NUTRITIONAL

ANEMIA
 Introduction
• Anemia is a major global problem.
• The disease is of particular significance in
preschooler  (3-5 years of age), and pregnant
women because of the high prevalence and the
adverse functional consequences.
• In school children anemia impairs scholastic
performance and in young women, the
reproductive performance.
• Anemia is also directly and indirectly
responsible for of maternal deaths, high
incidence of premature births and intrauterine
malnutrition.
 Introduction
The term ‘nutritional anemia’ encompasses all
pathological conditions in which the blood
hemoglobin concentration drops to an abnormally
low level, due to a deficiency in one or several
nutrients. The main nutrients involved in the
synthesis of hemoglobin are iron, folic acid, and
vitamin B12.
Iron Deficiency
Iron deficiency (ID)is defined by an abnormal
iron biochemistry with or without the presence
of anemia. Iron deficiency is usually the result of
inadequate bioavailable dietary iron, increased
iron requirement during rapid growth, and
increased blood loss for any reason
RDA of Iron
(2022)
Anemia is defined as reduction in the
haemoglobin (Hb) level in circulation. WHO
defines anaemia in children aged under 5 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.
Anemia, when caused by severe iron deficiency is termed as
Iron-deficiency anemia (IDA). The table shows the World
Health Organization defined criteria for anemia cut off as
measured by the hemoglobin.
The Hb cut-off for mild anaemia in Asians was lower at 11.22
g/dl.
Iron Metabolism and its Importance
• The total iron level in an adult man is 3.5 – 4 g.
• A major portion (73%) of the body's iron is normally incorporated into
hemoglobin, 12% is in the storage complexes as ferritin and hemosiderin,
and 15% is incorporated into a variety of other iron-containing
compounds, some of them enzymes of vital importance.
• The heme iron compounds include myoglobin, cytochromes, catalases, and
peroxidases.
• Infants and young children are the most adversely affected by iron
deficiency due to high growth rate
• If iron deficiency is not corrected, it leads to anemia and is associated with
an impaired development of mental and physical coordination.
• Once afflicted, this impairment is not eradicated even after the anemia has
been treated, impairing school achievement in older children.
 Classification
Anemia can be classified from three points of view:
1) Pathogenesis
2) Red cell morphology
3) Clinical presentation.

PATHOGENIC CLASSIFICATION:
Pathogenic mechanisms involved in the production of anemia are very simple:
inadequate production and loss of erythrocytes a result of bleeding or hemolysis.
Based on the same, It can be divided into two types.

1. Hypo-regenerative: decreased blood production ; lack of nutrients (iron,

vitamin B12 or folic acid); defective marrow function or marrow infiltration
2. Regenerative: Here marrow is normal and it responds appropriately to
anemia by increasing production of erythrocytes.
 Classification
CLINICAL PRESENTATION:
• Anemia is classified into acute anemia and chronic anemia.
• Acute anemia is predominantly due to acute blood loss or acute
hemolysis. Chronic anemia is more common and is secondary to
multiple causes.

• The etiology of chronic anemia is based on mean corpuscular volume

(MCV). (MCV is the average size of RBC)

• Anemia of chronic disease is mostly normocytic but can be microcytic

too. Hemolytic anemia can cause either macrocytic or normocytic
anemia.
 Classification
MORPHOLOGICAL CLASSIFICATION:
 Microcytic anemia (MCV less than 80 femtoliters [fL])
• Iron deficiency anemia: Most common cause of anemia
• Thalassemia
• Anemia of chronic disease
• Sideroblastic anemia
 Macrocytic Anemia (MCV greater than 100 fL)
• Vitamin B12 and folic acid deficiency
• Alcoholism and liver disease
• Drug-induced
• Hypothyroidism
 Normocytic anemia (MCV 80 to 100 fL)
• Bone marrow suppression
• Anemia of chronic disease
Erythropoiesis
Red blood cells are produced in bone marrow with the help of nutrients (iron,
B12, folic acid) etc. Once RBCs are released into the blood, they have a lifespan
of about 110 to 120 days. Approximately 1% of RBCs are removed every day
from the circulation. Under normal conditions, there is a balance between the
number of RBCs released into circulation by the bone marrow to the number
removed from circulation.
Imbalance of production and release by the bone marrow to loss of RBC
leads to anemia as below.

