FOR MORE PRESENTATIONS http://medicalpresentation.blogspot.in/

1. ANEMIA PROPHYLAXIS
PROGRAMME

2. Definition
♦ Anemia - insufficient Hb to carry out O2 requirement
by tissues.
♦ WHO definition : Hb conc. < 11 gm %
♦ CDC definition : Hb conc. < 11gm % in 1st and 3rd
trimesters and < 10.5 gm% in 2nd trimester
♦ For developing countries : cut off level suggested is
10 gm %

3. WHO Classification of Anaemia
Degree Hb% Haematocrit (%)
Moderate 7-10.9 24-37%
Severe 4-6.9 13-23%
Very Severe <4 <13%

4. Magnitude of Problem
♦ Globally, is about 30 %
♦ In developing countries &
India, incidence is around
40 – 90%.
♦ Responsible for 40% of
maternal deaths in third world
countries.
♦ Important cause of direct and
indirect maternal deaths

5. Reason For Increased
Incidence Of Anemia
♦ Poor pre-pregnancy iron balance due to –
untreated systemic diseases & menstrual
disorders
♦ Improper supplementation of iron in pregnancy
( late registration and poor follow up)
♦ Repeated childbearing
♦ Lack of awareness and illiteracy

6. Reason For Increased
Incidence Of Anemia
♦ Low socioeconomic status and poor hygiene
♦ Chronic malnutrition
♦ Poor availability of iron due to predominantly
veg diet, diet low in calories but rich in phytates.
Food and religious taboos
♦ GI infections and infestations
(e.g. Kala azar, worm infestations)

7. Complications - Pregnancy
IUGR CCF
PIH INFECTION
IUD IUH
Medical PRETERM
Disorder LABOUR

8. Complications - Labour
PPH
Instrumental Foetal
delivery CCF Distress
MATERNAL Morbidity
PERINATAL Mortality

9. Available studies on prevalence of nutritional
anemia in India show that 65% infant and
toddlers, 60% 1-6 years of age, 88% adolescent
girls (3.3% has hemoglobin <7 gm./dl; severe
anemia) and 85% pregnant women (9.9%
having severe anemia. The prevalence of
anemia was marginally higher in lactating
women as compared to pregnancy. The
commonest is iron deficiency anemia.

10. launched in 1970
to prevent nutritional anemia in mothers and
children.
1 tablet of iron and folic acid daily for a period of
100 days.
taken up by Maternal and Child Health (MCH),
Division of Ministry of Health and Family Welfare.
Now it is part of RCH programme.

11. The Ministry of Health and Family Welfare has revised the
guidelines on IFA supplementation related to the National
Nutritional anaemia Prophylaxis programme.
The infants between 6-12 months should also be included in
the programme as there is sufficient evidence that iron
deficiency affects this age also.
Children between 6 months to 60 months should be given
20mg elemental iron and 100 mcg folic acid per day per child
as this regimen is considered safe and effective.
National IMNCI guidelines for this supplementation to be
followed.

12. For children (6-60 months), ferrous sulphate and folic acid should be
provided in a liquid formulation containing 20 mg elemental iron and
100mcg folic acid per ml of the liquid formulation. For safety reason,
the liquid formulation should be dispensed in bottles so designed that
only 1 ml cab be dispensed each time.
The current programme recommendations for pregnant and lactating
women should be continued.

13.
School children, 6-10 year old, and adolescents, 11-18 year olds,
should also be included in the National Nutritional Anaemia
Prophylaxis Programme (NNAPP).
Children 6-10 year old will be provided 30 mg elemental iron and
250 mcg folic acid per child per day for 100 days in a year.
Adolescents, 11-18 years will be supplemented at the same doses and
duration as adults. The adolescent girls will be given priority.
Multiple channels and strategies are required to address the problem
of iron deficiency anaemia. The newer products such as double
fortified salts / sprinkles/ ultra rice and other micro nutrient
candidates or fortified candidates should be explored as an adjunct or
alternate supplementation strategy.

14. THANK YOU