Impact4nutrition

Working Towards An Anemia Free India- Narayana Health

January 5, 2021   | author: Narayana Health

POSHAN Abhiyaan or the National Nutrition Mission is a priority programme of the current government. The programme is under the aegis of the Ministry of Women and Child Development (MWCD), Government of India, and one of the goals in this involves controlling anemia through the Anemia Mukt Bharat (AMB) program. The target is to reduce anemia by 3% per year to help in attaining the end goal of achieving a malnutrition free India by 2022.

The Comprehensive National Nutrition Survey (2016-2018) conducted by the Ministry of Health and Family Welfare and the United Nations Children Fund (UNICEF) came out with important findings on anemia among other indicators among children and adolescents in India, with a focus on nutritional indicators among children of age groups 0-4, 5-14, and 15-19 years of age. It specified that 41% of children under 5, 24% of school-age children, and 28 % of adolescents were anemic. Moreover, the incidence of anemia was twofold in females (31%) to that of males (12%).

In Rajasthan, as per National Family Health Survey III, the prevalence of anemia in adolescent girls was 53.9% while in adolescent boys, the prevalence of anemia was 30.8%. Looking at the criticality of the situation, several private stakeholders came forward to mitigate the issue and Suposhan program was envisaged by Narayana Health as a pilot intervention in Jaipur District in partnership with Britannia Nutrition Foundation, National Health Mission, Rajasthan and the Jaipur Education Department.

Narayana Health, pledged partner of the IMPAct4Nutrition platform, is a chain of multi-specialty hospitals, heart centres, and primary care facilities with its headquarters in Bengaluru, India. The group takes the commitment to fulfil its corporate social responsibility beyond the mandatory norms to ensure it helps the disadvantaged and helps the government in the attaining social welfare goals.

What is Suposhan Program?

Suposhan program was envisaged as a pilot intervention in Jaipur District in collaboration with Britannia Nutrition Foundation, National Health Mission & Education department in Rajasthan. The program, modelled as an action research study, aimed at introducing iron fortification which would supplement the existing Weekly Iron-Folic Acid Supplementation (WIFS) program of the government.

KAP Study

Through a lottery method, Chaksu was chosen as the intervention block, while Phagi was the control block. In the first phase,600 students, in the age group of 10-19 years, were randomly selected from 52 Government Schools of Chaksu and Phagi blocks, in Jaipur. Knowledge, Attitude & Practice (KAP) surveys along with haemoglobin and other vital parameters were assessed in this sample population. Periodic 24-hour dietary recall studies were conducted to understand the dietary habits of adolescents in the schools.

Results of the KAP Study

The baseline survey found that knowledge levels regarding anaemia were such that, 60-75% of the students did not know what anemia was. Similarly, 60-70% of students did not know about the dietary sources of Iron. Based on the dietary recall, it was observed that there was an overall lower intake of foods that are rich/ good sources of iron.The baseline study provided strong evidence on the inadequate state of nutrition and need for nutritional awareness and fortification amongst adolescents.

During the first phase of intervention, biscuits enriched with iron were rolled out across 6750 students from 24schools in Chaksu for 100 days. The program was augmented by sensitizing students, faculty and community about anemia, its prevalence and nutritional guidelines to improve the same.

Phagi, as the control block, received only the information dissemination programs. The team implementing the program had to study the initial knowledge, attitude and practice survey of the adolescent students to come up with the intervention strategies which involved awareness through innovative means like street plays performed in the local Marwari language. Folk artists reached out to the community to make them aware of anemia and ways to mitigate it. Students were chosen as Suposhan Champs and these students were specially trained to promote the cause within their schools.

Hemoglobin levels were mapped thrice at regular intervals through the course of the program. The students in the intervention block were given 4 iron rich biscuits an hour before closing of the schools. This also motivated student to attend school daily.

After 100 days of intervention in Chaksu schools with the biscuits(along with continuing WIFS program and educational activities), the prevalence of anemia in Chaksu among female students decreased from 64.9% to 40.9%, and in male students from 47.8% to 30.3%. There was an overall decrease in anemia levels by almost 20% across the population of adolescent students in Chaksu.
In Phagi, as a result of the educational activities and WIFS program alone, there was an insignificant decrease in anemia in female students from 73.6% to 67.9% and male students from 69.2% to 58.9%

In the second phase, the biscuits enriched with ironwere introduced in 26 schools for 6158 students in Phagi which showed even better results. There was an overall decrease in anemia levels by 40% among the adolescents who had consumed the biscuits.

Way forward

The Suposhan intervention ran for a year and saw the roll-out of approximately 54 lakh biscuits enriched with ironacross 12,808 students over a period of 1 year. The program that showed a significant increase in haemoglobin levels across the adolescent population and decrease in the overall prevalence of anemia.

Dr. Anupama Shetty, General Manager and Head – CSR initiatives at Narayana Health shares that “Anemia is a widely prevalent issue and over the years, several stakeholders have tried tackling it through various means; But it is still widely prevalent. We knew we had to do things differently. Apart from introducing the iron-fortified biscuits, we had to get the students and the larger community to understand and own the change. Which is why the program was deeply contextual, adaptive and sustained. This really helped get the results we envisaged.”

This pilot program goes on to show that results can be obtained through effective interventions and sensitization. All of this is in alignment with SDG 2 which intend to put an end to all forms of hunger and malnutrition by 2030.

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