India is one among the countries with very high prevalence of anaemia. Fifty six per cent adolescent girls and 30 adolescent boys in India in the age group 10-19 years are anaemic according to the third National Family Health Survey.
In our country almost 50 per cent of nutritional deficency related anaemia is iron deficiency anaemia. It is mainly the result of under nutrition and poor dietary intake of iron, not just among pregnant women, infants and young children but also adolescents. It is estimated that five crore adolescents in the age group of 15to 19 are anaemic.
Iron deficiency anaemia during adolescence can impair physical growth, cognitive development, reduce physical fitness and energy levels and can affect concentration and work performance. Iron deficiency in girls has more serious health consequences. It can have impact on their entire life cycle. Anaemic girls have lower pre pregnancy stores of iron. Anaemic adolescent girls have a higher risk of preterm delivery and having babies with low weight. Anaemia in adolescent girls also increases the risk of maternal death. One third of all the material deaths take place in young women in the age group of 15 to 24 years.
Therefore regular consumption of iron folic acid supplements along with diet rich in micronutrients is essential for prevention of iron deficiency anaemia in adolescent girls and boys.
It is in this context that a nation-wide Weekly Iron and Folic Acid Supplementation (WIFS) programme was launched in January this year to address this critical health issue.
The Weekly Iron and Folic Acid Supplementation (WIFS) programme is currently reaching out to 13 crore school-going girls and boys (class VI – XII) and out-of-school adolescent girls in government/ aided and municipal schools and Anganwadi Centresacross all states in India.
There have been a few reports of minor side affects like nausea and vomiting in the recent past although guidelines have been issued on the consumption of these iron folic acid tablets to prevent side affect like nausea.
At a recent press conference Public health experts from Public Health and Nutrition Centre, AIIMS and UNICEF while sharing shared insights on the IFA tablets and WIFS programme threw light the side effects.
“When iron tablet is taken for the first time, the body may find it little difficult to digest and symptoms such as stomachache and nausea may occur. However, if taken after food, the absorption will be little low but stomach ache and nausea will not occur. These side effects will eventually disappear once the tablet is regularly taken for a few weeks as the body adjusts to the iron tablets. Hard stools after consuming iron-folic acid tablet are harmless. The body takes the iron it needs and the extra iron is removed through faeces. To reduce side affects IFA tablets should be taken on full stomach. Taking any vitamin or nutrient is never restricted during an illness. In fact, it helps speedy recovery from illness by improving immunity of the body. Iron folic acid tablet can be taken during illness and even during menstruation.”
Under WIFS programme functionaries across the states have been provided training as well as resource material to help build up skills so that this very important health programme is effectively implemented and monitored. The resources material talks about why it is important to prevent iron deficiency and anaemia, building skills for screening of moderate to severe, supply of logistic management four Iron Folic Acid (IFA) tablets. The states have also been advised to set up external quality monitoring cell for period inspection and also to ensure standards prescribed for quality are maintained for WIFS programme. Also in addition, there is a provision under the scheme for random batches of IFAs to be taken from the supplies of the state for periodic testing on quarterly or six monthly basis by the Minister of Health and Family Welfare in identified labs for monitoring the quality.
There are instruction at the schools and anganwadi levels also for monthly reporting and monitoring of the distribution of IFA and its proper storage as well as ensuring biannual de-worming of target groups.
Guildelines have also been issued on the intake of IFAs
These include:
· Iron-folic acid tablets should be consumed after the main meal of the day to prevent side effects such as nausea.
· Adolescent boys and girls who complain of side effects should be advised to take the IFA supplements after dinner and before retiring to sleep.
· Increased intake of foods rich in Vitamin C such as lemon, amla etc can help absorb iron from the vegetarian Indian diet.
· Use of iron vessels for cooking should be encouraged.
· Drinking tea or coffee within an hour of consuming main meals should be discouraged.
· Adolescent boys and girls should be motivated to follow correct hygiene practices and the habit of using footwear to prevent worm infestation.
Although guidelines have been issued, there a need to address to program implementation issues including training of teachers and functionaries involved in this critical health mission. There is a need for renewed emphasis on training with special reference to supervised ingestion which ensures correct method of IFA tablet intake. There is also a need for better monitoring of the programme.
The Current data shows that slow release ferrous sulphate preparations remain the established and standard treatment of iron deficiency. Weekly supplementation with iron and folic acid in menstruating women has been successfully implemented using different mechanisms in several countries (including Cambodia, Egypt, Laos, Philippines and Vietnam).
As rightly pointed out by Additional Secretary and Mission Director, NRHM, Mrs. Anuradha Gupta, the weekly Iron Folic Acid Supplementation (WIFS) is an evidence based programme for addressing Iron Deficiency Anaemia which is both safe and effective. She said that miniscule number of cases where some adolescents have had some minor side-effects should not act as a deterrent to this very important public health initiative.
There is however a need to spread awareness and not misinformation about WIFS by ensuring effective implementation and proper monitoring of this ambitious programme critical for the health growth and development of adolescent boys and girls.
