Anaemia in India

What’s in today’s article?

• Why in news?
• What is National Family Health Survey (NFHS)? 
• News Summary: India rethinking its anaemia policy
• What is Anaemia?
• India’s anaemia burden
• What prompted the change?
• Shift in assessment of anaemia in India
• Why the focus is on anaemia?

Why in news?

• Questions related to anaemia are slated to be dropped from the National Family Health Survey (NFHS-6) scheduled to begin on July 6.
• The omission comes after health experts questioned the efficacy of the method being used to estimate haemoglobin levels.

What is National Family Health Survey (NFHS)? 

• The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
• The first National Family Health Survey (NFHS-1) was conducted in 1992-93. Subsequent NFHS’ were conducted as below –
  • NFHS-2 was conducted in 1998-99
  • NFHS-3 was conducted in 2005-06
  • NFHS-4 was conducted in 2015-16
  • NFHS-5 was conducted in 2019-21
• The main objective of the NFHS has been to provide reliable and comparable data relating to health and family welfare and other emerging areas in India.
• All the rounds of NFHS have been conducted by the International Institute for Population Sciences (IIPS), Mumbai, as the national nodal agency.
• Nodal Ministry: Ministry of Health & Family Welfare

News Summary: India rethinking its anaemia policy

What is Anaemia?

• About
  • According to the World Health Organization (WHO), anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal.
  • Haemoglobin is needed to carry oxygen.
  • If there are too few red blood cells, or not enough haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues.
  • This results in symptoms such as fatigue, weakness, dizziness and shortness of breath among others.
• Factors
  • The most common nutritional cause of anaemia is iron deficiency although deficiencies in folate, vitamins B12 and A are also important causes.
  • Certain chronic diseases, such as kidney disease, liver disease, cancer, or autoimmune disorders, can interfere with the production of red blood cells.
  • Inherited conditions, such as sickle cell anemia or thalassemia, affect the structure or function of red blood cells, leading to chronic anemia.

India’s anaemia burden

• India’s anaemia burden has grown alarmingly with NFHS-5 (2019-21) finding that: 
  • 57% of women in the age group 15-49 and 
  • 67% children between six months and 59 months are anaemic (from the corresponding 53% and 58.6% respectively in NFHS-4 (2015-16)). 
• The Health Ministry has noted that anaemia is a public health challenge.

What prompted the change?

• WHO cut-offs for haemoglobin may not be suited to India
  • The WHO defines: 
    • anaemia in children aged under five years and pregnant women as a haemoglobin concentration <110 g/L at sea level, and 
    • anaemia in non-pregnant women as a haemoglobin concentration <120 g/L.
  • Experts had cautioned that there is a danger of anaemia being over-diagnosed in India as it follows WHO cut-offs for haemoglobin.
  • This may not be suited to India, because the cut-off point depends on the age, gender, physiological status, altitude and other factors.
• Differences in the way blood is drawn for sampling in NFHS
  • Various studies also pointed to differences in the way blood is drawn for sampling in NFHS. 
  • The NFHS survey measured haemoglobin in a drop of capillary blood that oozes from a finger prick. 
  • This, as per the report, can dilute the blood and give a falsely lower value. 
  • The recommended method of venous blood sampling, as per the report, gives a more accurate value.

Shift in assessment of anaemia in India

• According to the Health Ministry, assessment of anaemia in India is being shifted to the new Diet and Biomarkers Survey in India (DABS-I).
• DABS-I was launched in December 2022 to map diet, nutrition and health status and provide the correct estimate of anaemia among the rural and urban population.
• The survey will define food and nutrient adequacy by collecting individual dietary intake data of different age groups of people.
• The study will also provide nutrient composition data on cooked and uncooked foods from various regions of the country for the first time.

Why the focus is on anaemia?

• Data on anaemia remains an important indicator of public health due to following reasons:
  • Impact on morbidity and morality
    • Anaemia is related to morbidity and mortality in the population groups usually considered to be the most vulnerable — pregnant women and children under five.
  • Effect on reproductive health
    • A prevalence study on anaemia is useful to monitor the progress of reproductive health. 
  • Impact on economy
    • Also, iron-deficiency anaemia reduces the work capacity of individuals and entire populations, with serious consequences for the economy and national development.

Q1) What is reproductive health?

Reproductive health refers to the state of complete physical, mental, and social well-being in all matters relating to the reproductive system and its functions. It encompasses various aspects of human sexuality, including the ability to have a satisfying and safe sex life, the capability to reproduce, and the freedom to make informed decisions about one’s reproductive health. The concept of reproductive health goes beyond the absence of disease or infirmity and emphasizes the positive aspects of sexual and reproductive well-being.

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Q2) What is WHO?

WHO stands for the World Health Organization. It is a specialized agency of the United Nations (UN) responsible for international public health. Established in 1948, the WHO is headquartered in Geneva, Switzerland, and operates in over 150 countries. The primary goal of the WHO is to promote and protect the health of all people worldwide. It achieves this by providing leadership in global health matters, setting norms and standards, conducting research, providing technical assistance to countries, and coordinating international health initiatives.

Source: Explained | Why is India rethinking its anaemia policy? | National Family Health Survey | The Hindu | Deccan Chronicle