Pregnancy Anaemia in India

Pregnancy Anaemia in India
The 2nd most common cause of maternal deaths in India
(reference)
Definition
“The Quantitative or qualitative reduction of Haemoglobin (Hb) or
circulating the RBCs or both resulted in decreased level of oxygen carrying
capacity of the body” (Chowdhury, Rahman & Moniruddin, 2014)
WHO
- Haemoglobin (Hb) content less than 11gm/dl & hematocrit <33%
- Postpartum haemoglobin less than 100gm/dl
CDC definition
- Hb < 11gm/dl- 1st and 3rd trimesters
- <10..5gm/dl- 2nd trimesters

Objectives
• Target- pregnant women
• Setting-India
• Interpret needs-using
epidemiological, qualitative,
quantitative
• Prevalence - to identify mortality
morbidity rates
• Strategies-to reduce inequalities
• Actions-specific to national ,state,
community level
• Evaluation of intervention
• Conclusion

Pregnancy Anaemia
Cause of:
• Premature birth
• Cardiac failure of the mother
• Abruption
• Maternal deaths
• Stillbirths of babies
• Preeclampsia
• Reduces the tolerating power of bleeding during the child birth.
• Uterine atony
• Infections
• Behavioural abnormalities
• Adult onset HTN
• Low birthweight
• Cognitive dysfunction (World Health Organisation, 2016).

Burden of disease
• In the period between 1995 and 2011, pregnancy anemia
was the leading cause of about 68.4 million years of deaths
and disability (YLD) among women globally (Siddiqui et al.,
2017).
• It results in adverse affects on both the child and maternal
health outcomes right from low birth weight, Preeclampsia,
cognitive dysfunction, neonatal, maternal mortality etc.

Causes of Pregnancy Anaemia
(Anand et al., 2014
Nutritional
Anaemia
• 1. B12
deficiency
• 2. Folate
deficiency
• 3. Iron
deficiency
Haematologi
cal
conditions
• 1.
Thalasaemia
• 2. Leukemia
• 3. Sickle cell
disease
Infections
• 1. Malaria
• 2. HIV
Chronic
blood Loss
• 1. GI
Bleeding
• 2.
Haemorroids
Short birth
intervals

Rates of
Pregnan
cy
anaemia
in India
In India, about 20% of the total maternal
deaths are because of Anemia (Anand et
al., 2014).
80% of the maternal death due to
pregnancy anaemia (Chowdhury,
Rahman & Moniruddin, 2014).
About 50.4% of pregnant women were
found to be Anemic in the year 2016 in
India as per the report of NFHS

Distribution of Anaemia in India
•Age, Education and occupation
•Parity
•Vegetarian and mixed diet (Rajamouli et
al., 2016).

Distribution of Anaemia by age, education and
occupation

Distribution of Anaemia by Parity
Distribution of Anaemia by Vegetarian and
Mixed diet

Vicious circle of Anaemia in
Indian womenPoverty |
malnutrition
Gender
bias in
educati
on
Poor spacing |
early
marriages
Anaemi
c
mothers
Anaemi
c babies
Parasite
s

Variations across the country
(Kaur, 2014)

Variations across the world
(Melku et al., 2014)

Case study
ANFHS-3 survey was conducted in the year 2005
and 2006 nationwide. A representative sample
survey of about 109,041 households, 124,385
women in the age group 15-49 years were
conducted. It was the only survey in India that
collected a comprehensive nutrition data with
representative samples from all the 29 states of
India.. The samples of pregnant (n = 5,911),
lactating (n = 21,973) and NP-NL (n = 97,418)
women are adequate to carry out the robust

Strategies
• Managing the iron deficiency in the mother right
from the very beginning of pregnancy.
• Iron supplements to be given by mouth or parental
route as intravenous and intramascular injections.
• Helplines and online help
• Awareness Schemes (Policy Making)
• Care homes
• Work places
• Schools, Colleges and Universities
• Primary care physician practice
• Community centres, patient group meetings