 Decreased Red Blood Cell Production

• Lack of nutrients (malnutrition and malabsorption)

• Bone marrow problems (suppression and lack of RBC precursors)
• Lack of hormones (CKD, hypothyroidism)
• Ineffective erythropoiesis (defective RBC production)
• Increased Red Blood Cell Destruction (Hemolytic Anemia)

CKD- Chronic Kidney Disease

 Inherited hemolytic anemia  Blood Loss
• Sickle cell anemia • Gastrointestinal
• Thalassemia • Menstrual cycles (menorrhagia)
• Pyruvate kinase deficiency • Surgery
• Acquired hemolytic anemia • Trauma
• Some conditions can cause anemia by
 Immune hemolytic anemia over one mechanism (two or even all
• Mechanical hemolytic anemia the three mechanisms).
• Paroxysmal nocturnal hemoglobinuria

• Paroxysmal nocturnal hemoglobinuria: (PNH) is a rare, acquired, life-threatening disease of the
blood. The disease is characterized by destruction of red blood cells, blood clots, and impaired
bone marrow function.
• Sideroblastic anemia: anemia from lack of red blood cells and too much iron in your system
because your body's not making use of iron in your red blood cells.
 Megaloblastic Anemia
 Encompasses a heterogeneous group of
macrocytic anemia
 Characterized by the presence of large
red blood cell precursors called
megaloblasts in the bone marrow.
 This leads to an asynchronous
maturation between the nucleus and
cytoplasm of erythroblasts, explaining
the large size of the megaloblasts.
 The process affects hematopoiesis as
well as rapidly renewing tissues such
as gastrointestinal cells.
 Megaloblastic Anemia
 Megaloblastic anemia is most often due to hypovitaminosis, specifically
vitamin B12 (cobalamin) and folate deficiencies, which are necessary for the
synthesis of DNA.
 Copper deficiency and adverse drug reactions (due to drug interference
with DNA synthesis) are other well-known causes of megaloblastic anemia.
 A rare hereditary disorder known as thiamine-responsive megaloblastic
anemia syndrome (TRMA) is also identified as a cause of megaloblastic
anemia.
 The list of drugs associated with the disease is long however, frequently
implicated agents include hydroxyurea, chemotherapeutic agents,
anticonvulsants, and antiretroviral therapy (ART) drugs.
 Causes of megaloblastic anemia
• Cobalamin deficiency disturbed, scurvy and kwashiorkor
• Poor diet • Physiologic: pregnancy and lactation,
• Deficiency of intrinsic factor prematurity
• Pernicious anemia • Pathologic: Hematologic diseases
• Insufficient pancreatic protease activity • Inflammatory disease
• Inactivation enzyme • Metabolic disease
• Competition for cobalamin • Excess urinary loss
• Alteration of ileal mucosa • Malabsorption
• Surgical resection or by-pass • Anti-folate drugs
• Celiac disease, Tuberculosis • Congenital abnormalities of folate
• Induced by drugs metabolism
• Urinary losses (congestive heart failure) • Combined deficit of folate and cobalamin
• Folate deficiency • Congenital disorder of DNA synthesis
• Old age, infancy, poverty, alcoholism, • Anti-folate
chronic invalids, psychiatrically
 Pernicious Anemia
 PA is megaloblastic anemia that results from
a deficiency in cobalamin (vitamin B12) due
to a deficit of intrinsic factor (IF).
 Intrinsic factor is a glycoprotein that binds
cobalamin and therefore enables its
absorption at the terminal ileum.
 The disease is often described as an
autoimmune disorder due to the findings of
gastric autoantibodies directed against both
IF and parietal cells.
 PA also correlates with other autoimmune
diseases and as well as genetic diseases.
 The diagnosis is problematic secondary to
the restricted availability of diagnostic tools.
 Pernicious Anemia
• Symptoms may include
 Fatigue
 Pallor
 Paresthesia
 Incontinence
 Psychosis
 and generalized weakness

 Treatment aims at the repletion of therapeutic doses of vitamin B12 either

through intramuscular injections or oral supplementation.
 When the disease remains undiagnosed and untreated for an extended period, it
may lead to neurological complications and even fatal anemia.

