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Does India Know Anaemia Is Running Amok in the Country?

Does India Know Anaemia Is Running Amok in the Country?

Peripheral blood film of a patient with iron deficiency anaemia. Image: E. Uthman, MD/Wikimedia Commons, CC BY-SA 2.0.

India has been grappling with the issue of anaemia and its outsized impact on disease and death in the population, affecting almost all age groups in the country. In the global context, the burden of anaemia is huge within the subcontinent. Anaemia is known to have debilitating consequences for health and productivity, further increasing the financial burden.

The recently published NFHS-5 report has key findings for 22 states and UTs. Compared to the fourth round of the National Family Health Survey (2015-16), evidence from the latest NFHS-5 (2019-20) data has been more of a setback, with anaemia prevalence rates having jumped up across many groups (i.e., children, pregnant and non-pregnant women, and men) and in many states.

Numbers from the NFHS-5 report indicate that prevalence of anaemia has significantly increased in Maharashtra, relative to what it was in the 2015-2016 National Family Health Survey. Apart from a slight decline in prevalence (49.3% to 45.7%) among pregnant women of reproductive age, there has been a considerable increase in other groups.

Anaemia among children (aged 6-59 months) increased from 53.8% to 68.9% within the last five years, i.e. between NFHS-4 and NFHS-5. Similar jumps of 49.7% to 57.2% among adolescent women (aged 15-19 years) and 47.9% to 54.5% among non-pregnant women of reproductive age were found. There were increases in the prevalence of anaemia within the male population as well.

These facts are alarming and crudely show that programmatic efforts seem to be of little help, and only to pregnant women.

Moving on, we see that Maharashtra is in dire straits. Among women of reproductive age (15-49 years), anaemia’s prevalence has shot up in all districts in the state except in Mumbai, Mumbai Suburban, Ratnagiri, Sangali and Sindhudurg, which have reported a marginal decrease. The increase is greater than 10% in Akola, Bhandara, Bid, Gadchiroli, Jalgaon, Jalna, Latur, Osmanabad, Parbhani, Wardha and Washim.

More than 60% of all women aged 15-49 years are anaemic in the districts of Gadchiroli, Bhandara, Jalgaon, Nandurbar, Dhule, and Wardha. The prevalence rates were found to be more than 50% even in the more urbanised districts like Thane, Mumbai Suburban, Nashik and Pune.

Even though anaemia rates during pregnancy at the state-level showed little improvement, the districts of Nashik, Dhule, Nandurbar, Bhandara and Raigad reported more than 60% of its pregnant women to be anaemic. According to the data, there were fewer reports of anaemia in Maharashtra’s districts among pregnant women aged 15-49 years than among non-pregnant women in the same age group. This could be the result of iron-folic acid tablets distributed to expecting women.

The highest prevalence of anaemia among non-pregnant women was found in the northern and eastern districts of Maharashtra. The most affected are Gadchiroli, Bhandara, Jalgaon and Nandurbar, whereas the least affected include Ratnagiri and Sindhudurg.

Anaemia prevalence among children aged 6-59 months reveal a starker picture of the severity of the issue at hand. Some districts have reported more than 75% of their children population to be fighting anaemia. Anaemia rates in Akola, Amravati, Aurangabad, Bhandara, Hingoli, Jalgaon, Kolhapur, Nagpur, Nanded, Osmanabad, Parbhani and Wardha have increased by more than 20% in almost half a decade. And apart from Mumbai Suburban, not a single district has reported improvements in anaemia rates among children.

Jalgaon is the most affected district in the state, with an alarming 85% prevalence of anaemia among its children population. The lowest prevalence of 55% – which is still high – was reported from Sindhudurg.

That Maharashtra ranks 15th among India’s states in the Human Development Index is grossly at odds with its vulnerability to anaemia. Nutritional deficiency is the most common cause of anaemia in India, and distribution of iron supplements seems to be the most effective remedy, especially to treat the disease among pregnant women and children. However, other causes, such as infections and genetic blood disorders, are also common, and iron supplements could worsen one’s health in such cases.

While the burden of severe anaemia has been becoming lighter, anaemia as such continues to be rampant in India. The most well-known reasons for this state include lack of political commitment, poor coverage, gaps in meeting the needs of intended beneficiaries, and lack of greater awareness. Apart from these issues, we also need policies and interventions that account for geography, socio-economic gradients, level of epidemiological transition and other developmental indicators.

The National Nutrition Mission, or POSHAN Abhiyaan, that the Centre launched in 2018 aims to reduce anaemia by 9% before 2022. This is a very modest target, compared to the World Health Assembly’s goal of cutting anaemia prevalence rates by half (among women of reproductive age) – and reflects the government’s conservative attitude.

The coronavirus pandemic has likely only exacerbated the situation, deepening poverty and hunger and increasing the risk of contracting other diseases.

Mahadev Bramhankar is a research scholar and Rachel Gaikwad is a research graduate – both at the International Institute for Population Sciences, Mumbai.

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