1. Anaemia in pregnancychallenge or opportunity?Prema RamachandranDirector Nutrition Foundation of India andPresident , National Academy of Medical Sciences

2. Magnitude of the problemWhy is anemia so common?Why anaemia in pregnancy is a cause of graveconcern?National anaemia prophylaxis/control programmesProblems in implementationNew initiatives in the Tenth Plan NRHMChallenges and opportunities in Eleventh Plan 3. Magnitude of the problem 4. Prevalence of anaemia Source: WHO Global Developed Developing IndiaUrban RuralChildren 5yrs 37 7 46 50 60Men 18 3 26 35 45Women 35 11 47 5060Pregnant 59 14 51 6575WomenAbout one third of the global population ( over 2 billionpersons ) are anaemic .Anaemia is the most common nutritional deficiencydisorder in the worldPrevalence of anaemia is higher in developing countries 5. AN0102030405060708090Bangladesh China India Indonesia Malaysia Myanmar Nepal Pakistan Philippines Singapore Srilanka ThailandPrevalence of anaemia is high in South Asia. Evenamong South Asian countries prevalence ofanaemia in pregnancy is highest in India. 6. YEAR AUTHOR PLACE PREVALENCE %1975 Sood et al Delhi 801982 Prema Hyderabad 751987 Agarwal et al Bihar & UP 871989 Christian et al Chandrapur, Panchmahal 87,881988-92 Agarwal et al Rural Varanasi 941989 ICMR 11 states 871994 Sheshadri Baroda 742000 NFHS 2 All India 52.0?99- 2000 ICMR 11 states 84.62002-04 DLHS 2 All districts 90.42006 NNMB 8 states 70.32007 MFHS 3 All India 57.9?Trends in prevalence of anaemia in pregnant women in IndiaOver 70 % of pregnant women in India are anaemic. Therehas been no decline in anaemia in the last three decades 7. Prevalence of Anaemia (%){DLHS 2003}0%20%40%60%80%100%preschoolchildrenadolescentgirls pregnantw omenGroupPercentagesevere moderate mild noanaemiaAnaemia begins in childhood, worsens duringadolescence in girls and gets aggravated duringpregnancy 8. Source:NNMB2003Among the southern states, prevalence of anaemia inpregnancy is lower in Kerala and Tamil Nadu -?due tobetter access to health care 9. Anaemia pregnant women, India(Age between 15 - 44 years)50.952.951.4363636323RURALURBANTOTALMild Moderate SevereSource : DLHS2DLHS 2 showed that over 90% of pregnant women areanaemic both in urban and in rural areas 10. Prevalence of anaemia in children, adolescentgirls and pregnant women from 3 surveys020406080100NNMB ICMR DLHS NNMB ICMR DLHS NNMB DLHSPregnantw omen Adolescentgirls ChildrenNormal Mild Moderate SevereSource NNBMMajority of children, adolescents, adult men& women areanaemic.Anaemia antedates pregnancy& gets aggravated duringpregnancy. Maternal anaemia results in poor iron stores infoetusPrevalence anaemia in children is high because of pooriron stores, low iron content of breast milk andcomplementary foods.There is thus an intergenerational self perpetuating vicious 11. Prevalence of anaemia in adolescent girls & pregnantwomen by education & standard of living index020406080 Illiterate0-9yrs>10yrsLowMediumHighIlliterate0-9yrs>10yrsLowMediumHighEducation StandardoflivingindexEducation StandardoflivingindexAdolescentgirls PregnantwomenSevere ModerateSource: Ref 7.11.1.6Prevalence of anaemia is high even in high incomegroups and among well educated pregnant women 12. Why is anemia so common 13. Major causes of anemiaInadequate iron, folate intake due to low vegetableconsumption and perhaps low B12 intakePoor bioavailability of dietary iron from the fibre,phytate rich Indian dietsChronic blood lossIncreased requirement of iron during pregnancy 14. Nutrients NNMBRural Urban1975-791988-90 1996-97 2000-01 2004-05 1975-79 1993-94Iron (mg) 30.2 28.4 24.9 17.5 14.8 24.9 18.96Vit C 37 37 40 51 44 40 42Folicacid* * 153 62 52.3 * *Time trends in intake of iron, folic acid and vitamin C in ruraland urban areas (c/day) (NNMB)Dietary intake of iron and folate are less than 50% of the RDABioavailability of iron from phytate and fibre rich Indian diets isonly 3 % 15. Time trends in intake of iron (mg / day) in different groupsAge group 1975-79 1996-97 2000-01 2004-0510-12B 19 20 12.2 12G 18 19 12.1 11.513-15B 21 21 15.4 13.3G 20 21 12.9 1316-17B 25 26 16.7 16.4G 22 22 15.3 13.4Adult males 26 27 17.5 19.6Adult females(NPNL) 21 22 17.1 13.8Pregnant women 20 23 14 14Lactating women 23 23 14.6 14.7Iron intake is low in all age groups and does not increasein pregnancy; there has been no increase in iron intake over 16. Why is anaemia in pregnancy a cause of graveconcern 17. INDIAIndias share in global maternal deathsIt is estimated that globally there are over 5 lakh maternaldeaths every year.There are about 1 to 1.2 lakh maternal deaths in India everyyearIndia with 16% global population accounts for 20-25 % %of all maternal deaths in the world 18. Prevalence of Iron deficiency anemia in South Asia%Country Children< 5 yearsWomen15-49 yearsPregnantwomenMaternal deathsfrom anemiaAfghanistan 65 61 - -Bangladesh 55 36 74 2600Bhutan 81 55 68