Paresthesia: an abnormal sensation, typically tingling or pricking (‘pins and needles’), caused
chiefly by pressure on or damage to peripheral nerves.
 Sickle Cell Anemia
• In this, red blood cells are crescent- or “sickle”-
shaped.
• These cells do not bend or move easily and can
block blood flow to the rest of your body.
• Thus can lead to serious problems, including
stroke, eye problems, infections, and episodes of
pain called pain crises.
• A blood and bone marrow transplant is
currently the only cure for sickle cell disease,
but there are effective treatments that can
reduce symptoms and prolong life Sickle Cell Anemia at 40x
Magnification
A variety of factors contribute to Iron
deficiency
 Iron Intake and Absorption:
• the availability of iron from cereal and legume based diets is very poor
• phytates and tannins inhibit iron absorption
• deficiencies of ascorbic acid, calcium and protein lower iron absorption
• Absorption of 10 % of dietary iron maintain iron balance studies indicate
that only 3-5 % of dietary iron is absorbed in a normal healthy individual.
• factors which may influence iron absorption in pregnancy are:
A. Increased erythropoiesis resulting in increased hemoglobin mass and
decreased iron stores due to increased demands in the later half of pregnancy
B. endocrine factors.
• While an increase in erythropoietin levels may enhance iron absorption,
estrogen has been found to impair erythropoietin synthesis.

 Iron stores and Iron Loss

• Iron losses during menstruation (15-30 mg /cycle)
• Excessive sweating in tropical climate, gastro-intestinal bleeding due to
peptic ulcer or haemorrhoids.
• Most women enter pregnancy with little or no iron reserve.
• In rural areas, postpartum hemorrhage on account of poor obstetric care
• Repeated and closely spaced pregnancies and prolonged periods of
lactation
• Resurgence of malaria is resulting in high incidence of anaemia.
• In women using intrauterine contraceptive device, menorrhagia
(increased blood loss) may result in further depletion of already poor
stores of iron.

