Shooting shadows: India’s struggle to reduce the burden of anaemia

Rai, R K and Kumar, S S and Gupta, S S and Parasannanavar, D J and Anish, T S N and Barik, A and Varshney, R K and Rajkumar, H (2022) Shooting shadows: India’s struggle to reduce the burden of anaemia. British Journal of Nutrition, 129. pp. 416-427. ISSN 1475-2662

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Despite several efforts by the Government of India, the national burden of anaemia remains high and its growing prevalence (between 2015–2016 and 2019–2021) is concerning to India’s public health system. This article reviews existing food-based and clinical strategies to mitigate the anaemia burden and why they are premature and insufficient. In a context where multiple anaemia control programmes are in play, this article proposes a threefold strategy for consideration. First, except the Comprehensive National Nutrition Survey, 2016–2018, which measured Hb concentration among children and adolescents aged 1–19 years using venous blood samples, all national surveys use capillary blood samples to determine Hb levels, which could be erroneous. The Indian government should prioritise conducting a nationwide survey for estimating the burden of anaemia and its clinical determinants for all age groups using venous blood samples. Second, without deciding the appropriate dose of Fe needed for an individual, food fortification programmes that are often compounded with layering of other micronutrients could be harmful and further research on this issue is needed. Same is true for the pharmacological intervention of Fe tablet or syrup supplementation programmes, which is given to individuals without assessing its need. In addition, there is a dire need for robust research to understand both the long-term benefit and side effects of Fe supplementation programmes. Third and final, the WHO is in process of reviewing the Hb threshold for defining anaemia, therefore the introduction of new anaemia control programmes should be restrained.

Item Type: Article
Divisions: Global Research Program - Accelerated Crop Improvement
Uncontrolled Keywords: Anaemia, Iron deficiency anaemia, Micronutrients, Iron supplements, Food policy
Subjects: Others > Food and Nutrition
Others > India
Depositing User: Mr Nagaraju T
Date Deposited: 05 May 2023 04:31
Last Modified: 05 May 2023 04:31
Official URL:
Funders: This work was supported by the West Bengal State Department of Health and Family Welfare, India
Acknowledgement: This work was supported by the West Bengal State Department of Health and Family Welfare, India [Memo number: 114-P&B/ HFW-27011/114/2019-NHM SEC], and this research grant was awarded to R. K. R. and A. B. The funders had no role in the design or conduct of the study, collection or analysis or interpretation of the data and preparation or review or approval of the manuscript. R. K. R. conceived and designed the study. R. K. R. performed the analysis and prepared the first draft. S. S. K., S. S. G., D. J. P., T. S. N. A., A. B., R. K. V. and H. R. critically reviewed content and commented on subsequent versions of the manuscript. All authors approved final content presented in the study.
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