Severe anemia is a high-risk factor in pregnancy and needs to be treated appropriately to prevent poor maternal and fetal outcomes. A pregnant woman with severe anemia reluctant for blood transfusion due to issues of accessibility was given four doses of 300 mg intravenous iron sucrose (IVIS) in 300 ml normal saline starting at 31 weeks 5 days of gestation and her hemoglobin level increased by 4.2 gm/dl over a period of five weeks without any complications and without any intake of iron and folic acid tablets during the entire duration. Intravenous iron sucrose is a useful intervention for severe anemia of pregnancy even in late pregnancy with rapid increase in haemoglobin levels and can be used regularly for treating severe anemia in pregnant women alternative to blood transfusion who have limited accessibility to blood transfusion facilities.
Introduction The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on health services around the world. Many hospitals and clinics were overwhelmed by the influx of patients, leading to delays and disruptions in care. The fear of contracting the virus also led to a decrease in the number of people seeking medical care, even for urgent or life-threatening conditions. Various studies have reported a decrease in overall utilization of maternal health services. However, it remains vital to find the reasons for reduced utilization along with the experiences of the women as well as healthcare workers during the pandemic. Objective The objective of this study was to identify the facilitators and barriers to maternal healthcare services utilization during the COVID-19 pandemic. Methods It was a qualitative study conducted in a rural area of Haryana, India. Twelve in-depth interviews (IDIs) were conducted with health workers and four focused group discussions (FGDs) were conducted with pregnant women. Textual analysis was done for both IDIs as well as FGDs. Qualitative analysis was done manually. Results The identified themes were complete cessation of services, no outpatient department (OPD) services for many months, no antenatal care (ANC) services for two months, disruption of supply of medicines, unavailability of drugs, fear of getting COVID-19 infection, mandatory COVID-19 negative report for admission in hospital, and increased referral from government health facilities during the pandemic and lockdown. Conclusion Maternal healthcare services suffered during COVID-19 for various reasons including the closure of health facilities, limited supply of stocks, or fear of the disease among pregnant women. This evidence can be used to prepare as well as manage healthcare services in future.
Anemia is globally recognized as an important public health problem in women and children, thus the consequences of anemia have predominantly been described in these two groups. India's large population, high anemia prevalence and male-dominated workforce imply that productivity consequences of anemia in men could have large implications. We sought to explore the association between local anemia rates and productivity outcomes in Indian men. Data on anemia were from the 2015–2016 National Family Household Survey (NFHS) and data on productivity outcomes—number of hours works and total earnings in the last week—were from the 2017–2018 Periodic Labour Force Survey (PLFS), for a combined sample of 245,073 men aged 15–54 years. NFHS was collapsed at three levels (district, urban/rural, and five-year age brackets; n = 9818) and then merged with the full PLFS sample to generate an analytical sample of 135,500 observations. We report sample means using survey weights. Individual-level productivity outcomes were regressed on means from the collapsed data using ordinary least squares regression, adjusting for state of residence, age and education. The primary predictor was anemia quintile, with anemia defined as hemoglobin below 130 g/L from a finger-prick blood sample. Anemia affected 23% of men aged 15–54 years in India in 2016 and was more common in rural (25%) than urban (19%) areas. On average, men worked 51.5 hours and earned 2430 Indian Rupees in the last week. In the adjusted models, being in the top quintile of anemia prevalence (ref: lowest quintile) predicted 2.1 fewer hours worked (95% CI 1.5–2.8) and 240 less rupees earned (95% CI 173–307) in the last week (P < 0.001 for both). These effects translate to 4% lost work hours and 10% lost earnings related to anemia. Nearly one in four men are anemic in India and our findings suggest that anemia is associated with reduced productivity at the population level. Anemia reduction policies and programs in India should work toward the inclusion of men. Agriculture for Nutrition and Health/IFPRI.
Fortification of staple food items with iron is a potential strategy to address anemia for a larger population. We reviewed studies to assess the impact of iron-fortified rice (IFR) on hemoglobin levels of individuals more than six months of age. We included studies assessing the effectiveness of IFR (with or without other micronutrients) conducted in any part of the world available in PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, clinicaltrials.gov, International database of prospectively registered systematic reviews in health and social care (PROSPERO), unicef.org, and who.int databases and published from January 1, 1990 to April 1, 2019 (PROSPERO registration number: RD42020139895). We extracted the changes in hemoglobin, serum ferritin, and serum transferrin levels among the participants. Finally, data from 15 trials and their 21 subsets were analyzed. Mean difference in hemoglobin was 0.53 g/dl (95% CI: 0.26, 0.80, P < 0.001, I2 = 84%) in the IFR group compared to the control group. In the subgroup analysis after removing studies with small sample size and high risk for bias, a mean difference of 0.44 g/dl (95% CI: 0.20, 0.69, P < 0.001, I2 = 82%) was observed. No significant effect on serum ferritin or transferrin levels was observed. From this review it can be concluded that fortification of rice with iron can be adopted as an intervention to improve hemoglobin levels, especially in countries where rice is the major part food of staple diet. Research is needed on an optimal iron compound for fortification and the acceptance of IFR.
