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Why should Anemia be a Public Health Concern? 

Anemia is a deficiency that arises due to a low count of red blood cells in the human body. Lack of the red blood cells that carry oxygen to the tissues causes the body’s oxygen level to drop, which can result in several symptoms including weariness, breathlessness, pale complexion, and headaches. Anemia affects many women and girls, especially those from low-income families or societies where access to specific foods high in iron or in general is restricted. Indian women and children continue to suffer anemia rates between 15% to 20%, which is higher than the global norm. India’s growing population has contributed to a worldwide anemia burden. In 1970, the Indian government introduced a program to prevent nutritional anemia by giving iron and folic acid (IFA) pills to expectant women and young children. Males in India make up 25% of the anemic population while females make up 57%, according to the Fifth National Family Health Survey (NFHS). This suggests that more than 300 million individuals countrywide suffer from anemia.

The cause of the sharp increase in anemia is a combination of factors. Dietary deficiencies, malabsorption, infections, pregnancy, decreased productivity, an increase in the risk of pregnancy difficulties, and low iron deficiency have all been found to be rising causes. The nation has yet to witness a preventative strategy for anemia among Indian pregnant women and children, despite the nation’s rising socioeconomic growth and history of anti-anemia public health initiatives. Poor intellectual ability, a drop in academic performance, and slow physical development are all effects of anemia in children and adolescents. Adults nevertheless struggle with fatigue, low energy, and a decline in physical performance at work, which has an indirect impact on the economy and growth of the nation. The senior population, on the other hand, often struggles with more severe effects which include low quality of life, increased morbidity and mortality rates, cognitive impairment, weakness, and trouble walking. According to research by professionals, Hb levels during pregnancy are linked with the birth rates of neonates. If a severe anemia condition arises in mothers it can lead to adverse fetal outcomes such as premature birth, low birth weight, and cognitive impairment, and also increases the risk of death of mother or child. The continued high prevalence of Anemia has several reasons.
Some of them include: 
• Considering that anemia is an unseen condition: Due to its invisible symptoms, such as exhaustion, weakness, and low physical strength, it is regarded by young adolescent girls and women as a typical component of their well-being. Anemia is more prevalent in women and girls than in males, in part because of menstruation, pregnancy, childbirth, nutrition, and infections. Furthermore, it is frequently believed to be an illness that primarily affects homes in poverty. According to the most recent NFHS-5 report, anemia prevalence has decreased from the lowest to the highest income categories. More than 50% of the nation’s wealthiest people still struggle with anemia. Low anemia testing rates are a result of misinformation and misconceptions, as well as a lack of awareness.
• Poor treatment rates: According to data from the Health Management Information System and the Ministry of Health and Welfare, more than 90% of pregnant women got 180 doses of IFA tablets as a type of anemia prevention. However, according to statistics, only 26% of women (as per NFHS-5) have taken the full recommended dosage of IFA pills. The adverse reactions of IFA pills, which include constipation, diarrhea, nausea, stomach discomfort, and headaches, as well as a lack of knowledge about how to handle these side effects, are mostly to blame for poor adherence to the treatment. According to research, one in every four school-age children who use IFA supplements reports side effects in the first week. Even though IFA’s continuous constipation has resulted in an 80% reduction in negative effects. Since more than 50% of the population is anemic, poor IFA supplement consumption and consistency, combined with low treatment rates, contribute to the condition’s rise.  
• Primary Goals for IFA Treatment of Anemia: Nutritional deficiencies, genetic hemoglobin deficiencies, infections, and inflammation are the three main causes of anemia. In all age groups, nutritional anemia—which is caused by a deficiency in iron and folic acid—contributes to 50–70% of anemia cases. Instead of addressing the other reasons, the current preventative approach concentrates on treating nutritional anemia. Therefore, after taking IFA supplementation for three months of treatment, all anemic individuals need to retest to see how their Hb levels have changed. If Hb levels are not increased after using IFA tablets, it could be required to investigate further causes of anemia, such as infections and hemoglobin disorders.
• Poor absorption of Iron from the Vegetarian diet: non-heme iron, which is the type of iron found in plant-based foods, and heme iron, which is found in animal products, are the two sources of iron in the diet. Heme iron can be absorbed up to 35%; however, non-heme iron from a diet heavy in mixed grains and pulses, which is often vegetarian, can only be absorbed up to 8.7 According to the NSS 68th Round (2011–12), just 1% of the iron in the Indian diet comes from animal sources, with 99% coming from plant sources. The majority of Indians ate rice and red gram dal (arhar), a pulse with a low iron level, the most often. According to the “What India Eats” study from 2020, just one-fourth of the daily recommended 350 g of green leafy vegetables are consumed on average each day. High iron GLVs are either thrown as trash or ingested seldom and in modest amounts. To prevent anemia, it is important to satisfy the increased iron needs with IFA supplements due to poor absorption and insufficient ingestion of iron-rich foods. More scientific study and proof are needed, nevertheless, to fully understand how nutrition affects anemia prevention and treatment as well as the incorporation of dietary strategies into current anemia programs.

Since anemia affects people of all ages and socioeconomic levels, healthcare practitioners, who are in close touch with the public, must recommend routine Hb-level monitoring and offer anemia therapy that is based on etiology. All private schools are required to give parents advice on how to screen for and treat their children’s anemia. To dispel myths about IFA and increase treatment adherence, it is crucial to implement a robust social and behavior change communication strategy as well as comprehensive interpersonal counseling on the negative effects of anemia and control of side effects.