 Increased Demands
• Demand for iron is substantially increased during pregnancy and growth.
• The demand for iron during pregnancy arises from the need for
a) basal iron requirement 280 mg
b) expansion of red cell mass 570 mg
c) transfer to foetus 200-370 mg
d) iron content of placenta and cord 34-170 mg
e) blood loss at delivery 100-250 mg.
 Increased Demands
• Overall 500-600 mg of additional iron is required during entire pregnancy
• Daily requirement of 4-6 mg of absorbed iron
• Twin pregnancy tends to further increase the requirement of iron.
• Exclusive breast-feeding over 6 months may result in loss of another 100-
180 mg of iron.
• Rapid growth during infancy and childhood increases iron requirement.
• Since most infants are born with poor reserves and are solely breastfed
for prolonged periods of time, iron deficiency in them gets aggravated.
Also during weaning the food provided for the infant is deficient in most
of the nutrients including iron.
• Unhygienic feeding practices leading to repeated diarrhoea can result in
malabsorption.
• Worm infestations especially round worms in children and hook worms in
adults result in iron losses and malabsorption of iron.
 INVESTIGATIONS FOR DIAGNOSIS OF
ANAEMIA
 A thorough history and physical must be performed.
Some important questions to obtain in a history:
• Obvious bleeding- per rectum or heavy menstrual bleeding, black tarry stools,
hemorrhoids
• Thorough dietary history
• Consumption of nonfood substances
• Bulky or fatty stools with foul odor to suggest malabsorption
• Thorough surgical history, with a concentration on abdominal and gastric surgeries
• Family history of hemoglobinopathies, cancer, bleeding disorders
• Careful attention to the medications taken daily
 INVESTIGATIONS FOR DIAGNOSIS OF
ANAEMIA
 Symptoms of anemia
Classically depends on the rate of blood loss.
Symptoms usually include the following:
• Weakness
• Tiredness
• Lethargy
• Restless legs
• Shortness of breath, especially on exertion
• Chest pain and reduced exercise tolerance-
with more severe anemia
• Pica- desire to eat unusual and nondietary
substances
• Mild anemia may otherwise be asymptomatic
 INVESTIGATIONS FOR DIAGNOSIS OF
ANAEMIA
 Signs of anemia:
• Skin may be cool to touch
• Tachypnea - rapid and shallow breathing
• Hypotension (orthostatic) - a form of low blood pressure that happens when standing
after sitting or lying down.
• Abdominal exam: Cholesterol and pigmented gallstones are commonly seen in sickle
cell anemia; decreased absorptive surface with the loss of the terminal ileum leads to
vitamin B12 deficiency
• Cardiovascular: Severe anemia may lead to high output heart failure
• Neurologic exam: vitamin B12 deficiency
• Rectal and pelvic exam: These examinations are usually overlooked and
underperformed in the evaluation of anemia.
 INVESTIGATIONS FOR DIAGNOSIS OF
ANAEMIA
 Hb Measurement : Haemoglobin can be measured from fingerpick blood samples by
direct colour comparison of acid or alkaline haematin. It is advisable to bring the
blood samples on a filter-paper and estimate hemoglobin colorimetrically after
extraction. Haemoglobin measurement by 'Haemocue' and Dry Blood Spot method is
available.
 Leucocyte and Platelet Count: These help to differentiate between anemia due to
general bone marrow defects and other causes.
 Reticulocyte Counts: In anemia the count increases from the normal value of 0.5-
2.0% Very high value (> 6%) indicates severe anemia.
 Blood Film: Examination of peripheral smear would be of value in indicating
iron/folate deficiency by presence of micro or macrocytes, abnormal cells and platelet
distribution.
 FUNCTIONAL CONSEQUENCES OF
ANAEMIA
• Neurological and Behavioral Implications
• Some of the manifestations of anemia are: fatigue, dullness, lack of concentration,
reduced activity, all leading to poor performance. Iron deficiency is also sometimes
associated with pica, temper tantrums and breath holding spells by children.
• Gastrointestinal Manifestations
• Iron deficiency is associated with varying gastrointestinal manifestations. Epithelial
changes are seen. Intestinal absorption has been shown to be reduced especially for
xylose and fat.
• Immunocompetence and Infection
• Iron is essential for normal development and function of lymphoid tissue. Iron
deficiency results in a reduction of cell-mediated immunity. Free iron is essential for
multiplication of all bacteria except lactobacillus..
 FUNCTIONAL CONSEQUENCES OF
ANAEMIA
• Changes In Epithelial Cells
• In untreated megaloblastic anemia epithelial cell changes occur, These include an
increase in the size of both Nucleus and cytoplasm with multiple nuclei (polyploidy).
These changes are seen in buccal mucosa and tongue, urinary and uterine cervix
resembling dysplasia.
• Reproductive Outcome
• During pregnancy, iron deficiency along with deficiencies of folate and vitamin B12
result in poor foetal growth, prematurity and intrauterine death of foetus. The foetus is
born with poor stores of iron and folate at birth and suffers from anemia from early
infancy due to poor availability of iron and folate from breast milk.
• Poor Work Capacity
• In the adult man or woman, anemia results in poor work output since the work capacity
is reduced considerably due to muscle fatigue.
 PREVENTION AND TREATMENT OF ANAEMIA

1. Management depends primarily on treating the underlying cause of anemia.

2. Anemia due to acute blood loss- Treat with IV fluids, crossmatched packed red
blood cells, oxygen Maintain hemoglobin of > 7 g/dL in a majority of patients.
Those with cardiovascular disease require a higher hemoglobin goal of > 8 g/dL.
3. Anemia due to nutritional deficiencies: Oral/IV iron, B12, and folate.
4. Oral supplementation of iron is by far the most common method of iron repletion.
The dose of iron administered depends on the patient's age, calculated iron deficit,
the rate of correction required, and the ability to tolerate side effects. The most
common side effects include metallic taste and gastrointestinal side effects such as
constipation and black tarry stools.
5. For such individuals, they are advised to take oral iron every other day, in order to
aid in improved GI absorption.
 PREVENTION AND TREATMENT OF ANAEMIA

