1. Initiatives in addressing Anemia in Assam
Dr. Priyakshi Borkotoky
Consultant Nutrition, NHM, Assam

2. Significant reduction in all categories
Status of Anemia
Significant reduction in all categories
34% reduction among WRA. ( India-4.1%)
49% reduction in among children under 5 years. ( India-6.85%)
27.2% reduction among PW. ( India – 7.6%)

3. Vulnerable Communities
Tea Garden Community
Minority Community

4. Causes of Anaemia in vulnerable Communities of Assam
How to Prevent Nutritional Anaemia
Well Balance Diet
IFA Supplementation .
Deworming
Proper introduction of complementary feeding.
Habit of taking black tea with salt instead of water in Tea Garden Community
Low protein diet.
Poor dietary iron source in diet and iron absorption enhancers
STH
Late complementary feeding
Multiple pregnancies

5. Poor compliance among PW Poor compliance among Pre schoolers
Interventions
NIPI 6 months to 59 months :
NIPI 5-10 & years :
NIPI Pregnant Mothers
Deworming
Malaria at eradication phase
Special Initiatives such as
Mission Tejaswee
Mission Rupjyoti
Focus on tea gardens by UNICEF, Assam
Focus on riverine areas by Boat Clinics
Issue of departmental directives for IFA supplementation from
department of Education & Social Welfare
Poor compliance among PW
Poor compliance among Pre schoolers
Resistant Schools

6. Mission Tejaswee-A month long Programme Anaemia Free Assam
Special drive for prevention and
awareness of anemia
Lauched in October, 2015
Initially Launched centrally at Guwahati
by Hon’ble Chief Minister followed by
District level Launching by MPs/MLAs
and Deputy Commissioners.
It is annually implemented across the
state with equal focus in all 27 districts
Branding: Wearing of Red Apparels by all
on the day of launching.
Implementation steps are analogous to NDD & IDCF

7. Mission Tejaswee-A month long Programme Anaemia Free Assam
Objectives:
To improve compliance for IFA in all age group.
Capacity building and regular sensitization of all services providers who deals with IFA supplementation on anaemia effects and its prevention.
Intensive awareness generation on effects of anaemia and its prevention as well as food diversification.

8. Mission Tejaswee-A month long Programme Anaemia Free Assam
Process:
Month long targeted approach against anaemia to reduce anaemia prevalence in Assam.
Demand generation through awareness.
Identification of High Risk Pregnant Women and their referral.
Strengthening and streamlining of drugs distribution system.
To extend weekly iron folic acid supplementation programme in all school & AWCs of Assam
Awareness generation on danger signs of pregnancy due to anaemia. This increased identification and referral of HRP.

9. Demand Generation for NIPI 6 months to 59 months
(Target: Parents)
Poor physical development
Poor attentiveness
Poor memory
Poor academic performances in future
Delayed psychomotor development
IFA supplementation is important Raising Healthy
Children

10. Demand Generation NIPI 5-10 & 10-19 years
Advantages of IFA Supplementation (Academic)
Target: School Teachers
Increase in IQ leading to better academic performance of the students.
Increase in learning ability.
Increase in concentration.
Increase in energy levels and output in day to day work.
Increase in overall capacity to work and earn.
Physically more active facilitating increased participation in extra
curricular activities.
Reduction in school absenteeism.

11. Target: adolescence girls & parents Health Benefits of IFA Supplementation
Increase in Hemoglobin level thus reduction in anemia.
Reduction of occurrence of dysmenorrhea
Increase appetite.
Reduced fatigue.
Regular Menstrual cycle.
Better sleep.
Improved Skin Appearance.
Building pre-pregnancy health.
Feeling stronger and less tired.

12. Demand Generation for Pregnant mothers
Target : PW , Husband & family members for safe delivery and healthy baby
Low birth weight
Premature birth
IFA supplementation is safe and essential during pregnancy
Target of HRPW (anaemia)/ASHA - ensuring identification & IFA compliance.
Involvement of CHO using MCTS work plan.

13. There are some harmless but expected mild side effects of IFA
Epigastric discomfort–nausea, diarrhoea or constipation
Dark stools
Metallic taste
Side effects are not universal, not frequent (<1%) and never lead to any adverse event (disability or death)
These happen most when is taken for the first time, since the body may find it little difficult to digest and disappear once IFA is regularly used for a few days or weeks. Dark stools are harmless. The body takes the iron it needs and the extra iron comes out of body through feces.

