ANEMIA IN CHILDREN UNDER 5 YEARS AGE

• Anemia is a condition in which the number of red

blood cells or their oxygen-carrying capacity is
insufficient to meet the body’s physiological
requirements, which vary by age, sex, altitude,
smoking habits, and during pregnancy.

• Anemia can be broadly classified as nutrional,

haemorrhagic, genetic and drug induced.

• Nutritional anemia is major public health challenge.

Etiology of Anemia
 Causes of Anemia
Nutrition
Iron deficiency
Folic acid deficiency
Vitamin B12 deficiency
Vitamin A deficiency
Protein energy malnutrition

Infectious disease
Soil-transmitted
Genetic hemoglobin helminths
disorders Malaria
Thalassemia Schistosomiasis
Hemoglobin variants Tuberculosis
Glucose-6-phosphate AIDS
dehydrogenase Leishmaniasis
deficiency Tropical sprue
Ovalocytosis Malabsorption&
disorders of the
small intestine
Ref: World Health Organization. The Global Prevalence of Anaemia in 2011. WHO Report. 2015.
Type of anemia among children

1-4 years

22.2

2.4
6.5
18.9

13.5
68.9%

36.5

Iron deficiency Anemia only Folate/Vit. B12 deficiency Anemia Anemia of hemoglobinopathies

Dimorphic Anemia Anemia of inflammation Anemia from other causes

Majority of cases of anemia are due to nutritional deficiencies or infection or

hemoglobinopathies in India.
Diagnostic criteria of anemia in under 5
children
Prevalance of anemia in under 5 children

Prevalance of anemia in under 5 children in india

Children 6-59 months (Hb NFHS-3 (2006) NFHS-4 (2016) Decline in 10yrs
<11gm/dl) %

India MP India MP India MP

69 74 58 68.9 11 5.1
Anemia in Madhya Pradesh
High Prevalence and slow progress across all ages

68.9%
68.9%
36.5%
36.5% 54.6%
54.6%
of children
of children
of
of ABs
ABs of
of PWs
PWs
(6-59
(6-59
(15-19yrs)
(15-19yrs) (19-49yrs)
(19-49yrs)
months)
months)

53.5%
53.5% 52.5%
52.5%
of 58.4%
of AGs
AGs of
of WRA
WRA
(15- (19-49 3% of LWs
5% (15- (19-49
Decadal 19yrs Decadal
19yrs )) yrs)
yrs)
decline decline

1% 4%
Decadal Decadal
decline decline

*Data Source : NFHS-4 (2015-

16)
 Signs and symptoms of anemia

Definitive diagnosis of anemia is made by estimation of hemoglobin (Hb) levels in the blood. However, there
are some signs and symptoms that may assist in identifying anemia. They include:

• Paleness or pallor in the inner rims of the lower eyelid (lower palpebral conjunctiva)
• Tongue
• Overall skin
• Nails and palms of the hand
• Soreness of the tongue
• Cracks at the corners of lips
• Brittle and spoon shaped nails
• Dizziness, tiredness, fatigue and low energy
• Unusually rapid heartbeat, particularly during exercise
• Shortness of breath
• Frequent headaches, particularly with exercise
• Lethargy, lack of interest in playing and studies
• Difficulty or inability to concentrate
• Leg cramps
• Lowered resistance to infections and frequent illness
Plummer-Vinson syndrome

Angular chilosis

Posterior
Glositis
cricoid web
Sign and symptoms of anemia
Diagnostic criteria of Anemia
 Health Programme for anemia in India
• National nutritional anemia control
programme; 1970.
• National Iron Plus Initiative (NIPI);2013.
• Intensified national iron plus initiative (I-NIPI):-
Anemia Mukt Bharat under poshan abhiyan;
2018.
“Anemia Mukt Bharat”
Why the need?
Anemia is a silent
epidemic impacting our
physical growth, mental
and work capacity, and
lives of future generations.

All population groups in

India are affected by
anemia and, hence,
intensified efforts are
needed to tackle this
problem.
Objectives of Anemia Mukt Bharat

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.
Anemia Mukt Bharat Anemia reduction Targets
for 2022

Anemia Mukt Bharat- Operational Guidelines

 Anemia Mukt Bharat Strategy
With nearly half of the country’s population being anemic, 6x6x6 Strategy of Anemia-
Mukt Bharat sets ambitious targets, and an effective system, to fight Anemia

6X6X6
Strategy
6 6
Institutional
Intervention mechanisms
 Beneficiaries of Anemia Mukt Bharat
• Children (6–59 months).
• Adolescent girls (15–19 years).
• Adolescent boys (15–19 years).
• Women of reproductive age(15-49).
• Pregnant women.
• Lactating Women.
In FY 19-20 approx. 2.25 Cr
beneficiaries have been targeted in MP.
INTERVENTIONS
Intervention 1.Prophylactic dose and regime for Iron
Folic Acid supplementation in under 5 children