Prevention Program\steering
groups• 1970 National Nutritional Anaemia Prophylaxis
Programme (NNAPP) was initiated for reducing the
rate of anaemia to 25 % Khan, Srivastav & Dixit,
2014).
• Daily dose of elemental iron for prophylaxis and
therapy are increased to 150 to 200mg under the
Child Survival and Safe Motherhood (CSSM)
Programe
• Under Anemia Prevention and Control Program of
Indian Government, folic acid and iron tablets are
distributed to the pregnant women.
• Under Weekly Iron Folic Acid Supplementation
(WIFS) programme, folic acid supplements are

Steering groups(asset based
approach)
• There is a strong need to work around the suggestive
measures arising from this study.
• In particular, strengthening and monitoring the existing
programs (e.g., 1970 National Nutritional Anaemia
Prophylaxis Programme (NNAPP), Child Survival and
Safe Motherhood (CSSM) Programe, Anemia Prevention
and Control Program, Weekly Iron Folic Acid
Supplementation (WIFS) programme is important to
manage and monitor the improvement
• promoting awareness and health knowledge among
women regarding nutrition is likely to decrease the
negative outcome.

Evaluation on the effectiveness of
intervention
• Increasing functionality of the centres for easier access
and use in different parts of India (especially Rural)
• Continuous monitoring and tracking the improvements
and reports from the public health professionals for
collecting the updated data and identify gaps
• Decrease in the percentage of pregnant women in
India who are anaemic from 58% to 50% as per 2016
(Kassebaum et al., 2014).

Conclusion
• Nutritional Anaemia (iron deficiency) is the major
common cause of this disease.
• With the proposed strategies, there is likely to be
reduction in the outbreak of this disease.
• Addressing the specific needs of pregnant is
important.

References:
• Anand, T., Rahi, M., Sharma, P., & Ingle, G. K. (2014). Issues in prevention of
iron deficiency anemia in India. Nutrition, 30(7-8), 764-770.
• Chowdhury, S., Rahman, M., & Moniruddin, A. B. M. (2014). Anemia in
pregnancy. Medicine Today, 26(1), 49-52.
• Dhikale, P., Suguna, E., Thamizharasi, A., & Dongre, A. R. (2015). Evaluation of
weekly iron and folic acid supplementation program for adolescents in rural
Pondicherry, India. Int J Med Sci Public Health, 4(10), 1360-1365.
• Kassebaum, N. J., Jasrasaria, R., Naghavi, M., Wulf, S. K., Johns, N., Lozano,
R., ... & Flaxman, S. R. (2014). A systematic analysis of global anemia burden
from 1990 to 2010. Blood, 123(5), 615-624.
• Kaur, K. (2014). Anaemia ‘a silent killer’among women in India: Present
scenario. European Journal of Zoological Research, 3(1), 32-36.
• Khan, M. S., Srivastav, A., & Dixit, A. K. (2014). The burden of anaemia
amongst antenatal women in the rural population of northern
India. International Journal of Scientific Study, 1(4), 40-42.

• Melku, M., Addis, Z., Alem, M., & Enawgaw, B. (2014). Prevalence and predictors of
maternal anemia during pregnancy in Gondar, Northwest Ethiopia: an institutional
based cross-sectional study. Anemia, 2014.
• Nair, M., Choudhury, M. K., Choudhury, S. S., Kakoty, S. D., Sarma, U. C., Webster,
P., & Knight, M. (2016). Association between maternal anaemia and pregnancy
outcomes: a cohort study in Assam, India. BMJ Global Health, 1(1), e000026.
• Natale, V., & Rajagopalan, A. (2014). Worldwide variation in human growth and the
World Health Organization growth standards: a systematic review. BMJ open, 4(1),
e003735.
• Siddiqui, M. Z., Goli, S., Reja, T., Doshi, R., Chakravorty, S., Tiwari, C., ... & Singh,
D. (2017). Prevalence of anemia and its determinants among pregnant, lactating,
and nonpregnant nonlactating women in India. Sage Open, 7(3),
2158244017725555.
• Tabrizi, F. M., & Barjasteh, S. (2015). Maternal hemoglobin levels during pregnancy
and their association with birth weight of neonates. Iranian journal of pediatric
hematology and oncology, 5(4), 211.
• World Health Organization. (2016). Guideline daily iron supplementation in infants
and children. World Health Organization.
References:

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