Poor dietary habits, low adherence to supplementation, lack of awareness and health education, infections, and poor sanitation remain a challenge in addressing anaemia in the country, says Dr Rema G, clinical assistant professor in haematology, in an interview with Anna Jose. Edited excerpts:
1. How does malnutrition cause anaemia?
Malnutrition contributes to anaemia in several ways. One is iron deficiency. Inadequate intake of iron rich foods, like meat and green leafy vegetables, leads to iron-deficiency anaemia, the most common type. It also causes deficiency of vitamins like B12, folate, and vitamin C affects red blood cell (RBC) production and haemoglobin synthesis. Proteins are essential for haemoglobin and enzyme production, and their deficiency reduces RBC synthesis. In some cases, malnourished individuals may have gastrointestinal issues that impair nutrient absorption. Malnutrition weakens the immune system, increasing susceptibility to chronic infections like parasitic infestations and tuberculosis, which further contribute to anaemia.
2. What is the role of iron in the production of haemoglobin? What is the treatment for iron deficiency?
Iron is a core component of heme, the oxygen-binding part of haemoglobin. It facilitates oxygen transport from lungs to tissues and is also involved in energy metabolism and DNA synthesis in RBC precursors. Oral iron supplements, like ferrous sulphate and ferrous gluconate, and parenteral iron therapy, used in cases of severe deficiency, poor absorption, or intolerance to oral forms, and vitamin C supplementation can treat iron deficiency. Increasing the intake of iron-rich foods (red meat, beans, fortified cereals, and spinach) can also help. It is also important to treat the underlying causes, which are hookworm infestation, chronic blood loss, and celiac disease.
3. In India, several programmes have been initiated to create awareness about anaemia. Has the prevalence rate of anaemia come down?
We have several programmes, including Anaemia Mukt Bharat (AMB), National Iron Plus Initiative (NIPI), which provides weekly iron and folic acid supplementation, and POSHAN Abhiyaan. Despite these efforts, anaemia remains highly prevalent in India. NFHS-5 in 2019-21 has reported that 67.1% of children and 59.1% of adolescent girls, and 57% of women (15–49 years) in India are anaemic (NFHS-5), which is higher than NFHS-4. Poor dietary habits, low adherence to supplementation, lack of awareness and health education, infections, and poor sanitation remain a challenge in addressing anaemia. While programmes have increased awareness, implementation gaps and socio-economic factors continue to hinder progress. Strengthening community-level interventions, improving health literacy, and addressing social determinants are critical for real change.
4. What is the significance of preventing anaemia during pregnancy? How does the condition affect the mother and child?
Pregnancy increases iron demand due to foetal growth, placenta formation, and expanded maternal blood volume. Preventing anaemia ensures better maternal and foetal outcomes. Anaemia can cause fatigue, breathlessness, increased risk of infections, higher risk of postpartum haemorrhage, poor labour outcomes and delayed recovery in the mother, while it causes preterm birth, low birth weight, impaired brain development and increased neonatal mortality in the child. Anaemia during pregnancy also raises the intergenerational risk of anaemia in the newborn, continuing the cycle of malnutrition.
5. What are the treatment options? How can lifestyle modifications reverse the condition?
Iron and folic acid supplementation, parenteral iron therapy in moderate and severe cases, can help. In case of deficiency, vitamin B12 and folate supplements can be given. Blood transfusion is administered in cases of severe anaemia with hemodynamic compromise. Treating infections like malaria, helminths, TB and nutritional rehabilitation also help in reversing the condition. An anaemic person needs to be careful about their diet as well. Iron-rich foods like meat, legumes, fortified grains, and vitamin C (citrus fruits) should be included in the diet. Also avoid tea and coffee, which hinder absorption, with meals. Use iron utensils to enhance iron content in food. Regular deworming also plays a major role. Regular haemoglobin monitoring, especially for women and adolescents, can help in identifying the condition. It is also crucial to educate the public about sustainable dietary habits.