Anaemia has, for long, been recognized as a public health issue in India. To be specific, the first initiative against the disease — the National Anaemia Prophylaxis Programme — was launched as far back as in 1970. Since then, numerous programmes and initiatives for different target groups have followed.

Yet, there are information gaps in our understanding of the disease. Most national analyses have missed out on a significant section of the population: children and adolescents aged 5–14 years. There is little knowledge of the specific kinds of anaemia based on micronutrient deficiencies that affect these age-groups. Filling these gaps is an essential step in reaching the goal of alleviating the disease burden through targeted supplementation programs.

In The Lancet Child & Adolescent Health, authors report the results of their study of anaemia in a nationally representative sample of Indian children (aged 1–4 years and 5–9 years) and adolescents (aged 10–19 years) from the Comprehensive National Nutrition Survey (CNNS). This study addresses the knowledge gap regarding the distribution of different types of anaemia in India.

Notably, the prevalence of anaemia in the age group 1-4 years in this study is lower than that found through other national sources. This could be attributed to the use of different methods or fewer participants of this age bracket in the CNNS, a comment piece in The Lancet said, while still acknowledging the study’s implications for eradication programmes for anaemia.

The following infographic discusses these findings and indicates where exactly our efforts need to be directed.

Way Forward: Expanded Outreach Targeting Deficiencies

The study concludes:

• Iron deficiency anaemia is the most common form of anaemia among younger children and anaemia of other causes among 5–9-year-old children and adolescents.
• Folate or vitamin B12 deficiency anaemia accounts for more than a third of anaemia prevalence.
• Even though anaemia of inflammation was found to be the least common form, the authors suggest it could be because the children part of the study did not have any underlying illnesses - which could be contributors to anaemia.
• Anaemia prevention efforts should focus on strengthening iron and folate supplementation programmes and prevention of folate or vitamin B12 deficiency anaemia, along with haemoglobinopathy screening in high prevalence regions.
• The existing Iron and Folic Acid (IFA) supplementation programme needs strengthening with additional focus on compliance and service delivery.
• Even though the focus of India’s national programme has been on iron deficiency anaemia, anaemia by other causes would need to be addressed as well - because these individuals have adequate ferritin concentrations and may not require iron supplementation. For those with thalassaemia trait, in fact, this could lead to iron overload.
• Adolescent girls need targeted focus in the IFA supplementation programme, with an emphasis on dietary diversity and regular monitoring of their anaemia status, including ferritin concentrations.
• To know the kind of people should consume to avoid some of these deficiencies, read our previous article on iron and B12 here.

The National Nutrition Mission (Poshan Abhiyaan) was launched in 2018 to push the existing initiatives for better service delivery, an increased focus on dietary diversity and food fortification, and addressing non-nutritional causes of anaemia in endemic pockets, with a focus on malaria, haemoglobinopathies, and fluorosis, under the Anaemia Mukt Bharat strategy, the authors state.

Poshan Abhiyaan has set a target of reducing anaemia by 3% per year.