The World Health Organization (WHO) defines anemia as a condition in which the number of red blood cells or their oxygen–carrying capacity is insufficient to meet physiological needs.
Commonly, anemia is the final outcome of a nutritional deficiency of iron, folate, vitamin B12, and some other nutrients. Many other causes of anemia have also been identified, which include malaria, hemorrhage, infection, genetic disorders (hemoglobinopathies), parasite infestation (hookworm), chronic disease, and others.
A blood smear can provide important morphologic clues to diagnosing different kinds of anemia and can show morphologic differences among various clinical forms of anemia caused by iron deficiency, vitamin B12 deficiency, a genetic disorder called thalassemia, and malaria.
Anemia is a public health concern for both developed and developing countries as it impacts human health as well as social and economic development.
Anemia among adolescent girls, women, and pregnant women is of more consequential significance. In adolescent girls, anemia has been linked to affecting physical activity, growth, and mental development.
Also, anemia in adolescent girls increases reproductive morbidities among them during their womanhood as depicted by many studies.
Likewise, studies have shown with increasing age women are more prone to anemia than their male counterparts. Maternal anemia is known to have detrimental health implications, particularly for mothers and young children.
Women with severe anemia can experience difficulty meeting oxygen-transport requirements at the time of giving childbirth, especially if significant hemorrhaging occurs. This may be an underlying cause of maternal death and prenatal and perinatal infant loss.
In fact, unfavorable pregnancy outcomes have been reported to be more common in anemic mothers than in non-anemic mothers. The deleterious health impacts of mild anemia are less well-documented than the effects of severe anemia.
However, in several studies premature delivery, placental hypertrophy, and reduced excretion of estriol (maternal hormone) have been observed to be more common in mildly anemic mothers than in non-anemic mothers.
Effects of anemia among children have been demonstrated in many studies to be associated with impaired cognitive and intellectual performance, motor development, coordination, language development, and scholastic achievement.
Apart from this its (anemia) social costs remain extremely high, both in terms of disability-adjusted life years (DALYs) and income losses, besides intangible costs and production losses as shown by several studies.
There are many healthy and vibrant health programs in place to ameliorate anemia in children, adolescent girls, women, and pregnant women, keeping in view the impact of anemia on health outcome indicators. Programs like Anemia Mukt Bharat (AMB) as part of Intensified Iron Plus Initiative (NIPI) launched in 2018.
The target groups for AMB are children (6-59 months,5-9 years), women of reproductive age (15-49 years), pregnant women, and lactating mothers.
Other programmes include Weekly Iron and Folic Acid Supplementation (WIFS) to meet the challenge of high prevalence and incidence of anemia amongst adolescent girls and boys, Integrated Child Development Scheme(ICDS), National Nutritional Anemia Control Program(NNACP), etc to combat anemia.
Nevertheless, the National Family Health Survey (NFHS-5) data shows anemia rates increased from 53 percent to 57 percent in women and 58 percent to 67 percent in children in 2019-21.Although, the percentages of both children and women consuming iron-rich foods have increased from NFHS-4 to NFHS-5 in both groups.
Also, the percentage of children consuming an adequate diet has increased from 9.6 percent to 11.3 percent and those being exclusively breastfed have increased from 54.9 percent to 63.7 percent from NFHS-4 to NFHS -5.
Now, few perceptible opinions have been raised by the research findings of the paper published in the Lancet Global Health by Prof. Harshpal Singh Sachdev et al, these researchers asserted the need for re-examination of WHO hemoglobin cut-offs to define anemia.
Also, they showed substantial variation in the 5th percentile of the hemoglobin values across the 1-19 years age range and between sexes which argues against constructing common cutoffs in stratified age groups for convenience.
The epidemiology and etiologies of anemia are multi-factorial and involve a complex interplay of various variables. Therefore, is there a requirement for the broader health strategy to effectively address the issue of anemia, also, is there a need to bridge the gap between policy and practice by doing the holistic evaluation of the programmes to look for the gaps, if any, remain the moot questions for discussion.
(Dr.Khalid Bashir is a Senior Resident,Department Of Community Medicine, Government Medical College,Srinagar. )
DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.