The story so far: Questions related to anaemia are slated to be dropped from the National Family Health Survey (NFHS-6) scheduled to begin on July 6. The omission comes after health experts questioned the efficacy of the method being used to estimate haemoglobin levels. India’s anaemia burden has grown alarmingly with NFHS-5 (2019-21) finding that 57% of women in the age group 15-49 and 67% children between six months and 59 months are anaemic (from the corresponding 53% and 58.6% respectively in NFHS-4 (2015-16)). The Health Ministry has noted that anaemia is a public health challenge and accurate estimates are needed to tackle the crisis.
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What causes anaemia?
According to the World Health Organization (WHO), anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. Haemoglobin is needed to carry oxygen and if there are too few red blood cells, or not enough haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues, resulting in symptoms such as fatigue, weakness, dizziness and shortness of breath among others. Anaemia, according to WHO, may be caused by several factors. The most common nutritional cause of anaemia is iron deficiency although deficiencies in folate, vitamins B12 and A are also important causes. According to the Health Ministry, assessment of anaemia in India is being shifted to the new Diet and Biomarkers Survey in India (DABS-I), launched last year to map diet, nutrition and health status and provide the correct estimate of anaemia among the rural and urban population.
What prompted the change?
Researchers from Sitaram Bhartia Institute of Science and Research, New Delhi, St. John’s Medical College, Bengaluru, and the Indian Institute of Population Sciences, Delhi, had cautioned that there is a danger of anaemia being over-diagnosed in India as it follows WHO cut-offs for haemoglobin which may not be suited to India, because the cut-off point depends on the age, gender, physiological status, altitude and other factors. The WHO defines anaemia in children aged under five years and pregnant women as a haemoglobin concentration <110 g/L at sea level, and anaemia in non-pregnant women as a haemoglobin concentration <120 g/L. The study by the Indian team also pointed to differences in the way blood is drawn for sampling in NFHS. The NFHS survey measured haemoglobin in a drop of capillary blood that oozes from a finger prick. This, as per the report, can dilute the blood and give a falsely lower value. The recommended method of venous blood sampling, as per the report, gives a more accurate value.
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Will a dietary survey help?
The Health Ministry says DABS-I is a comprehensive national-level dietary survey, which will define food and nutrient adequacy by collecting individual dietary intake data of different age-groups of people from all States and UTs across the country. The study will also provide nutrient composition data on cooked and uncooked foods from various regions of the country for the first time. On the other hand, NHFS provides information on population, health, and nutrition for India and each State/UT. Besides providing evidence for the effectiveness of ongoing programmes, the data from NFHS helps in identifying the need for new programmes with an area specific focus.
Why the focus on anaemia?
Data on anaemia remains an important indicator of public health since anaemia is related to morbidity and mortality in the population groups usually considered to be the most vulnerable — pregnant women and children under five. A prevalence study on anaemia is useful to monitor the progress of reproductive health. Also, iron-deficiency anaemia reduces the work capacity of individuals and entire populations, with serious consequences for the economy and national development.
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Dr. Antaryami Dash, deputy director, Health and Nutrition, Bal Raksha Bharat (Save the Children), said the proposed method of screening under DABS-I is likely to provide better estimates of anaemia. “There will be appropriate screening but through a different survey and we are hopeful that in the coming years we will be able to make a dent in the prevalence of anaemia across different age groups,” he added. Additionally, Dr. Vishesh Kasliwal, founder, Medyseva (health start-up with e-clinics across the country), stated that NFHS’s strength lies in its ability to provide a broader understanding of the issue and facilitate evidence-based policy-making and targeted interventions.