• Biweekly 1ml iron and folic acid syrup

• Each 1ml of Syrup containing 20mg elemental iron and
100mcg folic acid.
• Bottle of 50ml provided with autodispenser.
• Prophylaxis with iron and folic acid should be withheld in case
of acute illnesses (fever, diarrhoea, pneumonia, etc.), and in a
known case of thalassemia major/ history of repeated blood
transfusion.
• In case of severe acute malnutrition (SAM) children, IFA
supplementation should be continued as per SAM
management protocol.
 Intervention 2 : Deworming
• Indicated only in children 12 to 59 months.
• Biannual dose of 400mg (1/2 tablet for 12 to 24 months and 1
tablet for 24-59 months children)
• National Deworming Day programme:- biannual mass deworming.
• For children and adolescents in the age groups between 1 and 19
years.
• On designated dates – 10 February and 10 August every year.
• Not pregnant or non-lactating newly wed/married women of 20–
24 years of age.
• Pregnant women will be provided services under the strategy
through antenatal care contacts (ANC clinics) for deworming in
the second trimester.
 3. Intensified year-round Behaviour Change
Communication Campaign (Solid Body, Smart Mind)

1. Compliance to Iron Folic Acid supplements and deworming.

2. Promotion of Optimal Infant and Young Child Feeding (IYCF)
practices.
3. Increase intake of iron-rich, protein-rich and vitamin C rich
foods through diet diversification and consumption of
fortified foods.
4. Promotion and monitoring of delayed clamping of the
umbilical cord for at least 3 minutes for improving the
infant’s iron reserves up to 6 months after birth.
Iron rich food
Vit C rich food
 4.Testing and treatment of anemia
• T3 strategy:- test; treat; and talk.
• SAHLI’s method:- time consuming and results may vary
individual to individual.
• The strategy thus proposes the use of digital
haemoglobinometers for haemoglobin level estimation in
two benefi ciaries groups namely:-

a) adolescent girls and boys 10–19 years, in government

and government-aided schools

b) pregnant women registered for antenatal check-ups.

• This maybe extended to all age groups later.

 Management of anemia in under 5 Children
Screening by:- by ANM at SHC,
by RBSK team at AW/School,
MO at PHC/CHC

Followup every month

by ANM at VHND. 3mg/kgBW
Monitoring for
compliance by ASHA
every 14 days.
 Intervention 5
Mandatory IFA Fortified Foods in Public Health Systems

Use of fortified salt, wheat flour and oil in food

under ICDS and MDM Schemes

 Fortified wheat and rice (with iron,

Folic Acid and Vit-B12 )
 Double Fortified Salt (with iodine
and iron)
 Double fortified Oil (with Vit-A &
D)
 Intervention 6
Intensified awareness, screening and treatment specially
for Malaria, Haemoglobinopathies & Fluorosis
The prevention and control strategy for Malaria

The testing of malaria and anemia will be integrated in the identified malaria endemic
regions as below :-
• The beneficiaries who report recent fever and being screened for anemia will also be
tested for malaria to ascertain the co- occurrence of malaria.
• Patients who are being tested for malaria will also be tested for anemia in these
endemic regions.
• The Prophylactic and therapeutic treatment protocol for management of anemia in
malaria-endemic regions will be the same.
• Utilization of Long-lasting insecticidal nets by all target groups especially pregnant
mothers and under-five children will be ensured by promoting IEC/ BCC.
Continue…………..
The prevention and control strategy for thalassemia, sickle cell
disease and hemoglobinopathy syndromes

• Setting up Regional Centers of Excellence as a referral and training centers for

hemoglobinopathies.
• Strengthening centers for treatment of thalassemia, sickle cell disease and
hemoglobinopathy syndromes.
• Extensive awareness and education programs in the community, specially in schools.
• Existing platforms such as AWCs, SCs and Health and Wellness Centers and events
such as VHNDs, Nutrition week, Breastfeeding week, Women’s Day, World
Thalassemia Day, etc. will be utilized to generate discussions and dialogue on non
nutritional causes of anemia in the endemic districts.

The treatment of anemia using parental iron administration is

contraindicated in sickle cell disease patients.
 Continue……
The 3 key interventions for prevention and treatment for
anemia due to fluorosis.

1. Identification of fluoride-affected habitations:-

Mapping of high fluoride-affected habitations in convergence with PHED Dept.
2. Activities for anemia control due to fluorosis:-
-Use of safe drinking water “Accha Paani, Takatvar Paani”
-Focus on diet corrections (Calcium, Magnesium, Vitamin C) by dietary diversity.
- Periodic check-up of hemoglobin in affected habitations for appropriate treatment.
3. Capacity building:-
Training of MO in PHC/CHC, ASHA, ANM and AWW for prevention , diagnosis and
management of Fluorosis cases.
 Fluorosis in Madhya Pradesh
• 15 out of 51 district of MP covered under
NPPCF(launched in year 2008).
• Ujjain,Chindwada, Mandla, Dhar, Seoni, Betul,
Jhabua, Raigarh, Sehore, Alirajpur, Dindori,
Khargoan, Raisen, Shajapur, Ratlam.
• Ujjain was 1st district in madhya pradesh
covered under NPPCF.