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EDITORIAL
Year : 2015  |  Volume : 59  |  Issue : 1  |  Page : 1-2  

Emplementation of national iron plus initiative for child health: Challanges ahead


Dy Commissioner, Child Health,Ministry of Health and Family Welfare, Govt. of India, India

Date of Web Publication9-Mar-2015

Correspondence Address:
Sila Deb
Dy Commissioner, Child Health,Ministry of Health and Family Welfare, Govt. of India
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.152844

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How to cite this article:
Deb S. Emplementation of national iron plus initiative for child health: Challanges ahead. Indian J Public Health 2015;59:1-2

How to cite this URL:
Deb S. Emplementation of national iron plus initiative for child health: Challanges ahead. Indian J Public Health [serial online] 2015 [cited 2019 Oct 18];59:1-2. Available from: http://www.ijph.in/text.asp?2015/59/1/1/152844

Anemia, a manifestation of undernutrition and poor dietary intake of iron is a serious public health problem among pregnant women, infants, young children and adolescents [1] in India. National Family Health Survey (NFHS) 3 (2005-06) data depicts that seven out of every 10 children aged 6-59 months in India are anemic: 3%are severely anemic, 40% are moderately anemic, and 26% are mildly anemic. The prevalence of anemia has actually increased from NFHS 2 (1998-99) to NFHS 3 (2005-06) both in women and children. [2]

Anemia is often multi-factorial and, therefore, requires a multi-pronged approach for its prevention and treatment. Iron deficiency and infections are the most prevalent aetiological factors. However, other conditions may have a contributory role. The Copenhagen Consensus (2004) panel of eminent economists deliberated upon the returns of investing in micronutrient programs (including iron), among a list of 17 possible development investments and the benefit-to-cost ratio of iron interventions based on resource savings, improvement in cognitive development and schooling, and physical productivity was estimated to be as high as 200:1. [3]

Success in prevention and control of anemia has shown to contribute in reduction of maternal and child mortality and improve health outcomes for population as a whole. Though iron and folic acid (IFA) supplementation in children, pregnant women, and lactating mothers were in place under national health programme of our country for the last few years, a comprehensive approach to combat anemia has been missing.

Taking this into cognizance, Ministry of Health and Family Welfare, GoI in 2013 launched the National Iron Plus Initiative (NIPI) as a comprehensive strategy to combat the public health challenge of iron deficiency anemia prevalent across the life cycle, as iron deficiency contributes more than 50% of anemia in our country. There are age specific interventions with IFA supplementation and deworming for improving the haemoglobin levels and reducing the prevalence of anemia for all age groups, i.e. children ages 6-59 months, children ages 5-10 years, adolescent girls and boys ages 11-19 years, pregnant and lactating women, and women in the reproductive age group (20-49 years). The NIPI attempts to holistically address both preventive and curative aspects of this challenge across all life stages and at various levels of care. The schedule of IFA supplementation has also been reviewed to make both administration and compliance much simpler. The age group specific interventions under the NIPI are as follows:

1. For children 6-59 months:

  • Bi-weekly 1 ml of IFA syrup containing 20 mg of elemental iron and 100 mcg of folic acid throughout the year. The IFA bottles should have an auto-dispenser so only 1 ml of syrup will be dispensed at a time.
  • Bi-annual deworming for anti-helminthes control (albendazole tablet 200 mg for children aged 12-24 months and albendazole tablet 400 mg for children aged 36-59 months).


2. For children 5-10 years:

  • One weekly IFA tablet containing 45 mg elemental iron and 400 mcg folic acid throughout the year.
  • Albendazole (400 mg) tablets for deworming are to be administered twice a year for anti-helminthic treatment.


3. For adolescents (10-19 years): Weekly iron folic acid supplementation (WIFS)

  • One weekly IFA tablet containing 100 mg elemental iron and 500 mcg Folic acid.
  • Albendazole (400 mg) tablets for deworming are to be administered twice a year for anti-helminthic treatment.


