Centre wants to treat anaemia with iron tablets. Can pills substitute nutritious food?
Eleven-year-old Indumati Katla, who lives in Wazirpur, Delhi, went to school on July 17. There, her class teacher asked her to gulp down a maroon tablet. Two hours later, she was in hospital recuperating from severe nausea, giddiness and fatigue. She was among the 200 government school students in Delhi who fell ill that day after being administered iron tablets as part of the Weekly Iron and Folic Acid Supplementation (WIFS) programme.
Centre launched the programme to tackle anaemia among adolescents in the country under the National Rural Health Mission in mid-July this year.
In 2000, the Centre had launched Unicef-Adolescent Girls Anaemia Control Programme, which was implemented in 13 states. But the programme was not addressing a large number of adolescent boys who were anaemic. WIFS was planned for all adolescents between 10 and 19 years.
“The beneficiaries of WIFS will be 6 crore boys and girls studying in class 6th to 12th in government schools, aided schools and 7 crore out-of-school adolescent girls, through anganwadi centres,” said Union health minister Ghulam Nabi Azad when the programme was launched. According to Census 2011, more than 5 crore adolescents are anaemic in the country.
| Lacunae in programme
50% of women
58% of pregnant women
56% of adolescent girls
30% of adolescent boys
80% of children below 3 years
Source: National Family Health Survey-3
Health minister of Delhi A K Walia discounts the cases of students falling sick after consuming iron tablets. Such problems can occur in one per cent of the cases, he says.
Reports of nausea, giddiness and diarrhoea discourage parents from allowing their children to take the supplements. A Unicef study conducted in 2011 after the launch of Adolescent Girls’ Anaemia Control Programme states that in Jharkhand, some parents did not allow their daughters to participate in the programme because they assumed that the tablets were contraceptive pills.
“The main reason for the fiasco in the programme is the casual attitude the authorities have towards the beneficiaries who are mostly children of the poor,” says Ashok Aggarwal, advocate and Right to Education activist.
It is crucial to control adolescent anaemia to reduce prevalence of anaemia in the country. Young boys and girls undergo hormonal and physical changes at this age and require more nutrition. Girls start menstruating at this age.
“In India, the marriageable age is low compared to other countries. This results in a substantial number of girls becoming mothers when they are still adolescent,” says Sushma Dureja, deputy commissioner, adolescent health. This starts a cycle of mild anaemia. A child born to an anaemic mother is likely to have low iron and haemoglobin levels and low iron storage capacity. If not treated in infancy, it can lead to childhood anaemia and later adolescent anaemia. Not treated at this point, the individual can become anaemic for life, says Dureja.
Anaemia reduces a person’s productivity due to low level of energy. One feels sleepy and cannot concentrate. Immunity level of the individual can go down leading to frequent illnesses.
According to Census 2011, of the 5.7 crore adolescent girls, 3.2 crore are anaemic, and of the 6.5 crore adolescent boys, 2 crore are anaemic. Nearly 22 per cent of anaemic girls have mild anaemia (11.9 gm to 10 gm haemoglobin/100 ml blood), 48.7 per cent have moderate anaemia (9.9 gm to 7gm Hb/100 ml blood) and 27.2 have severe anaemia (less than 7 gm Hb/100 ml blood). Studies by state governments show similar results.
In 2011-12, the Haryana government conducted a study in 11,776 schools. Of the 1,821,915 students, 1,291,058 (71 per cent) were anaemic. Nearly 48 per cent had mild anaemia, 23 per cent had moderate anaemia and 0.53 per cent had severe anaemia.
World Health Organization recommends a three-pronged strategy to control anaemia—dietary diversification and improvement, food fortification with iron and other essential micronutrients such as vitamins and minerals, and regular consumption of iron and folic acid supplements.
Tablets cannot replace food, says Mira Shiva, public health activist and coordinator of Initiative for Health and Equity in Society. “Even tablets are absorbed and become effective only with good food. Government cannot look for short cuts,” she adds.
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