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
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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…
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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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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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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…