Anemia Free Karnataka - A Way Forward

Since its independence, India has been continually striving to achieve the ultimate, ‘Health for All’. Universal Health Coverage has been the raison d’être for all the health and health-related initiatives taken by the Government of India. Despite the decline in total fertility rate, India still has a behemothic number of children under five years of age, school-going children, and adolescents. A steadily growing population with a staggering number of women in the reproductive age group has also been reported by the recent 5th National Family Health Survey (NFHS) data.¹ A multitude of health schemes catering to the health needs of young children, adolescents, and women of reproductive age are in action nationwide; yet the number of deaths among maternal age group, infants, young children, and adolescents are daunting. 

According to the World Health Organization (WHO), one of the major indirect causes of maternal mortality is anemia and the majority of the deaths in the aforementioned age groups can also be attributed to it.² A WHO systemic analysis to ascertain the global causes of maternal mortality³ reported that 28% of the maternal deaths may be ascribed to indirect causes like anemia and unsafe abortions. Anemia is a crucial public health problem of global concern particularly in low- and lower-middle–income countries as they bear the greatest burden of anemia; especially affecting the populations living in rural settings, in poorer households, and who have received no formal education.

Lack of age-appropriate nutrition, repeated infections, chronic diseases, menstrual disorders, thyroid dys- function, pregnancy, childbirth and family history are the various causes of anemia. Iron-deficiency anemia accounts for 50% of anemia in school-going children and women in the reproductive age group while a striking 80% of the children aged 2 to 5 years suffer from iron deficiency anemia. Deficiency of vitamin B12, folate, and vitamin A also contribute to the escalating percentage of nutritional anemia among the vulnerable age groups. Tuberculosis, helminthic infections, and malaria are the eminent causes among a myriad of infectious diseases that cause anemia and their contribution to the soaring burden of the disease is significant.

Among the varying manifestations of anemia, impaired cognitive development of children leading to poor performance in school, malnutrition-infection vicious cycle, post-partum hemorrhage, neural-tube defects, low-birth weight, preterm births, and stillbirths are perturbing but are preventable. All the consequences are further enhanced among the marginalized sections of the society, hence, there is a dire need to address the same to reduce the prevalence of anemia. A significant number of people living below the poverty line and in slums are facing the wrath of the disease and the rate of morbidity and mortality due to anemia are considerably higher in them when compared to the other sections of the society.

As anemia is preventable and treatable, to address the nutritional causes of anemia National Nutritional Anaemia Prophylaxis Programme was initiated in 1970. Due to certain lacunae in the program and lack of addressal of the issue at hand, in 2013, “National Guidelines for Control of Iron Deficiency Anaemia” was developed to identify strategies and comprehensive actions needed across the life cycle to eliminate this serious obstacle to survival, health and development and hence the National Iron plus Initiative came into being. In 2018, POSHAN Abhiyaan and National Nutrition Strategy, a multi-ministerial convergence mission with the vision to ensure attainment of malnutrition free India by 2022 were set afloat. To comply with the targets of the  aforementioned two, Anemia Mukt Bharat (AMB) was designed and launched in 2018 to reduce the prevalence of anemia by three percentage points per year among children, adolescents, and women in the reproductive age groups (15–49 years), from 2018–2022.⁴

The state governments are key to India’s progress on the Sustainable Development Goals (SDGs) as they are best placed to ‘put people first’ and to ensuring that ‘no one is left behind’. A considerable improvement has been recorded since the embarkment of AMB, and to bolster the efforts of same, the Karnataka State Government launched Anemia Muktha Poustika Karnataka on the adopted guidelines of the national program. It consists of the basic principles of the national program tailored to the local context of the state and its communities. The programme is designed to provide care and management services through all stages of the life cycle. It has been specifically designed to promote the health and nutrition of women and children, with the aim to improve community awareness, screening, treatment, and monitoring.

The state health minister, Dinesh Gundu Rao in association with the state women and child department, aspire to make Karnataka free from anaemia by 2025. Furthermore, Chief Minister, Siddaramaiah launched the Anemia Muktha Poustika Karnataka on November 22, 2023 while highlighting that India’s malnutrition index is rising. Out of the estimated population of 393 lakhs, 156.24 lakhs (40%) will be covered in Anemia Muktha Poustika Karnataka while the remaining 236.76 lakhs , which includes children not registered in Anganwadis, students in private schools, out-of–school children, women in pre-conception age group (25–49 years) will undergo opportunistic screening and the data shall be captured in Health Management Information System (HMIS) /manual registers. The state will also take measures to ensure proper diet supplements, de worming, and counselling services.

Anemia Muktha Poustika Karnataka has six pillars, namely, (1) mass screening of individuals (Modala Hejje), (2) tracking and monitoring system (Pragathi), (3) iron and folic acid supplementation, (4) take home ration and diet (Arogyapushti), (5) Information, Education & Communication (IEC) and counselling services (Rise above 12), (6) capacity building (Arogya Kaushalya), to counter and reduce the prevalence of anemia in the state. The consumption of Iron and Folic Acid (IFA) tablets and the biannual de-worming in the entire state has not been uniform. Additionally there has been an increase in the burden of anemia secondary to the rise in helminthic infestations in the marginalized section of the society, especially among the people staying in the high-risk areas (HRAs), urban slums, and other weaker sections. The pillars of Anemia Muktha Poustika Karnataka promise to bridge the existing gap and overcome the obstacles such as the lack of accessibility of affordable quality assured healthcare services, irrespective of the socio-economic class. Moreover, the fifth pillar viz., IEC and counselling for the disease will certainly ameliorate the health literacy among the people of Karnataka and further the agenda of anemia free Karnataka by 2025.