Background: Anemia poses a significant health challenge for pregnant women (PW), and accurate and timely diagnosis is essential for effective management. Objective: The objective was to assess the diagnostic validity of the new digital hemoglobinometer for hemoglobin against laboratory-based hematology autoanalyzer among PW. Methodology: The study was conducted at a secondary-level healthcare facility among 204 pregnant women to be sampled conveniently, their sociodemographic and iron intake data collected, and hemoglobin levels assessed using a digital hemoglobinometer (Device A) and a hematology analyzer. Specificity, sensitivity, PPV, NPV, diagnostic accuracy, and method agreement were evaluated via Bland-Altman analysis and Lin's concordance correlation coefficient. Results: The proportion of anemia using the Device A was 64.7% while the hematology analyzer reported a proportion of 52.9%. Device A showed a sensitivity of 97.22%, specificity of 80.30%, and diagnostic accuracy of 86.3%, with substantial agreement indicated by Cohen's kappa coefficient (kappa = 0.72) and the weighted kappa coefficient for different grades of anemia was 0.67. Bland-Altman analysis revealed a mean difference (bias) of -0.28 (± 0.5) between the two methods, with limits of agreement at -1.24 and 0.68. Lin's concordance correlation coefficient of absolute agreement was 0.91. Conclusion: The DH showed high sensitivity and diagnostic accuracy for anemia detection in PW, with substantial agreement with the hematology analyzer. It offers a convenient and rapid alternative for POC hemoglobin estimation in resource-constrained settings.
Anemia has been a severe public health problem in India for decades, owing to its multifactorial etiology. Large surveys investigating causal factors of anemia in both male and female adolescents 10–19 years have not been available, thus our understanding of optimal interventions has been limited. Using data from a recent national micronutrient survey, our aims were to 1) describe the prevalence of anemia and micronutrient deficiencies (MNDs) in Indian adolescents and 2) examine risk factors of anemia in this population. Data were from India's Comprehensive National Nutrition Survey (CNNS, 2016–18). Analyses were run separately for females (F; n = 3966) and males (M; n = 3944) aged 10–19 years. CNNS used a multi-stage, stratified, probability proportion to size cluster sampling design. Prevalence of anemia and micronutrient deficiencies were estimated based on age- and gender-specific WHO cutoffs, using weights for biomarker data. We examined predictors covering socio-demography (age, sex, residence, religion, caste, schooling status, parental education), nutrition (diets, anthropometry, micronutrient status), hygiene, sanitation and access to school-based services. Multivariable logistic regression models were used to examine associations between these factors and anemia. Forty % of females and 18% of males were anemic. The prevalence of anemia was higher in adolescents aged 15–19 years (F: 48%, M: 18%) than those aged 10–14 years (F: 32%, M: 17%). Deficiencies of iron (F: 31%, M: 12%), vitamin B12 (F: 27%, M: 35%), folate (F: 34%, M: 39%), vitamin A (16% in both), vitamin D (F: 35%, M: 14%) and zinc (F: 28% girls, M: 35%) were also common. Iron deficiency was the strongest predictor of anemia (adjusted OR and 95% CI for F: 4.23, 2.99–5.99; M: 4.12, 2.78–6.12). Among females, other risk factors were being older (1.53, 1.09–2.15) and belonging to a disadvantaged caste (1.86, 1.12–3.09). Among males, other risk factors included being older (1.47, 1.02–2.13), being short for age (1.61, 1.12–2.31) and no mobile or internet access (1.59, 1.16–2.19). Anemia and MNDs are highly prevalent in Indian adolescents. Iron deficiency is a major biological risk factor for anemia as are a range of social determinants. Program design and targeting should fully account for the range of risk factors. UNICEF, POSHAN.
Mental Health is an indispensable dimension for human development. It deals with human thoughts and emotions, and provides a pathway for healthy minds and contributes to a healthy living. Absence of healthy mind poses a great burden to the economic, political, and social functioning of human beings, society and nation. Mental health in India is a neglected paradigm with the shortage of trained staff and inadequate infrastructure. Mental illness has been veiled in stigma, ignorance and superstition since a long time in India. Lack of political and administrative leadership, financial commitments and human resources, are missing in the national and expanded district programmes. Efforts have been put in recent times by the government to oversee the disease burden and provide remedial measures. Draft national health policy formulated in 2015 had thrown a light of hope in this scenario. The gap in the provision of efficient health care to the needy was the building block of this draft formulation.The hassles in the existing system should be identified and efforts to cut down the over-burdened system should be made to cater to the actual needs of the community.
