PHOTO COURTESY: Unicef/Giacomo Pirozzi

Hundreds of children across the country are falling ill after consuming iron and folic acid tablets under the weekly iron and folic acid supplementation (WIFS) programme to combat anaemia.

But why is this happening? Is the WIFS programme inherently flawed or are these children psychologically ill — prepared to cope with symptoms like stomach ache and nausea? Have their parents and teachers not warned them about the possible consequences? Or is it that they were administered these tablets on an empty stomach?
Psychological ill-preparedness could lie at the heart of the problem because the sheer scale of this ambitious programme is mind-boggling. The health ministry plans to roll out iron folic acid (IFA) tablets every week to 13 crore adolescent girls in the age group of 10-19 years. And since boys have also been found to suffer from anaemia, the tablet is being given to school-going boys in several states.
India is home to 113 million adolescent girls from which nearly 60 per cent are estimated to suffer from anaemia while 30 per cent of boys suffer from anaemia. Folic acid is necessary for cell growth and repair and also essential for the formation and maturation of red blood cells.
Why are adolescents more prone to anaemia? Dr Vani Sethi, a nutrition specialist (adolescents) with Unicef pointed out, “Adolescence is a period of rapid growth and development. The body needs extra iron to keep pace with the exponential increase in weight, height and muscle mass.”
“Anaemia amongst girls diminishes their concentration, limits their learning ability, causes loss of appetite and affects their overall productivity. Our objective is to reduce cases of anaemia by giving them weekly IFA tablets and follow this up with regular de-worming tablets.”
Dr Sethi admits that nausea and vomiting may occur in some cases. Constipation and diarrhoea can also occur in some other. In fact, Anuradha Gupta, director, National Rural Health Mission said, “Scientific evidence globally suggest that there is a 5-15 per cent chance of children reporting adverse effects after consuming iron tablets. In India, incidents reported is less than one per cent which is inevitable.”
Delhi health and family planning welfare minister A.K. Walia, following the complaints of 200 children complaining of adverse effects in Delhi, said, “The body gradually adjusts itself to the intake of iron and folic acid supplementation after the first administration. This can be safely repeated in subsequent doses,” Dr Walia added. Setting at rest concerns about the quality of tablets, Dr Ramji, professor of paediatrics at Maulana Azad Medical College said that the tablets were manufactured in June 2013 and could be consumed until 2015. The same batch of tablets were sent to all the states but adverse effects were reported only from two clusters in Delhi where 15 lakh children had been administered these tablets in schools and three lakh in anganwadi centres. “The side-effects are self-limiting and would be reduced on regular consumption of the tablets,” Dr Ramji explained.
Health specialists feel that eating foods from animal sources, including eggs and meat products as also green, leafy vegetables help ensure there is adequate iron store in our body. Herein lies the crux of the problem. High food inflation has ended up removing eggs and meat products from the diet of the average family. Dr Sethi said, “Families can scarcely afford to give their children milk and eggs on a regular basis. Earlier, leafy vegetables were part and parcel of the mid-day meal programme (this works out to `3 per child per meal) but rising food prices have stopped midday meal providers from incorporating these food items in the scheme.”
Unicef experts point out that anaemia alleviation was first implemented across 52 districts in 13 states between 2000-2005. Eighty per cent of the girls who participated in the initial stage reported that they had benefited from the programme. The next five years were spent in consolidation of this programme which ended up benefiting nearly 14.5 million school going girls.
Statistics show that the mean haemoglobin concentration in Uttar Pradesh showed an increase from 85g/L to 112g/L. Cases of severe anaemia declined across Maharashtra and Madhya Pradesh. Girls admitted to “feeling healthier”, “having more energy”, “not feeling sleepy”, “having regular menstrual cycles” and also “experiencing less abdominal pain during menstruation”.
Initially, around 50 per cent of the girls who had participated in the first phase had reported some undesirable effects including nausea, heartburn and vomiting. The decline in the incidence of undesirable effects was attributed to the fact that teachers, anganwadi workers, ASHAs and community resource persons provided regular counselling and support to these girls.
The death of 23 kids in Chhapra in Bihar while taking a midday meal, followed by reports of several kids from other states falling sick while consuming mid-day meals, has also helped build up a sense of hysteria and suspicion regarding health initiatives being taken by the government.
We cannot however forget that 20-40 per cent of maternal deaths in India are attributed to anaemia. A substantial proportion of these deaths due to antepartum and postpartum haemorrhage occur in women with moderate anaemia. Doctors also warn that anaemic women are less able to cope with the risk of sepsis during delivery.
All in all, if the government wants to make a success of anaemia control, they need to promote it in the way the they the pulse polio campaign roping in celebrities, politicians , teachers and community resource people at the village levels to rebuild the trust deficit which is entering this otherwise excellent programme.