The NFHS-5 also records that 36.0 percent (27.6 percent in urban areas and 37.5 percent in rural areas) of older adult men in the 15–49 age group suffer from nutritional anaemia. These figures are high in the districts with tea gardens, indicating that nutritional anaemia is worse among the tea garden population than others.

The most common type of nutritional anaemia in Assam 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. 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 and boys, women of reproductive age, pregnant women, and lactating mothers in Assam are vulnerable to these adverse consequences of nutritional anaemia. 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 Assam are linked to nutritional anaemia, especially iron deficiency anaemia. Nutritional anaemia in adult men decreases the productivity and per capita income of the State.

Under the National Anaemia Control Programme, the Assam Government 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. They often run some special drives to make Assam nutritionally anaemia-free. Still, there is no decline in the prevalence and adverse consequences of nutritional anaemia in Assam.

The coverage under IFA supplementation is low in Assam, as the majority of pregnant women don’t always receive IFA tablets; 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.

Therefore, redressing nutritional anaemia among the vulnerable groups in the State requires urgent attention. The anaemia control programme needs to be implemented more efficiently in Assam. New innovative strategies are the need of the hour to make IFA readily available as well as provide the mechanism to motivate vulnerable groups 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 Assam.

But only a free IFA supplementation programme can eradicate nutritional anaemia in Assam. 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, and appropriate management of nutritional anaemia. The Government should provide nutritional support to meet the recommended dietary allowances for vulnerable groups through Anganwadi programmes. An integrated programme for hookworm eradication, proper sanitation, etc. must be properly implemented.