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ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 1691-1694  

A study to assess prevalence of anaemia among beneficiaries of Anaemia Mukt Bharat Campaign in Uttarakhand


1 Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
2 Department of Pathology, AIIMS, Rishikesh, Uttarakhand, India
3 Department of Anatomy, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission25-Oct-2019
Date of Decision14-Feb-2020
Date of Acceptance24-Feb-2020
Date of Web Publication26-Mar-2020

Correspondence Address:
Dr. Mahendra Singh
Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_941_19

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  Abstract 


Context: Anaemia is defined as a decreased concentration of blood haemoglobin. It is one of the most common nutritional deficiency diseases observed globally affecting both developing and developed countries. Aims: To find out the prevalence of anaemia among the beneficiaries of Anaemia Mukt Bharat and its association with age and gender. Settings and Design: A cross-sectional study was conducted in Uttarakhand by AIIMS Rishikesh in a month-long campaign including 5,776 beneficiaries. Camps were organized at the hospital campus, schools, district hospitals, Community Health Centre (CHC), Primary Health Centre (PHC), subcentres (SC), Anganwadi Centres (AWCs), slum areas, adolescent health day celebration sites and Village Health and Nutrition Day (VHND) sites. Methods and Material: Data on age and gender along with haemoglobin level using HemoCue Haemoglobinometer was collected. Statistical Analysis Used: These data were entered into Microsoft Excel and analysed to calculate the prevalence of anaemia and its association with age and gender using Epi Info software version 7. Pearson's Chi-square test was applied. P value < 0.05 was considered as significant. Results: Out of 5,776 participants 53.2% were anaemic. Females (54.6%) were more anaemic than males (45.1%). 33.5% of pregnant females were found to be anaemic. Conclusions: Prevalence of anaemia was very high among the study participants. It shows that anaemia is a major public health problem so efforts should be taken to reduce the prevalence of anaemia and promote the health of an individual, community as well as the country.

Keywords: Anaemia, haemoglobin testing, prevalence


How to cite this article:
Kishore S, Singh M, Jain B, Verma N, Gawande K, Kishore S, Aggarwal P, Verma SK. A study to assess prevalence of anaemia among beneficiaries of Anaemia Mukt Bharat Campaign in Uttarakhand. J Family Med Prim Care 2020;9:1691-4

How to cite this URL:
Kishore S, Singh M, Jain B, Verma N, Gawande K, Kishore S, Aggarwal P, Verma SK. A study to assess prevalence of anaemia among beneficiaries of Anaemia Mukt Bharat Campaign in Uttarakhand. J Family Med Prim Care [serial online] 2020 [cited 2020 Apr 5];9:1691-4. Available from: http://www.jfmpc.com/text.asp?2020/9/3/1691/281224




  Introduction Top


Anaemia is defined as a decreased concentration of blood haemoglobin. It is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet the body's physiological requirements, which vary by age, sex, altitude, smoking habits, and during pregnancy.[1] Its prevalence is inordinately higher among developing nations, because of low socioeconomic status and indigent access to healthcare services.[2]

Anaemia affects an estimated 2.36 billion individuals globally, especially women and children.[3] The prevalence of anaemia is estimated to be higher in India when compared to all other developing countries.[4] Also, it is the second leading cause of maternal deaths in the country.[5] According to the National Family Health Survey 4 (NFHS-4), 58.4% of children aged 6–59 months, 53.1% of nonpregnant women aged 15–49 years, 50.3% of pregnant women aged 15–49 years, 53% of all women aged 15–49 years, 22.7% of men aged 15–49 years, 54% of adolescent girls and 29% of adolescent boys were anaemic in India.[6]

In the short run, anaemia leads to tiredness, heart palpitations and difficulty in breathing.[7] Children, women of reproductive age and pregnant women are at high risk of developing anaemia. Maternal anaemia is associated with maternal and child morbidity and mortality such as increased increased risk of miscarriage, stillbirth, prematurity and low birth weight of the baby.[8] About 20% of perinatal mortality and 10% of maternal mortality in developing countries is attributed to iron deficiency.[9]

To achieve the targets of the World Health Assembly of 50% reduction of anaemia in women of. This has been built upon the existing framework of NIPI with a special focus on intensive behaviour change communication, vulnerable geographies, procurement and supply chain management issues and others.

The primary care physician who is the backbone of the health care system and also the first contact point for a patient plays a crucial role in the identification and management of anaemia. ASHA, ANM and Anganwadi workers present at Subcentres, Anganwadi centres and PHCs should be trained and well equipped for early identification and management of anaemia in the community as in the public sector, majority of the anaemic cases can be handled at the level of primary health care level only. Also, data collected about the prevalence of anaemia will help the policymakers to further implement policies and programmes to decrease the burden of anaemia. The present study was conducted under this programme with an aim and objective to determine the prevalence of anaemia and its relationship with age and gender among the beneficiaries of Anaemia Mukt Bharat in Uttarakhand.


