Anemia control program in india needs to be more comprehensive

Iron-deficiency anemia has continued to remain high in India. It is possibly due to relying on only iron-folic acid (IFA) supplementation through Anemia Control Program (ACP) that is National Iron Plus Initiative (NIPI). Based on the WHO's recommendations, we studied different interventions that can help to increase the effectiveness of NIPI such as Vitamin C supplementation with IFA, low-dose iron (LDI) with intensified health education (IHE), LDI with Vitamin C, and iron-rich food items to increase hemoglobin (Hb%) among adolescent girls through public-private partnership named Rashtriya Kishor Swasthya Karyakram. Increments in Hb after 12 weeks of interventions were compared with that of control groups one with NIPI and the other without any intervention. Highest increment in Hb% was observed in IFA under NIPI plus Vitamin C group, followed by LDI plus IHE group which was comparable to Hb increment in only the NIPI group. It emphasizes the need of making existing NIPI more stringent and comprehensive by integrating effective measures based on up-to-date scientific knowledge.

How Effective Is Iron Supplementation During Pregnancy and Childhood in Reducing Anemia Among 6-59 Months Old Children in India?

Objectives: The study sought to identify whether iron and folic acid supplementation of pregnant women and preschool children is associated with child's anemia status and the predictors of anemia among children in India.

Design: Secondary data analysis was performed using the National Family Health Survey 4 data. Multivariable logistic regression was used to identify the adjusted associations between child's anemia status and iron supplementation, both during pregnancy and childhood. Also, a model of significant predictors of anemia among children was fitted.

Setting: India.

Participants: Youngest children (6-59 months) in families.

Results: The adjusted association between supplementation during pregnancy and child's anemia status was significant (p = 0.010), whereas the adjusted association between supplementation during childhood and child's anemia status was insignificant (p = 0.16). The variables independently associated with anemia status of the child included younger age (95% CI 2.67–2.86), child's recent diarrhea (95% CI 1.02–1.14), low birth weight (95% CI 1.17–1.27), current underweight (95% CI 1.14–1.28), diet diversity score (95% CI 0.96–0.98), higher birth order (95% CI 1.01–1.05), mother's current anemia (95% CI 1.68–1.81), months of breastfeeding (95% CI 0.99–1.00), no/primary education (95% CI 1.23–1.35), family's low wealth index (95% CI 1.11–1.23), and backward caste (95% CI 1.04–1.14).

Conclusions: The National Iron Plus Initiative strategy of child's iron supplementation should be evaluated to identify the reasons of its ineffectiveness in anemia reduction. In addition, vulnerable groups of children, i.e., children from poor and less educated families and those with low birth weight, higher birth order, and poor nutritional status, should be targeted first with anemia reduction interventions.