Iodine deficiency disorders (IDD) constitute the single most important preventable cause of mental handicap at global level. Recognizing the importance of coordination and synergy of the activities of wide range of universal salt iodisation (USI) stakeholders, WHO/ Unicef/ ICCIDD has prescribed a national multi-sectoral coalition as one of the ten indicators essential for attaining sustainable elimination of IDD at national level. Challenge for coordination among different stakeholders of IDD/USI is even greater in democratic and diverse country like India. In the present article we present successful experience from India regarding formation of a national coalition and contributions made by the coalition towards promoting USI in India. The activities of the national coalition in India are classified into three phases; 1) Phase 1- year 2006 to 2009- the inception; 2) Phase 2- year 2009 to 2012- consolidation; 3) Phase 3- year 2013 and ongoing- expansion. The National coalition for Sustained Optimal Iodine Intake (NSOI) has been instrumental in ensuring greater coordination and synergy amongst IDD and USI stakeholders in India and partially responsible for the current 71 percentage household level coverage of adequately iodised salt. The most significant contribution of the national coalition has been to act as a high level advocacy channel and provide a platform for regular dialogue for all partners of the coalition. With "mission" approach and allocation of optimal resource, India can achieve and should achieve USI by 2015, an apt culmination of a decade of existence of the national coalition. 碘缺乏失調(IDD)是全球構成智力障礙最重要的單一可預防因素。全面食鹽加 碘(USI) 各個利害關係人，世界衛生組織/聯合國兒童基金會/ICCIDD，認知到 行動協調以及共同合作的重要性。他們已經規劃一個國家級多部門聯盟，當作 國家永續消弭IDD 十項必要的指標之一。在民主及多元的國家如印度，協調 各個碘缺乏失調/全面食鹽加碘利害關係者的挑戰更大。本文，我們呈現印度 全國聯盟組成及共同推動全面食鹽加碘的貢獻的成功經驗。全國聯盟在印度的 行動分成三個階段；1)第一階段 - 2006 至2009 年 - 創始；2)第二階段 -2009 年 至2012 年 - 鞏固；3)第三階段- 2013 年之後 - 擴展。永續最適碘攝取(NSOI)全 國聯盟已確保印度IDD 和全面食鹽加碘的利害關係者有更多的協調及合作， 對目前71%的家戶加碘鹽涵蓋率負部分的責任。全國聯盟最重要的貢獻為扮演 高層級的宣傳管道，並提供給所有聯盟夥伴作例行對話的平台。隨著任務的推 動及最適當的資源配置，印度應可以在全國聯盟成立十年之2015 年前，達到 全面食鹽加碘的目標。
ABSTRACT Iodine, an essential micronutrient, is crucial for the production of thyroid hormones - triiodothyronine(T3) and thyroxine(T4). Thyroid hormones regulate the optimum mental development, physical growth and development, regulation of body metabolism, heat generation, and maintenance of body temperaturein an individual. Geological processes like flooding, soil erosion, deforestation, and rivers changing course, deplete the surface soil of iodine, as it is present in the top layers of soil and easily soluble in water. As a result, the population residing in the area with iodine-deficient soil, becomes susceptible to a spectrum of functional and developmental abnormalities due to dietary deficiency of iodine. Universal Salt Iodization (USI) for prevention of IDDs in India is a public health success story. The adoption of the salt iodization strategy serves as a textbook example of the journey of an intervention through the iterative loop of research to policy to programme. Salt iodization has proved to be a safe, accessible, available, affordable, and cost-effective strategy to address the burden of IDDs in India. India has been at the forefront of the efforts to control IDDs globally. India is on its way to achieving the target of > 90 percent household coverage of adequately iodized salt. Revised Food Safety and Standards (Fortification of Foods) Regulations released in 2019 introduced an upper limit for iodine concentration in salt, the adequate iodine level required at the production and consumer level, including the distribution channel at 15 – 30 ppm. Universal Salt Iodisation (USI) is India’s public health success story. There is a need to consolidate progress so far and focus on strategy to reach the “last mile”. Sustainable elimination of Iodine Deficiency Disorders (IDDs) with Universal Salt Iodisation (USI) being the primary strategy needs to also factor in harmonisation with salt reduction strategy for control of non-communicable diseases.
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