  Subjects and Methods Top


Anaemia Mukt Bharat test and treat campaign

Anaemia Mukt Bharat Campaign was conducted by the Ministry of Health and Family Welfare, Government of India, in the month of September 2018 named as (Poshan Maah 2018). All India Institute of Medical Sciences (AIIMS), New Delhi was the nodal agency for its smooth functioning. A month-long campaign would be undertaken at all six new AIIMS (namely AIIMS Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh).[10]

Campaign at AIIMS Rishikesh

A month-long campaign was also undertaken in Uttarakhand by AIIMS Rishikesh in the urban and rural areas through various outreach camps. Camps were organized at the hospital campus, schools, District Hospitals, CHC, PHC, SC, AWCs, slum areas, Adolescent health day celebration sites, and VHND sites. Haemoglobin testing was done. Banners, posters, pamphlets were displayed at places such as schools, AWCs, hospital campus etc., A total of 5,776 beneficiaries were screened. All male and female of age groups < 5 years, 5-14 years and ≥15 years were included. The beneficiaries were tested for haemoglobin level using HemoCue Hemoglobinometer. Cut off values of Haemoglobin to diagnose anemia was taken from [Table 1].[11]
Table 1: Haemoglobin levels to diagnose anaemia (g/dL)[11]

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HemoCue haemoglobinometer

The HemoCue Hb 301 System (Kit) is a safe and convenient solution when performing mobile anaemia screening programmes. The robust HemoCue Hb 301 System is an accurate and effective tool for anaemia screening also in a demanding climate with high temperature and humidity. It is optimized for use in primary care and blood donation settings – in urban as well as in rural settings.

Inclusion criteria

  1. All male and female of age groups < 5 years, 5–14 years and ≥15 years were included.
  2. All those who gave consent to participate in the study.


Exclusion criteria

  1. All those who did not give consent to participate in the study or showed hostile behaviour.
  2. All those who were critically and terminally ill.


Data analysis

Haemoglobin level along with information on age and gender was collected and entered into Microsoft excel. Then data were analysed to calculate the prevalence of anaemia and its association with age and gender using Epi Info software version 7. Pearson's Chi-square test was applied. P value < 0.05 was considered as significant.

Ethical clearance

The study was ethically approved by the ethical committee of the institute (29/11/2019). The protocol and importance of the study were explained to the participants before recruitment into the study, followed by a signed informed consent by them.


  Results Top


A total of 5,776 participants were screened for anaemia comprising 834 (14.4%) males and 4,942 (85.6%) females. Out of 4,942 females, 164 (3.3%) females were pregnant and 4,778 (96.7%) nonpregnant.

As shown in [Table 2] overall prevalence of anaemia was found to be 53.2% and out of which 45.1% were anaemic males and 54.6% anaemic females. Similarly, out of 4,942 females nonpregnant females were more anaemic (55.3%) than pregnant females (33.5%).
Table 2: Age and sex-wise prevalence of anaemia among study participants (n=5,612)

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Males were more anaemic (53.2%) in the age group less than five years whereas females were more anaemic in the age group 5–14 years (51.1%) and 15–49 (57.1%) years.

[Table 3] shows the distribution of participants in various age groups depending on the severity of anaemia. Mild moderate and severe anaemia was more in the participants belonging to 15–49 years of age group. Females in each age group were moderately and severely more anaemic than males.
Table 3: Distribution of study participants according to the classification of anaemia as mild, moderate and severe (n=5612)

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[Figure 1] shows that out of 164 ANC females 55 (33.5%) were anaemic. Out of these anaemic 32 (19.5%) had mild anaemia whereas 18 (11.0%) and 5 (3.0%) had moderate and severe anaemia, respectively.
Figure 1: Distribution of pregnant females according to classification of anaemia (N = 164). Attached separately

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  Discussion Top


In the present study, overall 53.2% beneficiaries were anaemic out of which 45.1% were anaemic males and 54.9% anaemic females. It is similar to the study done by Malhotra et al. in North India [12] in which the overall prevalence of anaemia was 47.9% being 50% among females and 44.3% among males. As seen in the present study, total anaemic children of the age group < 5 years is 46.9% which is lower than the values (59.8%) seen in the NFHS 4 data of Uttarakhand.[13] A study was done by Nanjunda et al. in South Karnataka [14] showed that 62% of under 5 children were anaemic which is also higher than the present study. Similarly in the present study in the age group 15–49 years the anaemic males were (45.4%) and females (57.1%) which is quite high than the NFHS 4 data of Uttarakhand,[13] male (15.5%) and females (46.2%) In the present study, anaemia in pregnancy was 33.5%, out of which 19.5% had mild anaemia whereas 11.0% and 3.0% had moderate and severe anaemia, respectively. In a study done by Bara et al. in Jharkhand,[15] 76% of pregnant women were anaemic and out of the 20% of cases were mild anaemia, 44% of moderate anaemia and 31% of severe anaemia. Similarly, a study done by Alene et al. in eastern Ethiopia [16] anaemia in pregnancy was 56.8%, out of them 1.2% of them were severely anaemic, 26.7% were moderately, and 28.9% were mildly anaemic. According to the NFHS 4 report of Uttarakhand [13] anaemia in pregnancy is 46.5%.


