Model Answer
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Anaemia, a condition characterized by a reduced ability of blood to carry oxygen due to low haemoglobin levels or fewer red blood cells, poses a significant public health challenge in India. It contributes to increased maternal and child mortality, impaired cognitive development in children, and reduced work capacity in adults. Recognizing the pervasive impact of anaemia, the Government of India launched the Anaemia Mukt Bharat (AMB) programme in 2018 as part of the POSHAN Abhiyaan. This national strategy adopts a life-cycle approach to combat anaemia across various vulnerable population groups, aiming for a significant reduction in its prevalence through a multi-pronged strategy.
The Anaemia Mukt Bharat (AMB) Programme, launched by the Ministry of Health and Family Welfare (MoH&FW) in 2018, employs a multi-pronged "6x6x6 strategy" to address anaemia. This strategy focuses on six target beneficiary groups, implements six interventions, and utilizes six institutional mechanisms to achieve its goals of reducing anaemia prevalence by 3 percentage points per year.
Interventions Focused on by Anaemia Mukt Bharat Programme
The AMB strategy leverages six key interventions to prevent and manage anaemia:
- Prophylactic Iron and Folic Acid (IFA) Supplementation: This is a cornerstone intervention, providing IFA supplements across various age groups, irrespective of their anaemia status.
- Periodic Deworming: Intestinal worm infections can contribute to anaemia by causing chronic blood loss and nutrient malabsorption. Regular deworming helps mitigate this.
- Intensified Year-Round Behaviour Change Communication (BCC) Campaign: This aims to raise awareness and promote healthy behaviours related to nutrition and anaemia prevention.
- Testing of Anaemia and Treatment, using Digital Methods and Point of Care Treatment: Emphasizes early detection and appropriate management of anaemia, particularly for vulnerable groups.
- Mandatory Provision of Iron and Folic Acid Fortified Foods in Public Health Programmes: Integrating fortified staples into government-funded schemes to improve micronutrient intake at a population level.
- Addressing Non-Nutritional Causes of Anaemia in Endemic Pockets: Recognizing that anaemia is not solely due to nutritional deficiencies, this intervention targets other contributing factors like malaria, hemoglobinopathies, and fluorosis.
Specific Measures Undertaken Under the Programme
Under each intervention, specific measures are being undertaken:
1. Prophylactic Iron and Folic Acid (IFA) Supplementation
- Children (6-59 months): Bi-weekly IFA syrup.
- Children (5-9 years): Weekly IFA Pink tablets.
- Adolescents (10-19 years): Weekly IFA Blue tablets.
- Women of Reproductive Age (15-49 years): Weekly IFA Red tablets.
- Pregnant Women: Daily IFA Red tablets (60mg elemental iron + 500mcg Folic Acid) starting from the second trimester (4th month) for a minimum of 180 days during pregnancy and continued for 180 days post-partum.
- Lactating Mothers: Daily IFA Red tablets for 180 days post-partum.
2. Periodic Deworming
- Children and Adolescents (1-19 years): Biannual mass deworming on National Deworming Days (February 10 and August 10) using Albendazole tablets.
- Pregnant Women: Single dose of Albendazole tablet in the second trimester during antenatal care contacts.
3. Intensified Year-Round Behaviour Change Communication (BCC) Campaign ('Solid Body, Smart Mind')
- Promoting compliance to IFA supplementation and deworming.
- Enhancing appropriate Infant and Young Child Feeding (IYCF) practices, with emphasis on adequate, age-appropriate complementary foods.
- Encouraging increased intake of iron-rich, protein-rich, and Vitamin C-rich foods, focusing on dietary diversification and locally available resources.
- Promoting the practice of delayed cord clamping (by 3 minutes) after delivery in health facilities to optimize iron stores in newborns.
4. Testing of Anaemia and Treatment
- Widespread screening using digital invasive haemoglobinometers and point-of-care diagnostics.
- Development of AMB Training Toolkit and e-Training Modules for capacity building of healthcare providers (Medical Officers, Staff Nurses, ANMs, ASHAs, AWWs) on anaemia management guidelines.
- Special focus on pregnant women and school-going adolescents for early detection and treatment.
5. Mandatory Provision of IFA Fortified Foods in Public Health Programmes
- Supplying fortified rice (enriched with iron, folic acid, and Vitamin B12) through schemes like Targeted Public Distribution System (TPDS), Pradhan Mantri Poshan Shakti Nirman (PM POSHAN), Integrated Child Development Services (ICDS), and Other Welfare Schemes (OWS). By March 2024, all custom-milled rice has been replaced with fortified rice in every government scheme.
6. Addressing Non-Nutritional Causes of Anaemia in Endemic Pockets
- Focused interventions for conditions like malaria, hemoglobinopathies (e.g., Thalassemia, Sickle Cell Anaemia), and fluorosis, which contribute to anaemia in specific regions.
- Management of severe anaemia in pregnant women through administration of IV Iron Sucrose or blood transfusions.
- Providing incentives to ANMs for identification and follow-up of pregnant women with severe anaemia in high-priority districts.
Specific Population Groups Targeted
The AMB programme targets six specific population groups, adopting a life-cycle approach to address anaemia:
| Population Group | Age Range (if applicable) | Specific Relevance to Anaemia |
|---|---|---|
| Children | 6-59 months | Vulnerable due to rapid growth, low iron reserves, and common infections. Anaemia in this group can impair cognitive and physical development. |
| Children | 5-9 years | Continued vulnerability during school-going age; impacts learning and physical activity. |
| Adolescent Girls | 10-19 years | High risk due to rapid growth, onset of menstruation, and poor dietary habits. Critical for preventing intergenerational cycle of anaemia. |
| Adolescent Boys | 10-19 years | Affected by rapid growth and inadequate nutrition, impacting physical and intellectual development. |
| Women of Reproductive Age (WRA) | 15-49 years | High prevalence due to menstruation, multiple pregnancies, and inadequate iron intake. |
| Pregnant Women | Increased iron requirements to support fetal growth and maternal blood volume. Anaemia increases risk of maternal and infant mortality, premature birth, and low birth weight. | |
| Lactating Women | Nutrient demands remain high during breastfeeding. |
Conclusion
The Anaemia Mukt Bharat programme represents a comprehensive and strategically designed national effort to tackle the persistent challenge of anaemia in India. By employing a multi-pronged 6x6x6 strategy, it addresses both nutritional and non-nutritional causes of anaemia across vulnerable life stages. While recent NFHS-5 data indicates that anaemia prevalence remains high across several groups, necessitating further strengthening of implementation, the programme's holistic approach, integrating supplementation, deworming, behavioural change, early detection, food fortification, and addressing underlying diseases, lays a robust foundation. Sustained political commitment, inter-sectoral convergence, and rigorous monitoring are crucial for India to achieve its goal of becoming anaemia-free.
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