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The nutrients that are required in small quantities (<100 micrograms per day) for the maintenance of healthy life are called micronutrients and are crucial in the development, production and functioning of enzymes (folic acid, Vitamin B 12, zinc) and oxygen binding (primarily iron). Anaemia is caused by deficiency of iron, Vitamin B12 and the folic acid deficiency (in descending order). Anaemia is a condition in which there is a lack of healthy red blood cells to carry adequate oxygen to the body's tissues. Anaemia is also referred to as low haemoglobin, which can cause easy fatigability, poor appetite, reduced attention span and generalized weakness.
Besides the deficiency of calories and protein, anaemia is rampant in India. Micronutrient deficiency is referred to as the hidden hunger since oftentimes it is not an obvious killer or crippler, and usually begins to show when the condition is severe and has already led to serious health burdens, but extracts heavy human and economic cost. Anaemia (iron/folic acid deficiency) is a prototype and the most common micronutrient deficiency in India.
Data from the National Nutrition Monitoring Bureau over the last three decades have consistently shown that more than 70% of pre-school children consume less than 50% of the recommended daily allowances of iron and folic acid, of these, one-third are children below 5 years. In India, more than 6000 children below 5 years die per day, and more than half of these deaths are because of micronutrients deficiencies diseases majorly due to deficiency of iron, folic acid and Vitamin A. In India, in terms of the loss of productivity, illness increased healthcare costs, and death is 1% of Gross Domestic Product (loss of Rs. 280 million approximately) per annum due to anaemia.
Anaemia has complex aetiology. It usually occurs when children and women due to poor access to foods such as fruit, vegetables which are rich in micronutrients, especially green leafy vegetables, animal products, and fortified foods. In India, micronutrient fortified food (iron and folic acid) is not easily accessible because they are too expensive to buy or are locally unavailable. Besides inadequate complementary feeding practices right from infancy to poor dietary practices for women (due to poverty, ignorance, low agricultural productivity, and cultural factors); inadequate access to safe drinking water, a clean disease-free environment and health - care outreach also contribute. Infections result in loss of appetite, parasitic infections of the gastrointestinal tract, impaired absorption and utilisation of nutrients, particularly iron.
Repeated diet surveys done by the National Nutrition Monitoring Bureau, National Institute of Nutrition, ICMR in 9 states of India and a few other surveys, indicate, the following: Cereal-pulse based Indian diets are qualitatively deficient in micronutrients particularly iron, folic acid, calcium, vitamin A due to low intake of income-elastic protective foods such as pulses, vegetables particularly green leafy vegetables, fruits, and foods of animal origin. Within a family dietary deficits are more marked for preschool children and women due to inequitable distribution of food. This is because of a lack of awareness of children's nutritional needs, and the inability of a child to articulate. Menstruation and multiple pregnancies complicating the already anaemic adolescents keeps them in the vicious circle of anaemia and its detrimental effects.
There is no doubt that these micronutrients (iron, folic acid, vitamin B 12) are needed in a small amount for overall child development. These micronutrients, both directly and indirectly, contribute to child survival and should reach each and every child, adolescent girl and woman of reproductive age in the country. A policy should be prepared as an off-shoot of the earlier efforts, to focus specifically on priorities for research and action, for addressing the issue of anaemia. Nutrition literacy and leadership at all levels is needed to understand and act. Programmes for prevention and treatment of anaemia will become successful only when there is an effective implementation of inter-sectoral coordination between other complementary programmes such as the Integrated Child Development Scheme and convergence among health and women and child development.
(The article is contributed by Dr Arti Pawaria, Pediatric Gastroenterology & Hepatology, Global Hospital, Parel, Mumbai)
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