Anemia as a public health problem Adolescent Girls’ Anemia Control Program Baroda Experience and...

Anemia as a public health problemAdolescent Girls’ Anemia Control Program

Baroda Experience and Scaling up

For Nutrition WorkshopPrakash V Kotecha

Department of Preventive Social Medicine Medical College Vadodara, Gujarat, India

Technical Support : UNICEF Gujarat

13th May 2005 Kotecha

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Iron Deficiency

Iron deficiency is the most common nutritional disorder in the world. 4-5 billion people (66-80%) of the global population is iron deficit.

2 Billion anemic people (30% of global population) in the world are anemic

ID affects more people than any other condition in the world.. And remains silent despite severe consequences than other common conditions…


3Population, anemia prevalence in risk groups, and death and disability attributable to iron-deficiency anemia in the world

and in selected developing regions of the world

Source: Stoltzfus et ali. DALY = disability-adjusted life yearii. Excluding Egypt, Morocco, Somalia, Sudan and

Tunisiaiii. Excluding Cuba iv. Afghanistan, Djibouti, Egypt,Iraq,Morocco,

Pakistan, Somalia, Sudan, Yemen

Region Population(Thousands)

Anemia Prevalence Burden attributable to iron deficiency (thousands)

Women Men Children Deaths DALYs(i)

Africa(ii) 639,593 41% 28%

60% 271 10,140

Latin America (iii) 502,162 23% 11%

46% 33 1,249

Eastern Mediterranean (iv)

481,635 44% 17%

63% 80 3,195

Southeast Asia – I (v) 293,819 49% 32%

49% 34 1,528

Southeast Asia – II (vi)

1,241,806 60% 36%

66% 324 12,497

North America (vii) 325,183 8% 5% 7% 5 478

World 6,045,183 - - 841 35,057

GBD 2000 WHO estimates:Southeast Asia contributes 1/5th of the

population; But contributes to more than 40% of the deaths due to anaemia and

almost 1/3rd of the DALY lost due to anaemia!

v. Indonesia, Srilanka, Thailand (I)vi. Bandladesh, Bhutan, Democratic People’s Republic of

Korea, India, Maldives, Myanmar, Nepal (II)vii. Including Cubaviii. Because anemia cutoffs are defined as the 5th percentile of

normative distribution, this represents the theoretical minimum population prevalence of anemia


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Prevalence of Anemia in Children NFHS II

45.9

5.4

74.3

22.9

0

10

20

30

40

50

60

70

80

Anemia

Perc

enta

ge(%

)

Total Mild Moderate Severe

Large proportion anemiaMore than 2/3 of them are

moderate to severe


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Prevalence of Anemia in Women ICMR Mutli Centric Districts Study

60.1

13.1

84.9

11.8

0

10

20

30

40

50

60

70

80

90

Anemia

Perc

enta

ge(%

)

Total Mild Moderate Severe

Large proportion anemiaMore than 5/6 of them are

moderate to severe


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Anemia Control strategy Position Magnitude of the problem and its effects are

well appreciated in the programs…..! #Tenth five year plan 2002-2007 goal

To reduce prevalence of anemia by 25% and moderate and severe anemia by 50% in children, pregnant and lactating women and adolescents!

Screening of children for anemia whenever required and appropriate treatment of those found anemic!

Universal screening of pregnant women for anemia and appropriate treatment!

#Tenth Five Year Plan: Volume II Sectoral policies and Programs: Nutrition


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So what should we do?

Not just know anemia but UNDERSTAND anemia, its wide spread consequences in the field much beyond health

Effectively communicate that to those who DECIDE POLICY AND ALLOCATE RESOURCES

Come with technically sound, practically feasible and realistically targeted program


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Why Anemia Control?

Reduction of anemia means More School attendance Better Learning More capacity to work and increased

productivity More income for individual and country Less expenses and need for health care Ability for care for self and others

improved Quality of life improves….


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Why Anemia Control?

The World Health Organizations (WHO) 2002 Report titled “Preventing Risk, Promoting

Healthy Life”, mentioned iron deficiency as the 9th of 26 preventable risks to disease disability and death in the world today

It is social and economic scourge and not a medical problem…


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Gujarat Experience


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Why Adolescent Girls?

Anemia in pregnancy has not been controlled ever….and anywhere….

Quality of life matters…. Adolescent age group is 1/6th of the

total population and important one… Half of them adolescent girls: 40% marriage by age of 18 years

among all married women including young women (MICS 1999, 2001)


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Background for the Project

Baseline prevalence of anemia 75% in adolescent school girls

Similar among rural, tribal and urban areas

Readiness to take IFA tablets to 98% level

Technical and Administrative Assistance available

All 426 schools covered under the program

Department of

Education

Department of Health & Family WelfareUNICEF Gujarat

(Technical & Financial Help)

Medical College VadodaraProject Support unit

(Technical Guidance and Documentation)

Vadodara DistrictDistrict Education

officer

Regional Deputy Director Health &Chief District Health Officer

Medical Officer of Health

V. M.Corporation

193Rural

Schools

177Urban

Schools

56TribalSchool

s

426Total

Schools

Education Inspectors

MOsPHCs

MOsVMC

More than 4000 Teachers

Beneficiaries in the schoolsMore than 65000 Adolescent

Girls

Adolescent Anemia Control

Program

Indian Medical

Association

Association Of

Teachers and

Principal


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State Ministers Health, Education & UNICEF Chief Inaugurating


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Project Inputs

Once a week supervised IFA tablet IEC for girls, teachers and parents Training & Logistics – Monitoring-

Individual, Class (weekly), School SVS District level


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1.6

39.7

74.757.1

16.7

7.9

21.6

35.6

53.2

0.50

10

20

30

40

50

60

70

80

70 100 110 115 120

Hemoglobin gm/L

Cum

ulat

ive

Perc

enta

ge

Before After

Prevalence of Anemia at Different Hb. Cut off Points Before and After

Intervention


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Positive Lessons

Easy, doable and successful program. Replicable and effective to control anemia

Effective in reducing anemia by 20% with improvement in hemoglobin for 82% of girls in 17 months of the intervention period

Compliance for the schoolgirls to went up to 90%.... In 2003 in Vadodara district.

Kotecha


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Progress based on Vadodara Project lessons

Program extended to ALL 25 districts, owned by education and health department of Government of Gujarat jointly and supported by UNICEF (16 districts) and MI (9 districts)

Currently covers over one million adolescent girls in the schools

Internalized with education and health program with minimum extra input


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Monitoring

Education Schools to QDC and SVS DEO State

Health Schools PHC/SC CDHO/RCHO State

Beneficiaries want and ask for this program: We need to ensure that implementers to

implement…


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Vital Keys for Future Key for success is commitment and

monitoring by District and State authorities (DDO can help tremendously here with their team members DEO and CDHO)

State Offices for Education and Health need to emphasize the importance of monitoring and request regular reports and a discussion and follow up on the monitoring


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Key to success are District Authorities

Please ensure monitoring Please ensure joint review of monitoring

reports and corrective actions for regularity and necessary feed back….

Health and education and WCD need to be partners at district level with strong linkages…

These linkages will come from whole hearted commitment and follow up at state level authorities…GO & NGO


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Out of school girls… Out of school girls are about 70% of

adolescent girls and they are not effectively covered…

Reach “Out of school girls” through ICDS, Panchayat, NGO etc. Through ICDS AWW by involving them

in urban area. Over 10,000 girls covered under urban

areas…staring in rural areas too.. KSY is ensuring larger coverage…


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Thank You..

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