6. Anemia due to defects in the bone marrow and stem cells: Conditions such as
aplastic anemia require bone marrow transplantation.
7. Anemia due to chronic disease: Anemia in the setting of renal failure, responds to
erythropoietin. Autoimmune and rheumatological conditions causing anemia
require treatment of the underlying disease.
8. Anemia due to increased red blood cell destruction:
• Hemolytic anemia caused by faulty mechanical valves will need replacement.
• Hemolytic anemia due to medications requires the removal of the offending drug..
• Patients with life-threatening bleeding require the use of antifibrinolytic agents.
 Dietary Approach
1. Promotion of consumption of pulses, green leafy vegetables, other vegetables (which
are rich in iron and folic acid) and meat products rich in iron and superior
bioavailability of iron particularly by pregnant and lactating mothers and preschool
children. Only sources for B12 are meat or eggs.
2. Creation of awareness in mothers attending antenatal clinics, immunization sessions,
anganwadi centres and creches about the prevalence of anemia, ill effects of anemia
and its preventable nature.
3. Addition of iron-rich foods to the weaning foods of infants.
4. Regular consumption of foods rich in vitamin C to promote iron absorption such as
orange, guava, amla, etc.
5. Promotion of home gardening to increase the availability of common iron rich foods
such as green leafy vegetables.
6. Discouraging the consumption of foods and beverages like tea and tamarind that
inhibit iron absorption, especially by the vulnerable groups like pregnant women and
children.
 Food Fortification with Iron to Control Anaemia
 Fortification of foods with iron would act as a long-
term measure to improve the iron balance
 Salt has been found to be the most suitable vehicle
for this purpose since it is cheap and universally
consumed.
 Initial trials have proved that the iron-fortified salt
is improving the iron status of rural population.
 Technology is now available to double fortify the
salt with iron and iodine to tackle the twin
problems of (IDA) and (IDD).
 However, till it becomes universally available, it is
essential that anaemia prophylaxis programme is
implemented more effectively.
 SCHEMES TO BRING
DOWN ANEMIA IN INDIA
 NATIONAL NUTRITION ANEMIA PROPHYLAXIS
PROGRAMME
 The NNAPP was started in 1970. It is a centrally sponsored scheme.
 Objectives : The programme aims at significantly decreasing the prevalence and
incidence of anaemia in women in reproductive age group, especially pregnant
and lactating women, and preschool children.

 The specific objectives of the programme are :

 to assess the baseline prevalence of nutritional anaemia in mothers and young
children through estimation of haemoglobin (Hb) levels.
 to put the mothers and children with low Hb levels (less than 10 g and less than
8 g respectively) on anti-anaemia treatment.
 to put the mother with Hb level more than 10 g/dl and children with Hb more
than 8 g/dl on the prophylaxis programme.
 NATIONAL NUTRITION ANEMIA PROPHYLAXIS
PROGRAMME
 to monitor continuously the quality of the tablets, distribution and consumption
of the supplements.
 to assess periodically the Hb levels of the beneficiaries.
 to motivate the mothers to consume the tablets through relevant nutrition
education (and to give to their children also).

 Beneficiaries : The scheme beneficiaries are children in 1-5 years of age,

pregnant and nursing mothers, female acceptor of terminal methods of family
planning and IUDs. The target beneficiaries of the scheme are 50 per cent of total
pregnant and nursing mothers and 25 per cent of total women acceptors of
terminal methods and IUDs. The target child population is 50 per cent of total
population in the age group of 1-5 years.
 NATIONAL NUTRITION ANEMIA PROPHYLAXIS
PROGRAMME
Activities : The programme focuses on the following activities:
1) Promotion of regular consumption of foods rich in iron.
2) Supply of iron and folate supplements in the form of tablets (folifer tablets) to
the target group.
3) Identification and treatment of severely anaemic cases. The recommended daily
dosages of iron and folic acid (IFA) tablets is as follows:
Adult women : 60 mg elemental iron + 0.5 mg folic acid
Children (1-5 years) : 20 mg elemental iron + 0.1 mg folic acid.

