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INTENSIFIED

NATIONAL IRON
PLUS INITIATIVE
(I-NIPI)

Ministry of Health and Family Welfare


Government of India
Milestones in Control of Anemia in India

2018

2013
2007
6 m-60 m age
I-NIPI
1991
Program
6-60 m intensification
1970 (Anemia Mukt
-20 mg iron in
syrup form Bharat)
60 mg Iron 60 mg Iron
5-10 yrs age Wkly and biwkly PLW 100mgX180
supplementation changed to
group added supplementation. days
for PW and 100mg
PLM-100 mg Test and treat 6X6X6 strategy
20 mg for 1-5 yr
(NIPI)
X100 days
Why Anemia Mukt Bharat?
Anemia impacts our physical growth, mental and work capacity, and
lives of future generations.

In India:
Anemia is prevalent in:

58% 54% 29% 53% 50% 58%


of children of adolescent of adolescent of women in their of pregnant women of breastfeeding
(6-59 months) girls boys reproductive age mothers
(15-19 years) (15-19 years)
Why Anemia Mukt Bharat?

All States affected by Anemia


Highest Political

1
Combination of Commitment

2
interventions Target setting,
convergence and
• Diets (animal reviews at highest level
and iron-rich
States with
foods)

• IFA,
deworming
7 >=30% anemia
decadal decline 3 No supply stock
outs/ruptures
and malaria What did they
interventions do differently? BCC and IEC

6 4 counseling, mass
and mid media

Monitoring and
strengthening outreach
service coverage
5 Special strategies for Malaria zones
Screening, Tag-tracking high-
risk/anemia cases and treatment
What is the Anemia Mukt Bharat target?
Anemia reduction targets for 2022

To reduce Anemia prevalence (%)

the Baseline
Age group (NFHS 4) National target 2022
prevalence
Children 6–59 months 58 40
of anemia
by 3 Adolescent girls 15–19 years 54 36
percentage Adolescent boys 15–19 years 29 11
points per
Women of reproductive age 53 35
annum
Pregnant women 50 32

Lactating women 58 40
How will this be done?

Anemia Mukt Bharat 6


will use a 6x6x6
strategy to
combat anemia 6X6X6
strategy
6
6 institutional
interventions mechanisms
Six beneficiaries

124
million
Children
17 (6-59 months)
million 134
Estimated women of million
children
reproductive
450 million age
(20-24 years) 6
(5-9 years)

beneficiaries
Reaching nearly 50% of 27 115
the country’s population million
million
adolescent boys
lactating
and girls
mothers
30 (10-19 years)
million
pregnant
women
Six interventions

2
1 Periodic deworming of children,
Prophylactic iron folic acid adolescents, women of
supplementation reproductive age and pregnant
women

4
3
Testing of anemia using digital
change communication HOSPITAL
methods and point of care
campaign including ensuring
treatment
delayed cord clamping

6
5 ANGAN WADI
Mandatory provision of iron Addressing non-nutritional causes
of anemia in endemic pockets,
public health programmes with special focus on malaria
Prophylactic IFA supplementation- Regime
Age group Dose

• Bi-weekly, 1 ml iron and folic acid syrup.


• Each ml containing 20 mg elemental iron + 100 mcg of
6 – 59 months of age
folic acid.
• Bottle to have an auto-dispenser in mono-carton.

• Weekly, 1 iron and folic acid tablet.


• Each tablet containing 45 mg elemental iron + 400 mcg
5- 10 years children
folic acid.
• Sugar-coated, pink-colour.
Prophylactic IFA supplementation- Regime
Age group Dose

Adolescent • Weekly, 1 iron and folic acid tablet.


girls and boys, • Each tablet containing 100 mg elemental iron + 500 mcg folic acid
10-19 years of age • Preferably sugar-coated, blue-colour

• Weekly, 1 iron and folic acid tablet.


Women of
• Each tablet containing 100 mg elemental iron + 400 mcg folic acid,
reproductive age
preferably sugar-coated, red-colour.
(non-pregnant, non-lactating)
• Daily, 1 Folic acid tablet.
20-49 years
• Each tablet containing 400 mcg of folic acid