  Conclusion and Recommendation Top


The present study shows that the prevalence of anaemia was very high among the study participants. Females were more anaemic than males. The prevalence of moderate and severe anaemia was also high among females.

So, it is clearly seen that despite the progress made for anaemia reduction in the last decade especially in children and women, anaemia continues to be a major public health concern in India. To accelerate anaemia reduction health interventions should be targeted at pregnant women together with interventions for women and children during childhood. A holistic approach is needed. Various measures should be taken to combat anaemia such as eating nutritious and iron-rich foods, IFA supplementation during pregnancy and lactation, weekly iron-folic supplements for adolescents, deworming, health education, provision of fortified foods and screening and treatment of nonnutritional causes of anaemia. Improving women's education and empowering them is also important so they can make better dietary choices for themselves and their families.

Financial support and sponsorship

Funded by Ministry of Health and Family Welfare under Anemia Mukt Bharat Campaign.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO | Anemia. WHO [Internet]. 2018 [cited 2019 MARCH 20]. Available from: http://www.who.int/topics/anaemia/en/.  Back to cited text no. 1
    
2.
Sasidharannair A, Kumari C, Sinha P, Singaravelu SL, Jaikumar S. Prevalence of anemia among adolescent girls in a rural area of Tamil Nadu, India. J Family Med Prim Care 2019;8:1414-7.  Back to cited text no. 2
    
3.
Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in hemoglobin concentration and prevalence of total and severe anemia in children and pregnant and non-pregnant women for 1995–2011: A systematic analysis of population representative data. Lancet Glob Health 2013;1:e16-25.  Back to cited text no. 3
    
4.
Ramachandran P, Kalaivani K. Time trends in prevalence of anemia in pregnancy. Indian J Med Res 2018;147:268.  Back to cited text no. 4
    
5.
Vindhya J, Nath A, Murthy GVS, Metgud C, Sheeba B, Shubhashree V, et al. Prevalence and risk factors of anemia among pregnant women attending a publicsector hospital in Bangalore, South India. J Family Med Prim Care 2019;8:37-43.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Government of India. National family health survey 4- key indicators: 2015-2016. National Family Health Survey 2016;4:1-8.  Back to cited text no. 6
    
7.
Ezzati M, Lopez AD, Dogers A, Vander HS, Murray CJ. Selected major risk factors and global and regional burden of disease. Lancet 2002;360:1347-60.  Back to cited text no. 7
    
8.
Gautam S, Haju M, Kim H, Jeong HS. Determining factors for the prevalence of anaemia in women of reproductive age in Nepal: Evidence from recent national survey data. PLoS One 2019;14:e0218288.  Back to cited text no. 8
    
9.
Chellan R, Paul L, Prevalence of Iron-Deficiency Anemia in India: Results from a Large Nationwide Survey. Prevalence of iron-deficiency anemia in India: Results from a large nationwide survey. J Popul Stud Soc Stu 2010;19:1-23.  Back to cited text no. 9
    
10.
11.
Anemia Mukt Bharat, Operational Guidelines, Intensified National Iron Plus Initiative, released on April 2018 by Ministry of Health and Family Welfare, GOI. Available from: http://www.aadivasiaarogyam.com/wpcontent/uploads/2018/06/Poshan Abhiyan- NHM.pdf. [cited on 2019 Mar 22].  Back to cited text no. 11
    
12.
Malhotra P, Kumari S, Kumar R, Varma S, Prevalence of anemia in adult rural population of North India. J Assoc Physicians India 2004;52:18-20.  Back to cited text no. 12
    
13.
National Family Health Survey (NFHS4) 2015-2916, Uttrakhand report, cited 25 March 2019.  Back to cited text no. 13
    
14.
Nanjunda. Prevalence of under-nutrition and anemia among under five rural children of South Karnataka, India. Nitte University Journal of Health Science 2014;4:24-7.  Back to cited text no. 14
    
15.
Bara M, Srivastava M, Samuel A, Prevalence of anemia in pregnancy: A retrospective study at Tertiary care hospital in Jharkhand, India. J Dent Med Sci 2018;17:25-8.  Back to cited text no. 15
    
16.
Alene KA, Dohe A. Prevalence of Anemia and Associated Factors among Pregnant Women in an Urban Area of Eastern Ethiopia. Hindawi Publishing Corporation Anemia; 2014. p. 7. Article ID 561567.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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