For young children, who cannot swallow, liquid syrup containing the same amount
of IFA was given (2 ml at a time). This has been discontinued since 1991.
 NATIONAL NUTRITION ANEMIA PROPHYLAXIS
PROGRAMME
Organisation :

The programme is implemented through the Primary Health Centres and its sub-
centres. The multipurpose worker female and other para-medics in the PHC's are
responsible for the distribution of IFA tablets (adult and paediatric doses) to
beneficiaries. The functionaries of ICDS scheme assist in implementation of
programme.
 12 – By- 12 Initiative

 A 12 – by- 12 initiative was launched in 2007, which was jointly undertaken by MOHFW,
WHO, UNICEF, FOGSI and others to ensure that every child would have the hemoglobin
of 12 gram by the age of 12 years by 2012.
 Children between the age group of 10-14 years were screened and if hemoglobin was
found below 12 gm%, weekly IFA supplementation was provided.
 It also comprised of public awareness creation, correction of dietary pattern and control
of worm infestation through periodic deworming.
 Weekly Iron and Folic Acid Supplementation (WIFS) With the fact that one out of the two
adolescent girls (56%) and out of three adolescent boys were anemic,
 Weekly Iron and Folic Acid supplementation (WIFS) Program was launched to meet the
challenge of anemia amongst adolescent boys and girls.
 Weekly Iron and Folic Acid supplementation was given to all 6th to 12th class adolescent
boys and girls enrolled in all government/government
 National Iron Plus Initiative

National Iron+ Initiative was launched

by the Adolescent Division of the
Ministry of Health and Family Welfare
(MoHFW),Government of India.

AIM: To reach the following age groups

for the supplementation of iron and folic
acid.
 ICDS
 Launched on 2nd October, 1975, the Integrated Child Development Services
(ICDS) Scheme is one of the programmes of the Government of India and
represents one of the world’s largest and unique programmes for early
childhood care and development.
 It is the foremost symbol of country’s commitment to its children and nursing
mothers, as a response to the challenge of providing pre-school non-formal
education on one hand and breaking the vicious cycle of malnutrition, morbidity,
reduced learning capacity and mortality on the other.
 The beneficiaries under the Scheme are children in the age group of 0-6 years,
pregnant women and lactating mothers.
 ICDS
 Objectives of the Scheme are:
• To improve the nutritional and health status of children in the age-group 0-6
years;
• To lay the foundation for proper psychological, physical and social development
of the child;
• To reduce the incidence of mortality, morbidity, malnutrition and school
dropout;
• To achieve effective co-ordination of policy and implementation amongst the
various departments to promote child development; and
• To enhance the capability of the mother to look after the normal health and
nutritional needs of the child through proper nutrition and health education.
 ICDS
Government of India is implementing several programmes to prevent and treat Anemia at
different life stages. Such as:

1. Iron tablets for every life-stage

6 month to 5 year old child: 1 ml syrup twice in a week.
5 to 10 year old child: Weekly Iron tablet for in school children through teachers and out of
school children through AWC.
10 -19 year old adolescent boys/girls: Weekly Iron tablet for in school adolescents through
teachers and out of school adolescents through AWC.
During pregnancy: Starting from second trimester, 1 tablet per day for 100 days.
Post pregnancy: 1 tablet per day for 100 days
 ICDS
Government of India is implementing several programmes to prevent and treat Anemia at
different life stages. Such as:

2. Deworming tablets every six months:

12 month to 5 year old child: Deworming tablet once in 6 months.
5 -10 year old child: Deworming tablet once in 6 months for in school children through
teachers and out of school children through AWC.
Adolescents (10 to 19 years): Deworming tablet once in 6 months for in school adolescents
through teachers and out of school adolescents through AWC.
Pregnant Women: 1 deworming tablet during second trimester.
 ICDS
Government of India is implementing several programmes to prevent and treat Anemia at
different life stages. Such as:

3. Advice on consumption of Iron and Vitamin C rich diet, birth spacing, etc. by health
and ICDS frontline workers.
4. Advice on availing incentives under Pradhan Mantri Matritva Vandana Yojna (PMMVY)
to improve diet during pregnancy. The Anemia Mukt Bharat- intensified Iron-plus Initiative
aims to strengthen the existing mechanisms and foster newer strategies for tackling
anemia.