4. For pregnant and lactating women:

  • Daily dose of one IFA tablet supplementation (100 mg elemental iron and 500 mcg of folic acid) every day for at least 100 days, starting after the first trimester at 14-16 weeks of gestation, followed by the same dose for 100 days in post-partum period for lactating women.


5. For non-pregnant non-lactating women in reproductive age (20-49 years):

  • One weekly IFA tablet containing 100 mg elemental iron and 500 mcg of folic acid throughout the calendar year, i.e., in all 52 weeks, each year.
  • Albendazole (400 mg) tablets for deworming are to be administered twice a year for anti-helminthic treatment.
  • In addition to this, all women in the reproductive age group in the pre-conception period and up to the first trimester of the pregnancy are advised to have 400 mcg of folic acid tablets to reduce the incidence of neural tube defects in the fetus.
NIPI is a recently launched programme and all states and union terrorities (UTs) are in the process of budgeting in their annual Programme Implementation Plans (PIPs) under the National Health Mission and operationalizing the scheme. A few of the states like Assam, West Bengal, Uttarakhand, and Odisha have recently initiated bi-weekly IFA syrup supplementation to children aged 6-59 months. Almost all states and UTs are providing IFA tablets to pregnant and lactating mothers as part of their antenatal care package. Only Odisha and Assam have started with weekly IFA supplementation to children 5-10 years old. IFA and bi-annual deworming in non-pregnant non-lactating women age group is yet to start in program mode in any state or UT at this date.

There are few programmatic challenges that are being faced in effective implementation of the interventions under NIPI, including many states are not prioritizing the interventions of both IFA supplementation and deworming. Moreover, challenges lie in ensuring compliance of bi-weekly IFA syrup supplementation to children under 5 years old and weekly IFA to children 6-19 years old. Ensuring supervised consumption of IFA supplements in presence of Acredited Social Health Activist (ASHAs) is a time and resource intensive activity, practically not feasible to implement in view of work burden of ASHA, though the central ministry has introduced the concept of incentivizing the frontline workers for the same. Moreover, procurement and logistics management of IFA syrup, IFA tablet, and albendazole as well as reporting formats is also difficult and transport of the same upto each Anganwadi and School remains a herculean task. Further, states have shared facing difficulty in getting reports from schools in view of already burdened school teachers. Indeed, effective coverage of children under 5 years old, school going and out of school children, pregnant and lactating women, and women of reproductive ages calls for streamlined inter-sectoral convergence between various line departments and ministries like Ministry of Health and Family Welfare, Ministry of Women and Child Development, Ministry of Human Resource Department (Deptartment of School Education and Literacy), Ministry of Tribal Affairs, Rural Development, Urban Development, etc. which is challenging to ensure and translate in to effective implementation of all components.

Ministry of Health and Family Welfare, however, is committed to reducing anemia across all life stages and is constantly striving and putting efforts to streamline effective implementation of this initiative. The launching of National Deworming Day (February 10, 2015) in 11 states and UTs in the first phase, for ensuring coverage of deworming intervention across all children 1-19 years old through a fixed day strategy is one such step towards it.

 
   References Top

1.
Ministry of Health and Family Welfare. Govt of India. Guidelines for control of anaemia: national iron plus initiative. Available in: http://www.unicef.org/india/10._National_Iron_Plus_Initiative_Guidelines_for_Control_of_IDA.pdf [Last accessed on 2015 Feb 10].  Back to cited text no. 1
    
2.
International Institute for Population Sciences and Macro International (September 2007). "National Family Health Survey (NFHS-3), 2005-06". Ministry of Health and Family Welfare, Government of India. Available from: http://www.measuredhs.com/pubs/pdf/FRIND3/FRIND NFHS - 3 2005 -06. National Family Health Survey, 2005-06. [Last accessed on 2015 Feb 23].  Back to cited text no. 2
    
3.
Behrmann JR, Alderman H, Hoddinott J. Copenhagen Consensus hallenge Paper: The Challenge of Hunger and Malnutrition. 2004. Available in http://www.copenhagenconsensus.com/sites/default/files/CP+-+Hunger+FINISHED.pdf [Last accessed on 2015 Feb 10].  Back to cited text no. 3
    



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