Re-evaluating the need for universal iron supplementation in pregnant Indian women in the light of gestational age specific low hemoglobin prevalence

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DOI:

https://doi.org/10.47203/IJCH.2021.v33i03.005

Keywords:

Anemia, Dietary Supplements, Health Surveys, Program Evaluation

Abstract

Background: Anemia prevalence among Indian pregnant women in 2015-16 was 50.4% and has not declined from 49.7% in 1998-99 despite the national policies on iron-folic acid supplementation. New gestational age-specific cut-offs (INTERGROWTH cut-off) for risk of low Hemoglobin (Hb) have been identified. Aims and objectives: Compare prevalences of low Hb  based on WHO and INTERGROWTH cut-offs Methods: The prevalence of anemia/low Hb among pregnant women in trimesters 2 and 3 from NFHS-4 data were estimated using the current WHO recommendations and the INTERGROWTH cut-offs. Results: Prevalence of low Hb by the INTERGROWTH cut-off was 28.1%(95% CI:26.9-29.4) and 21.7%(95% CI:20.6-22.9) in trimesters 2 and 3. Anemia prevalence by WHO cut-off was much higher at 41.2%(95% CI:39.8-42.5) and 54.8%(95 CI:53.2-56.3) in trimesters 2 and 3. The prevalence of low-Hb was similar between ANC and no-ANC reported groups in both trimesters (26.1% and 28.9% in trimester-2; 20.1% and 22.4% in trimester-3). Conclusion: The  prevalence of low-Hb with gestational age specific cut-offs is much lower compared to earlier estimates using WHO cut-off. The universal iron supplementation program for pregnant women in India need to be re-examined in this light and a tragetter Hb testing based supplementation may be more beneficial in reducing anemia prevalence.

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References

International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS. [Internet]. IIPS; Available from: http://rchiips.org/nfhs/pdf/NFHS4/India.pdf [Last accessed on 25/09/2021]

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-2), 2019-20 fact sheet: India. Mumbai; 1998-1999 [Internet]. IIPS; Available from: https://dhsprogram.com/pubs/pdf/frind2/frind2.pdf [Last accessed on 25/09/2021]

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019-20 fact sheet: India. Mumbai:IIPS [Internet]. [cited 2021 Feb 19]. Available from: http://rchiips.org/NFHS/NFHS-5_FCTS/NFHS-5%20State%20Factsheet%20Compendium_Phase-I.pdf [Last accessed on 25/09/2021]

World Health Organization, editor. WHO recommendations on antenatal care for a positive pregnancy experience [Internet]. Geneva: World Health Organization; 2016. 152 p. Available from: https://www.who.int/publications/i/item/9789241549912 [Last accessed on 25/09/2021]

Ohuma EO, Young MF, Martorell R, Ismail LC, Peña-Rosas JP, Purwar M, et al. International Values for Haemoglobin Distributions in Healthy Pregnant women. EClinicalMedicine. 2020;29,30:100660.

De Benoist B, World Health Organization, Centers for Disease Control and Prevention (U.S.). Worldwide prevalence of anaemia 1993-2005 of: WHO Global Database of anaemia [Internet]. Geneva: World Health Organization; 2008. Available from: http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf [Last accessed on 25/09/2021]

Nguyen PH, Scott S, Avula R, Tran LM, Menon P. Trends and Drivers of Change in the Prevalence of Anaemia among 1 million Women and Children in India, 2006 to 2016. BMJ Glob Health. 2018;3(5):e001010.

Nankinga O, Aguta D. Determinants of Anemia among women in Uganda: further analysis of the Uganda demographic and health surveys. BMC Public Health [Internet]. 2019 Dec 30 [cited 2021 Feb 19];19. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937990/

World health organization. WHO Scientific Group on Nutritional Anaemias & World Health Organization. (?1968)?. Nutritional anaemias?: report of a WHO scientific group meeting held in Geneva from 13 to 17 March 1967. [Internet]. World Health Organization; Available from: https://apps.who.int/iris/handle/10665/40707 [Last accessed on 25/09/2021]

Varghese J, Thomas T, Kurpad A. Evaluation of Haemoglobin Cut-off for Mild Anaemia in Asians - Analysis of Multiple rounds of Two National Nutrition Surveys. Indian J Med Res. 2019;150(4):385.

Kapil U, Kapil R, Gupta A. National Iron Plus Initiative: Current status & future strategy. Indian J Med Res. 2019;150(3):239.

World Health Organization. Guideline: Daily Iron and Folic acid Supplementation in Pregnant women. [Internet]. 2012. Available from: https://www.who.int/elena/titles/guidance_summaries/daily_iron_pregnancy/en/ [Last accessed on 25/09/2021]

Varghese JS, Swaminathan S, Kurpad AV, Thomas T. Demand and Supply Factors of Iron-Folic acid Supplementation and its Association with Anaemia in North Indian Pregnant women. van Wouwe JP, editor. PLoS ONE. 2019;14(1):e0210634.

Petry N, Olofin I, Hurrell R, Boy E, Wirth J, Moursi M, et al. The Proportion of Anemia Associated with Iron Deficiency in Low, Medium, and High Human Development Index Countries: A Systematic Analysis of National Surveys. Nutrients. 2016;8(11):693.

National Sample Survey Office, Ministry of statistics and program implementation, Government of India. Key Indicators of Employment and Unemployment in India- 2011-2012 [Internet]. Available from: http://mospi.nic.in/sites/default/files/publication_reports/KI-68th-E%26U-PDF.pdf [Last accessed on 25/09/2021]

ICMR-National Institute of Nutrition. Recommended Dietary Allowances and Estimated Average Requirements Nutrients Requirements for Indians - 2020 [Internet]. ICMR-National Institute of Nutrition; Available from: https://www.nin.res.in/downloads/DietaryGuidelinesforNINwebsite.pdf [Last accessed on 25/09/2021]

Shastri L, Mishra PE, Dwarkanath P, Thomas T, Duggan C, Bosch R, et al. Association of Oral Iron Supplementation with Birth outcomes in Non-anaemic South Indian Pregnant women. Eur J Clin Nutr. 2015;69(5):609–13.

Shastri L, Pammal RS, Mani I, Thomas T, Kurpad AV. Oxidative Stress During Early Pregnancy and Birth outcomes. Public Health Nutr. 2016;19(17):3210–5.

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Published

2021-09-30

How to Cite

1.
Saji A, Baby J, Kurpad AV, Thomas T. Re-evaluating the need for universal iron supplementation in pregnant Indian women in the light of gestational age specific low hemoglobin prevalence. Indian J Community Health [Internet]. 2021 Sep. 30 [cited 2024 Mar. 4];33(3):435-9. Available from: https://www.iapsmupuk.org/journal/index.php/IJCH/article/view/2145

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