Women should wait at least 18 months before getting pregnant again. The 18-month rest period is
called “birth spacing.”
The reduction of anemia is one of the important
objectives of the POSHAN Abhiyaan launched in
March 2018. Complying with the targets of
POSHAN Abhiyaan and National Nutrition
Strategy set by NITI Aayog, the Anemia Mukt
Bharat strategy has been designed to reduce
prevalence of anemia by 3 percentage points
per year among children, adolescents and
women in the reproductive age group (15–49
years), between the year 2018 and 2022.
Beneficiaries and
Targets
The strategy is estimated to reach out to
450 million beneficiaries with specific
anemia prevalence targets for year 2022
to be achieved among various population
groups
Beneficiaries and
Targets
The strategy is estimated to reach out to
450 million beneficiaries with specific
anemia prevalence targets for year 2022
to be achieved among various population
groups
 The Anemia Mukt Bharat strategy is a universal strategy and will focus on the
following interventions:
1. Prophylactic Iron and Folic Acid supplementation
2. Deworming
3. Intensified year-round Behaviour Change Communication Campaign
(Solid Body, Smart Mind) focusing on four key behaviours
a. Improving compliance to Iron Folic Acid supplementation and
deworming
b. Appropriate infant and young child feeding practices,
c. Increase in intake of iron-rich food through diet
diversity/quantity/frequency and/or fortified foods with focus
on harnessing locally available resources and
d. Ensuring delayed cord clamping after delivery (by 3 minutes) in
health facilities
 The Anemia Mukt Bharat strategy is a universal strategy and will focus on the
following interventions:
4. Testing and treatment of anemia, using digital methods and point of care
treatment, with special focus on pregnant women and school-going
adolescents
5. Mandatory provision of Iron and Folic Acid fortified foods in
government-funded public health programmes
6. Intensifying awareness, screening, and treatment of non-nutritional
causes of anemia in endemic pockets, with special focus on malaria,
haemoglobinopathies
Important Definitions:

• Sideroblastic anemia: anemia from lack of red blood cells and too much iron in
your system because your body's not making use of iron in your red blood cells.
• Haemorrhoids: a swollen vein or group of veins in the region of the anus.
• Hemoglobinopathies: group of disorders passed down through families (inherited)
in which there is abnormal production or structure of the hemoglobin molecule.
• Delayed cord clamping a straightforward process that allows placental transfusion
of warm, oxygenated blood to flow passively into the newborn
• Antenatal care (ANC) is an important entry point for pregnant women to receive
health promotion and preventive information and services including iron
supplementation, deworming tablet, tetanus injection, and malaria prophylaxis
• ANM - Auxiliary Nurse Midwife, usually known as ANM, is a village-level female
health worker in India who is known as the principal contact individual between the
local area and the health services.
 References:
• https://www.who.int/health-topics/anaemia#tab=tab_1
• https://www.wecollaborate4nutrition.org/wp-content/uploads/2015/12/RDA
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• https://anemiamuktbharat.info/
• http://icds-wcd.nic.in/nnm/NNM-Web-Contents/LEFT-MENU/ILA/Modules/N
NM-ILAmodule-07-Preventing_Anemia.pdf
• http://icds-wcd.nic.in/supplnutrition.aspx
• Mahtab S. Bamji, M. Prahalad Rao & Vinodini Reddy’s Textbook of Human
Nutrition
• file:///C:/Users/HP/Downloads/2056.pdf
• Badireddy M, Baradhi KM. Chronic Anemia. [Updated 2022 Aug 8]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK534803/

• https://www.wecollaborate4nutrition.org/wp-content/uploads/2015/12/RDA
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Thankyou