General Health

Anemia: An Intractable problem

Introduction

The WHO defines anemia as hemoglobin levels less than 12g/dl in women and 13g/dl in men. Anemia is a major public health problem worldwide, being the second leading cause of disability overall. Around 2 billion people are affected by it, 1 million die each year. 

Anemia is the most common nutritional disease in developing countries and a rampant affliction in India. It affects more than fifty percent of our children and women. These statistics are worrisome.  With a burden of disease so large, and significant impairment in functioning, combating it is imperative if we are to have a robust workforce.

Anemia is a major cause of morbidity and mortality. Delayed physical and mental growth, shortness of breath, exercise intolerance, diminished concentration, poor learning ability, and poor immunity are some of its ill effects. Pica, a desire to chew on non-food like ice and paint can also be seen,  pointing towards underlying iron deficiency if present. Anemic patients who happen to be pregnant have increased chances of heart failure and overall increased risk of death.

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Causes

While the causes and types of anemia are multifarious, we will talk at length about Iron Deficiency Anemia(IDA). Women in the reproductive age group are most likely to be iron deficient due to monthly blood losses and blood loss during parturition. Apart from that, hookworm infestation and poor nutrition contribute to IDA in children and adolescents. There is increased iron required during growth spurts which if unmet can lead to anemia. Exclusively breast-fed infants are also at increased risk.

Methods of control

Before initiating supplemental iron, it is important to find out and treat the underlying cause of the iron deficiency. In post-menopausal women for instance, and adult men, there are no physiologic reasons to be iron deficient. In these cases, therefore, relevant investigations are done to rule out malignancy as a cause.

Healthcare providers have always been at the forefront to combat IDA; doctors, auxiliary nursing staff, and ASHA workers are at the helm of the efforts. Educating the masses at the clinic level, through pamphlets and oral instructions have been some of the traditional ways. Dietary recommendations and attempts towards behavior modifications of the patient and their families have been practiced extensively too.

The National Nutrition Mission was set up to address the issues of nutrition. Integrated child development services (ICDS) and the Midday meal programs have traditionally provided nutritional supplementation to combat iron deficiency.  The SABLA scheme provides adolescent girls supplements in the form of Take-Home Rations (THR). The government’s flagship program, Anemia Mukt Bharat, aims to be rid of the menace by weekly blue iron folate tablet supplementation and deworming every six months. Their 6-6-6 strategy is worth mentioning, the beneficiaries including children as young as six months, adolescents, pregnant, lactating women, and boys.

Many startups are coming up with innovative techniques to allow for early and efficient anemia detection. The first in the series is EzeRx, which has come up with a device that detects anemia based on spectroscopic emissions from the conjunctiva. This non-invasive, non-touch technique seems revolutionary, especially in rural settings where diagnostic clinics might not be easily available. With each test costing less than rupee 1, this is path-breaking indeed. The Sanguina app is another example. Analyzing data and color from the nail beds, this app puts the charge of anemia detection in the hands of literally anybody who might have access to a smartphone. With a sensitivity of 97 percent, this might serve as a great screening tool.

As we saw, anemia is a major healthcare challenge, affecting a significant chunk of our population. In addition to traditional strategies, startups have begun to provide novel ways to combat the problem. Technology will come to play a huge role in the healthcare sector in the foreseeable future, the quicker we are to adopt it, the brighter the results are ought to be.

Authors:

Pratik - NiramaiPratik is a Research Engineer at Niramai Health Analytix. Pratik writes on everything that connects healthcare to technology and runs a weekly newsletter on healthcare.

 

Dr. ShreyaShreya is an MBBS graduate, with a keen interest in psychiatry and Public health. Outside of work, she likes reading, playing with dogs, and hiking.

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