Many eyes that track healthcare brightened when the finance minister Nirmala Sitharaman in her budget speech mentioned health, education and skilling and talked of the government’s mission to eliminate Sickle Cell anaemia by 2047. For this disease of the blood with linkages to faulty gene, awareness, screening in affected tribal areas, is to be taken up. A laudable intent and that this comes on top of the government’s already stated aim for some years now of making India free from anaemia (Anaemia Mukt Bharat) matters.
Why the focus on sickle cell anaemia? “There is a question of vulnerability of tribal population, which is already disadvantaged, and it could prove a major impediment to the development of tribal population, particularly the young. It is also a crucial health need because in cases of sickle cell crisis when the deformed red blood cells get trapped in smaller blood vessels it leads to severe pain,” says Dr K Srinath Reddy, founder (past) president, Public Health Foundation of India (PHFI).
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In fact, hailing the sickle cell mission, Dr Swati Piramal, vice chairperson, Piramal Group and a medical doctor herself, felt it was all the more crucial since about 10 per cent of the population lives in tribal areas with an overall disease burden more than in other regions.
Many feel this mission needs to be seen in the backdrop of the government’s overall plan on anaemia in general, which some argue is an area of concern. Anaemia in general, caused by iron deficiency, could over time and eventually impact brain development in children and lead to lot of weakness and dizziness among other symptoms in women and dangerous if left unattended.
The best resource on where we stand on this is the data from the National Family Health Survey-5 or NFHS (2019-21) and comparing it with NFHS-4 (2015-16). Here for instance, the figure for women of all age groups (15 to 49 years), anaemia has increased from 53.1 per cent, as per NFHS-4 to 57 per cent in NFHS-5. In the same period, figure for children 6 to 59 months is up from 58.6 per cent to 67.1 per cent.
Geographic Insights, a Harvard website, which looks at NFHS data and the change between the data from NFHS-4 to NFHS-5 points to the overall number for anaemia in children at 55.7 per cent in India as per NHFS-4 and at 65.9 per cent (NHFS-5).
Look at the data even more closely at the state and district level and take the arguably best performing state of Kerala and there are regions that have seen deterioration. Take Pathanamthitta, a district that experts in the financial world, describe as one with a high credit penetration, has seen a sharp increase in iron deficiency in children. Similar is the story in several other districts except for a few like Kozhikode, Malappuram, Kannur and Kasargod.
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Nachiket Mor, an economist who has over the years studied health systems and in his earlier avatar as a banker looked closely at financial inclusion, says, while anaemia appears as a problem that can be fixed, the real challenge seems to lie not in the availability of antidotes but in compliance since many patients do not end up taking the medication and the appropriate supplements. He says, “it is not as if the government is not making the iron and folic acid (IFA) tablets available but what is to be done if there is laxity in consumption.” Severe anaemia needs iron injections but moderate anaemia is easy to fix through tablets and for small children, a taste-less, colour-less powder added to the food.
“The high levels of anaemia reported in children and women of reproductive age groups will need to be addressed through multi-component interventions, which would require balanced nutrition apart from supplementation of iron and folic acid,” says Dr Reddy. Dietary diversity, he says, is very important. Then, there are the aspects of creating awareness at the community level that may also help.