Health camps as an instrument to fight Anaemia!

‘Anaemia Mukt Bharat’ Camp, Naraingarh General Overview Anaemia is a medical condition characterised by deficiency of red blood cells in the body. This leads to insufficient oxygen being transported across the body, which in turn can lead to various issues including fatigue, pale skin and light-headedness. Anaemia can also lead to complications during pregnancy and increase danger to life for both the pregnant woman and the child. It is widely recognised that Indian women suffer from Anaemia. In response to this state of affairs, the Anaemia Mukt Bharat strategy was launched in 2018 by the Ministry of Health & Family Welfare in conjunction with UNICEF.

The crux of the strategy to combat Anaemia is increasing awareness about the disease and the dietary habits to combat it, and to provide Iron Folic Acid (IFA) tablets to women. The National Family Health Survey, 2019–2020 also reported that in 15 States/Union Territories, including Haryana more than half the women are clinically Anaemic. Haryana has been heavily invested in the Anaemia Mukt Bharat campaign. In March 2019, the Hon’ble Health Minister, Anil Vij launched Assuring Total Anaemia Limit Abhiyan to implement the objectives of Anaemia Mukt Bharat in Haryana.

The continued efforts over the past two and a half years have shown very positive results. In August 2020, Haryana was ranked first in the country for its measures to combat Anaemia. The District Administration of Ambala has been highly active in this fight against Anaemia. In the past, camps took place in Ambala City and Ambala Cantonment, and the present camp was in the Naraingarh sub-division in Ambala.

Modus operandi of the camp The camp was a success with the coordinated efforts of multiple government departments along with civil society. The District Administration, Health Department, and Women and Child Development Department were the major stakeholders from the government side. Saksham Yuvas, Nehru Yuva Kendra volunteers, and medical students from the Civil Hospital were the on-ground volunteers.

Moreover, the Red Cross provided food for volunteers during the entirety of the camp and 14 prominent schools in the sub-division provided buses to transport the volunteers from Ambala city to the camp venues and back. The camps ran for 30 working days from September 13th to October 22nd 2021, covering Naraingarh and Shehzadpur blocks, with 15 camps being held every day. The camps covered a total of 60,098 women.[1] This is ~56% of the total women in Naraingarh sub-division as per the 2011 census.

The number of camps to be held in a particular locality was finalised based on the population in the village/ward from the 2011 census, adjusting for population growth with insights from Anganwadi workers. The camps were sought to be started by 10.00 AM. Prior to this, Anganwadi workers, WCD supervisors, and ASHA workers would go door-to-door to motivate women to participate in the camps and to spread awareness of the dangers of Anaemia. Buses would start from Ambala City and Ambala Cantt as early as 8.00 AM.

These buses transported the volunteers, and the necessary testing equipment from Ambala City/Cantt to the camps in Naraingarh. In the camps, the women were told their HB levels; women were provided awareness on the kinds of foods to include in their diets to combat anaemia, and anaemic women were given IFA tablets on the spot, and prescriptions for further treatment in government hospitals as needed. The camps were closed by 3.30 PM following which the volunteers were transported back to Ambala City and Ambala Cantt. Findings from the camp.

The camps in Naraingarh block took place over 16 days from September 17th to October 01st. 28,919 women were covered in the camps with an average of 1,807 women tested per day.[2] Shehzadpur block was completed in 14 days from October 04th to October 22nd. 31,179 women were tested, with an average of 2,227 women tested per day.[3] Detailed data on diets, income status, HB data were analysed initially for a random sample of 13,900 women (~23% of the total women tested). WHO records HB level lesser than 12.5 g/dL as the criterion for Anaemia.

Taking into account the observation that these are Western levels not transplantable to the Indian context, we take a more conservative figure of less than 12 g/dL as the criterion for Anaemia, and less than 8 g/dL as severely Anaemic. Based on the above limits, the representative sample indicates that ~78% of the women are Anaemic, and that ~2% are severely anaemic.

Way Forward Thus far, we have completed one round of testing and provision of IFA tablets on a universal basis, in Naraingarh sub-division. In the next phase, we will be providing IFA tablets, and testing door-to-door in Phase II to three target groups — 1) moderately anaemic, 2) severely anaemic, and 3) newly wed couples.

The routine testing is designed to help the Health department and district administration receive visibility on whether the interventions are actually creating a difference on ground, and make policy modifications on a real-time basis as needs be.

[1] Data from the field was compiled manually for 20 out of the 30 days. This was 41,604. For the remaining 10 days, the average of the existing data across both blocks were used to extrapolate and find the total number of women covered.

[2] Data from the field was compiled manually for 7 out of the 16 days. This was 12,652. For the remaining 9 days, the average of the existing data for the block was extrapolated to find the total number of women covered.

[3] Data from the field was compiled manually for 13 out of the 14 days. This was 28,952. For the remaining 1 day, the average of the existing data for the block was extrapolated to find the total number of women covered.

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