• Daily, 1 iron and folic acid tablet starting from the fourth month of
pregnancy (that is from the second trimester), at 14th week of
Pregnant women and
• gestation, continued throughout pregnancy (minimum 180 days
lactating mothers
• during pregnancy) and to be continued for 180 days, post-partum.
(0-6 months child)
• Each tablet containing 100 mg elemental iron + 500 mcg folic acid
• Sugar-coated, red-colour
Test and Treat strategy
Testing:
• Use of digital hemoglobinometers
• Good diagnostic accuracy (at least 90% sensitivity)
• relevant approvals like FDA/DGHS, DGCI/NHSRC HCT
• In two age groups- to begin with
• School-going Adolescent girls and boys 10-19 years, WIFS beneficiaries,
using RBSK mobile teams
• Pregnant women at all ANC contact points.
• At all high case load facilities at block level and above, hemoglobin level
estimation will be done using Semi-Auto Analyzers
• This may be extended to all age groups, later
Adolescents

Mild/moderate
First level of treatment (at all levels of care) • One 60 mg elemental iron tablet twice a day for
3 months, orally
• Given under observation of the school teacher
Line listing of all anemic cases
Two Follow-ups
• First follow-up after 45 days and second follow-
• up after 90 days in school premises.
• If hemoglobin levels have come up to normal
level, discontinue the treatment and continue
with the prophylactic IFA dose
If no improvement after first level of If no improvement after three months of
treatment treatment, RBSK team will refer the adolescent to
First Referral Unit (FRU)/District Hospital (DH)
severe anemia Management to be done by medical officer at
FRU/DH based on investigation and diagnosis
Pregnant women

Mild/moderate
First level of treatment (at all levels of Two tablets of iron and folic acid tablet (100 mg
care) elemental iron and 500 mcg folic acid) daily for 6
months, orally given by the health provider during the
ANC contact.
* Parental iron (IV Iron sucrose or Ferric Carboxy
Maltose may be considered as the first line of
treatment in pregnant women who are detected to
be anemic late in pregnancy or in whom compliance is
likely to be low (high chance of lost to follow-up).
Follow-up Every two month, during the ANC contact
If no improvement after first level of If no Hb (<1g/dl) increase; Refer to FRU/DH (case may
treatment be managed with IV Sucrose/FCM)
severe anemia (5-6.9 g/dl) By medical officer, using IV Sucrose/FCM. Immediate
hospitalization if pregnant woman is in 3rd trimester.
(<5 g/dl) Immediate hospitalization, irrespective of month of
gestation; care by specialist

Management protocol for severe anemia contraindicated for patients of thalassemia major and sickle cell disease.
Focus on Social mobilization and
behaviour change: 4 key behaviours

1. Compliance to Iron Folic Acid supplements and


deworming
2. Appropriate Infant and Young Child Feeding (IYCF)
3. Increase intake of iron-rich, protein-rich and
vitamin C rich foods through diet diversification
and consumption of fortified foods.
4. Practice of delayed cord clamping in all health
facility deliveries followed by early initiation of
breastfeeding within 1 hour of birth
Six institutional mechanisms

Intra-ministerial National Anemia Mukt


1 2 Bharat Unit
coordination

National Centre
of Excellence and Convergence with
3 4 other ministries
Advanced Research on
Anemia Control

Anemia Mukt Bharat


Strengthening supply dashboard and digital
5 chain and logistics 6 Portal - one-stop shop
for anemia
Key performance
Key performance indicators indicators
1. Percentage of children 6-59 months who received at least 8 doses of IFA syrup (HMIS
9.9)

2. Percentage of school children 5-9 years who received at least 4 pink IFA tablets (HMIS
23.1)

3. Percentage of school-going adolescents 10-19 years (girls and boys), eligible under WIFS
programme, who received at least 4 blue IFA tablet (HMIS 22.1.1)

4. Percentage of women of reproductive age 20-24 years, eligible under Mission Parivar Vikas,
who received at least 4 red IFA tablet (NEW)

5. Percentage of eligible pregnant women who received at least 180 IFA tablets during
antenatal contact point
(HMIS 1.2.4)

6. Percentage of states/districts with available stocks of IFA for all age groups (HMIS 19.6,
19.7, 19.8, 19.9)
A one-stop shop for all anemia-related materials

All resources including


guidelines, quarterly
report cards by state
and for aspirational
districts. Denominators
for services & stock and
all communication and
training materials can
be downloaded from
the Anemia Mukt
Bharat portal:

www.anemiamuktbharat.info
What’s new?
Coordinated management efforts – intra & inter ministerial

Use of digital methods of hemoglobin estimation and point of care


treatment

Denominator-based quarterly reports; KPI reviews and awards

Mass deworming of pregnant women and WRA in NDD; special focus on


Women 20-24 years

Linkage with Malaria; mandating use of fortified food in public health


programmes

Linkage with academic – national and regional networks- (re) learning and
policy decisions.

Communication material- awareness, intensive communication activities- all


channels. Creating a Jan Andolan…
Solid Hai Bharat.
Anemia Mukt Bharat

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