14. Steps of implementation
State workshop
District workshop
Block & micro level Training of Teachers/ANMs/Health Supervisors/LHVs/ASHAs/ ASHA supervisors
SC & Block micro planning
District Micro planning meeting
Mission Tejaswee Implementation
Review by state NHM
IEC- BCC Activities (7 days prior to the campaign)

15. Communication planning (IEC/BCC)
Leaflets
Miking with special focus on hard to reach & tea garden areas.
Audio jingles developed by state HQ .
Audio-visual spots generated for local cable TV & community radio.
Banners/ Posters
Group SMS to all citizens of Assam on the day of launching.
Rally
Street play by ASHAs in community meetings.
Media briefing

17. Mission Rupjyoti
Special IEC and BCC initiative for prevention and awareness of anemia

18. Out Comes
Group
(1st quarter)
NIPI for 6-59 months
46%
54%
63%
NIPI for 5-10 years
not started
56%
84%
NIPI for years
23.11%
58.90%
42%
NIPI for Pregnant Lady
 91%
93%
94%
Mission Tejaswee
72.60%
76.80%
Nov, 2018
Progressive improvement in coverage in case of all age group.
Improved awareness on anaemia among students, teachers, other beneficiaries and community.
Periodic sensitization during Mission Tejaswee, strengthening the NIPI programme by boosting confidence, ownership of ASHA, AWW & Teachers.
Enhance cooperation among Heath, Social Welfare and Education department.
Awareness generation on danger signs of pregnancy due to anaemia. This increased identification and referral of High Risk Pregnancy cases contributing to reduced MMR & IMR.
Optimum supply and use of IFA syrup and tablets.
Better acceptance of IFA in the community.

19. Case Study Patient name: Devi Doley History:
During the 1st ANC was detected with a Hemoglobin level less than 9 mg/dl and identified as severely anaemic.
Management:
Regular home visits with counselling to Doley as well as to her family members on ANC, importance of institutional delivery, balance diet, dietary diversification and compliance of 180 IFA tablets though home visits. AWC has ensured regular supply of take home ration also creating awareness on locally available iron rich food.
Out come:
Hb level increased to 11 mg/dl at delivery and she delivered a healthy child weighing 3.9 Kg at Govt. Hospital.
Presently she is in the 1st trimester of 2nd pregnancy with Hb -10mg/dl. She get registered herself to take all ANC facilities.

20. Actions to Sustain Good Coverage

21. Robust Monitoring Plan
At Sub Center (SC) Level:
The MPW (M) and ANM visit schools
and AWC under their jurisdiction and monitor
the school/ AWC reporting register on WIFS/
WIFS Junior fortnightly.
At Block Level:
All BMO, BPM, BCM, HE, BEE, LHV, BPA ABPM visit one school and one AWC per week regularly to monitor WIFS programme. Each person will visit separate institutions every time.
At District Level:
SDM&HO ( School Health)/ i/c SDM&HO ( School Health), DPM, DME, DCM, RBSK Coordinator, Urban Health Coordinator will visit one schools and one AWC per month regularly to monitor WIFS programme.

22. Drug Supply State District Block Sub centre
IFA tablet are available up to the Sub Centre level. Nodal teachers has to submit their requirement and collect medicine from sub centre. Furthermore MPW will be responsible for estimation of requirement of IFA, stock enquiry and availability of IFA at school/AWC.
In absence of MPW indent may be submitted to the respective ANM.
In SCs where no MPW or ANM is posted, medicine may be distributed by the RBSK team or ASHA , CRCC may be also be involved in such cases.

23. Reporting Formats Reporting format of NIPI-Under 5 & PW Simplified SN
School / AWC SN
Name of the Format
Person Responsible
Submitted to A
Monthly School Reporting Format
Nodal Teacher/ AWW
To be prepared in duplicate one copy to MPW/ ANM of nearest SC and one copy to parent Department B
Sub Centre Level Reporting Format
MPW/ANM
Sector C
Class Monthly Register/ Monthly AWC Register
To be maintained at School/ AWC E
Block Reporting Format for Education
BPA or block level in charge of WIFS programme
CDPO/BEEO/School Inspector F
Individual Compliance Card
Class Teacher
To be maintained against each student & filled by class teacher
Monthly AWC Register : Initiative of the State

24. Special focus on riverine areas
13 lakh people in 13 districts
IFA supplementation through boat clinics in riverine areas
IFA stock maintained by ASHA

25. Key drivers Enhanced outreach through MMUs specially in Tea Gardens
Strong communication campaign – Mission Tejaswee
Focus on vulnerable pockets
Supply issues effectively addressed
Convergence – A monthly meeting regularly held in O/o of MD, NHM and DSW is the convenor of the meeting.
Improved access to food and feeding behaviors – ration for tea garden areas.
Bottlenecks addressed – auto-dispenser.
ASHA incentive payment for IFA supplementation streamlined.

26. Thank You

27. Caused nutritional anemia in 6 – 5 years children
Poor Iron store in the body
Other micronutrient deficiency
Worm Infestation
Malaria
Infection
How to prevent anemia in preschool children 6 months to 5 years
ntation for Biannual Deworming
Hand washing habit of the mother and child at the later part of the life.
Introduction of Complementary Food at 6 months of age.
Introduction of common family food from 1 year age.
Maintenance of proper personal and environmental hygiene.

28. Hand Washing Benefits of Hand Washing
Wash hands before holding a neonate or infant.
Wash hands before serving foods to children.
Start hand washing training of a pre school child as soon as possible.
Benefits of Hand
Washing
Protects from Diarrhea,
Pneumonia, Worm
infestation and other
infections.