Pandemic hit anemia programme in schools, anganwadi centres
As the pandemic forced schools across the country to shut down, it wasn’t just learning that was disrupted — for almost half the students in Maharashtra their health was impacted too
Mumbai: As the pandemic forced schools across the country to shut down, it wasn’t just learning that was disrupted — for almost half the students in Maharashtra their health was impacted too.
Children and adolescents between six months to 19 years missed out on crucial iron and folic acid (IFA) supplements — distributed in schools and anganwadi centres — when they shut down on March 15 due to the Covid-19 pandemic. The state public health department data indicates that while 12.7 million children and adolescents received their supplements in 2019-2020, in 2020-2021, the coverage dropped to 7.1 million, which is a 44% decline.
Distribution of IFA tablets in government and government-aided schools and anganwadi centres is one of the key interventions to reduce the incidence of anemia— a condition in which the number of red blood cells or the hemoglobin concentration within them is lower than normal. While children between six months to 59 months get bi-weekly doses of IFA in syrup form, those between five to 19 get weekly supplements in the form of sugar-coated tablets.
Anemia has serious health implications ranging from fatigue to worsened pregnancy outcomes. These supplements are distributed to toddlers and to school-going children, as part of the Anemia Mukt Bharat programme. Distribution of IFA supplements has been undertaken by states since 1970, but the Anemia Mukt Bharat initiative was launched in 2018 as a comprehensive approach that looks at six interventions including prophylactic supplements, behavioral change, provision of fortified foods in public health programmes among others.
Schools across the state were shut down after the first case of Covid-19 was recorded in Maharashtra on March 11, 2020. In-person classes were opened for classes 5 to 8 in rural Maharashtra and classes 8 to 12 in urban areas in August 2020 but in a mix of in-person and online classes format. Classes 9 to 12 reopened in November, but all classes moved back to the online mode shortly after the second wave hit in February 2021.
“The weekly IFA supplementation programme is mainly designed to be implemented in schools and anganwadi centres,” said Dr Ramchandra Hankare, deputy director of the state’s family welfare bureau. “Due to the pandemic and the lockdown, the distribution suddenly came to a standstill as children were confined to their homes. The programme did take a hit,” he said.
According to the National Family Health Survey-5, nearly 69% children under 5 years of age are anemic in Maharashtra. More than 50% women and over 20% men in the age group of 15 to 49 years are anemic in the state. Maharashtra’s parameters were slightly better compared to Gujarat which has the highest prevalence of anemia among children under 5 years at 78%, but at par with states like Bihar (69%), Uttar Pradesh (66%) and West Bengal (69%). Given the high incidence of anemia in Maharashtra, the hit in the programme is damaging, experts said. “When setbacks happen, it takes such programmes a few years behind,” said Dr Usha Ram, head of the department of public health and mortality studies, International Institute for Population Sciences, Mumbai.
Already behind the curve
The state’s achievement in the IFA supplementation programme started in the 1970s, has been on the lower side even before the pandemic hit. The state has a target of administering these tablets to 8 million children between six and 59 months. In 2019-2020, the state’s IFA supplementation coverage in this age group was 39%, but fell to 27% in 2020-2021. Officials said that ASHA and anganwadi workers were roped in to home deliver supplements to achieve some target during the pandemic.
Similarly, from the 8.2 million target in the age group of 5 to 9 years, the state reached 57% beneficiaries in 2019-2020, but only to 30% beneficiaries in 2020-2021. The IFA supplementation coverage in the 10 to 19 years age group (11.1 million) had a 42% coverage in 2019-2020, but it dropped to 22% in 2020-2021.
Even the outtake of Albendazole, a deworming therapy, given twice a year to children and adolescents in between one and 19 years, has come down. Parasitic intestinal worm infestation is known to be a major cause of undernutrition leading to anemia. In 2019-2020, the state had 95.48% coverage of Albendazole tablets, which declined to 91% in 2020-2021.
“As soon as the first wave receded, we involved ASHA and anganwadi workers to distribute the supplements at homes. We could reach out to many beneficiaries with this intervention,” said Dr Hankare, adding that the IFA supplementation coverage has improved considerably between April to November 2021 as adequate stock was supplied to districts and focus was re-directed to non-Covid activities.
“Despite high incidence of anemia, the state’s low coverage of IFA supplementation programme prior to the pandemic has been concerning,” said Soumitra Ghosh, associate professor at the Centre for Health Policy, Planning and Management at Tata Institute of Social Sciences. “There is plenty of evidence that IFA supplementation programmes work. But the tablets should be given along with health education,” he said.
According to Ghosh, the state should look at multi-sectoral strategies to implement the programme by involving various departments such as education and women and child health. “To overcome the shocks like the ongoing pandemic, the focus should not be simply on supplements, but also on a diversified, iron-rich diet. The public distribution system (PDS) should offer a variety of pulses and food grains and not just rice and wheat,” he said.