Anaemia is a serious global public health problem that particularly affects young children, menstruating adolescent girls and women, and pregnant and postpartum women. WHO estimates that 40% of children 6–59 months of age, 37% of pregnant women, and 30% of women 15–49 years of age worldwide are anemic. Rising Kashmir’s senior health correspondent, M Peerzada interviews senior Paediatrician Department of Paediatrics GMC Srinagar, Dr Suhail Naik, who talks about causes and measures that are vital to prevent anaemia among children.
What is anemia in children?
Anemia is a condition in which the number of red blood cells or the hemoglobin concentration within them is lower than normal for the given age, sex, and geographical area. I meant to say that the hemoglobulin levels are different at different ages and the levels also vary with geographical area. The people living at higher altitudes like Ladakh have more haemoglobin than Kashmiris.
Haemoglobin is a very important molecule and carries oxygen from the lungs to all the tissues of the body. Therefore, decreased levels of hemoglobin mean decreased capacity of the blood to carry oxygen to the body’s tissues.
This non-availability of optimal oxygen results in different symptoms such as fatigue, weakness, dizziness, poor concentration, attention span, and shortness of breath, among others. Further, the normal iron status or hemoglobin is essential for optimal brain development during the first three years of life, what we call as formative years of brain development, and that determines the cognitive abilities, intellectual abilities, and overall total success of an individual in later years of life.
What are its causes?
Anaemia may be caused by several factors like improper nutrition or inadequate absorption of nutrients, infections, chronic inflammation, chronic diseases, gynaecological and obstetric conditions, and inherited red blood cell disorders. The most common nutritional cause of anaemia is iron deficiency, although deficiencies in folate, vitamins B12 and A are also important causes.
What are its symptoms?
Anemia can cause a range of non-specific symptoms including tiredness, weakness, dizziness or light-headedness, poor attention, poor concentration, learning difficulties and shortness of breath, especially upon exertion and heart problems. Children and pregnant women are especially vulnerable, with more severe cases of anemia leading to an increased risk of maternal and child mortality. Iron deficiency anemia has also been shown to affect cognitive and physical development in children and reduce productivity in adults.
Anaemia is an indicator of both poor nutrition and poor health. The iron deficiency anemia is rightly called as hidden hunger and can affect people across all socioeconomic strata. It is problematic on its own, but it can also impact other global public health concerns such as stunting. A pregnant lady with anaemia has significant probability to give birth to preterm and low birth-weight babies. The low-birth-weight babies will grow on the lowest trajectory of growth and development curves and vicious cycle will continue and that is going to impact the growth and development of the nation.
What are the remedial measures?
The major cause of iron deficiency anaemia is improper nutrition, poor knowledge about the nutrition and following advice of senior family members which are based on traditional myths. The people do not know how to start complementary feeding, what to feed, when to feed and how much to feed. The society is engulfed by nutritional disorders, where 33% people are obese and 33% people are underweight or wasted. The exponential rise in non-communicable diseases is due to improper nutrition. There is a dilemma whether people are eating food or food is eating the people.
The data revealed by the National Family Health Survey is shocking to say at least as only 60% babies are exclusively breastfed and 40 % babies in the age group 6 to 8 months take semisolid food. The survey revealed that only 11 % of babies in the age group 6 months to 2 years receive an adequate diet.
Subsequently, 30 % of children under 5 years of age are stunted and 17.6% are wasted. 70.1% of children in the age group 6 months to 5 years are anemic, NFHS 5 revealed. This amply shows that despite the availability of adequate food, hidden hunger is still prevailing and is a major public health problem.
What are the possible complications of anemia in a child?
Anaemia will negatively impact the growth and development of a child, cognitive abilities, school, and sports performance, learning abilities, and long-term anaemia can result in heart failure. The anemic children develop loss of appetite, poor food intake and that worsens the nutritional status and a vicious cycle is set.
Do children still die of anemia in Kashmir hospitals?
Look, anemia is indirectly contributing to under-5 child mortality. The anemic children can’t fight with common infections and frequently develop severe pneumonia and recurrent diarrhoea. Pneumonia and diarrhoea are leading causes of under-5 child mortality across the globe. Therefore, to decrease the under-5 child mortality, addressing anaemia is an important dimension besides other preventive and promotive health measures.
What is the treatment?
Instead of treatment, we should talk about prevention. Besides proper nutrition the different national programs of iron supplementation must be implemented in letter and spirit. The preventive measures start from womb like iron folic acid supplementation to mother, delayed cord clamping, iron supplementation from 6 weeks of life, iron rich diet in mid-day meals and Anganwadi, bi-weekly iron folic acid supplementation. Adolescent iron supplementation program and so on. To build a nation holistically, iron supplementation is must for the holistic development of individuals.
How can people prevent children from getting anemia?
As I said, proper nutrition, iron supplementation, exclusive breastfeeding, vaccination, deworming, etc. The maternal iron status determines the iron status of a person from womb to tomb.
Which children are at risk for anemia?
First thing first, any child is at risk of anemia irrespective of socio-economic status of the family, but children with devastating socio-economic conditions are susceptible to develop many health issues including anemia.
How is anemia diagnosed in a child?
Clinical assessment is a sufficient tool to diagnose anaemia in a child, but investigations are required to know the severity, etiology and iron status of the child.
What measures are needed to prevent childhood anemia?
Accurate characterization of anemia is critical to understanding the burden and epidemiology of this problem, for planning public health interventions, and for clinical care of people across the life course.
While iron deficiency anemia is the most common form and can often be treated through dietary changes, other forms of anemia must be treated by addressing underlying infections and chronic conditions requiring comprehensive health interventions.
Anaemia, as a public health issue, needs to be addressed from multiple perspectives and through multiple coordinated efforts, including multiple government sectors, nongovernmental organizations, United Nations agencies and the private sector each with specific and complementary roles to collectively achieve anaemia reduction and improve health and well-being.
In J&K, what measures are needed at the government level to prevent anemia?
Promoting exclusive breastfeeding, breastfeeding counselling to expecting mothers, nutritional advice to parents, implementing iron supplementation programs, ban on formula milk and food, nurturing the child with natural food and fruits, and finally tender love and care from the family.
