More Indians are anaemic than before, 67% children under 5 affected: NFHS-5

An increasing number of people across all population groups, including children below five years, adolescent girls and boys, and pregnant women, is being affected anaemia, findings from the fifth round of National Family Health Survey (NFHS-5, 2019-21) have revealed.
According to the survey report, at least 67 per cent children (6-59 months) have anaemia as compared to 58.6 per cent in the last survey conducted in 2015-16. Among adults , 57 per cent of women and 25 percent of men (in the 15-49 group) have anaemia, the report stated. Anaemia is a condition that is marked low levels of haemoglobin in the blood. Among women, its prevalence has increased from 53 percent in 2015-16 to 57 per cent in 2019-21. In men, it has increased from 23 per cent to 25 per cent.

The figures also seem to be a blow to the Anaemia Mukt Bharat strategy which had laid down the target of 3 per cent reduction in prevalence of anaemia per year among children, adolescents and women in the 20–49 age group, between the years 2018 and 2022. “NFHS-5 data suggests that India is nowhere close to the 2022 target set for the country – that is an overall 18 per cent reduction in the prevalence of anaemia in all age groups,” Dr Suparna Ghosh-Jerath, Professor and Head, Community Nutrition, Indian Institute of Public Health- Delhi, Public Health Foundation of India, told The Indian Express.
According to the nutrition expert, anaemia could be attributed to several risk factors that decrease iron intake and absorption or increase its demand and loss, with multiple etiologies often coexing in an individual.
Anaemia is a serious concern for children because it can impair cognitive development, stunt growth, and increase morbidity from infectious diseases.

Iron is a key component of haemoglobin, and iron deficiency is estimated to be responsible for half of all anaemia cases globally. Other causes of anaemia include malaria, hookworm and other helminths, other nutritional deficiencies, chronic infections, and genetic conditions.
“Presence of infection and inflammation in the body can reduce iron absorption. Therefore, addressing infection and inflammation is critical to improve the effectiveness of ongoing iron and folic acid supplementation programmes,” Dr Ghosh-Jerath pointed out. “Social issues like women in the households eating less iron-rich foods than the rest of the family, poor health-care seeking behaviour and reduced levels of empowerment can also be attributed to high prevalence of anaemia. Environmental factors like climate change and the resulting impairment of crops and agricultural yields leading to food shortages and insecurity may also trigger higher anaemia prevalence,” Dr Ghosh-Jerath said.
Overall, 67 per cent of children were found with some degree of anaemia (haemoglobin levels below 11.0 g/dl grams per decilitre). Twenty nine per cent of children had mild anaemia,
36 per cent had moderate anaemia, and 2 per cent had severe anaemia.
Anaemia was found to be more prevalent among children under 35 months as compared to older children, with a peak prevalence of 80 per cent observed among children age 12-17 months.
The prevalence of anaemia among children age 6-59 months was found highest among children in Gujarat (80 per cent), followed Madhya Pradesh (73 per cent), Rajasthan (72 per cent), and Punjab (71 per cent). The union territory (UT) of Ladakh, at 94 per cent, was found to have the highest prevalence of anaemia. Other UTs with high anaemia prevalence included Dadra and Nagar Haveli and Daman and Diu (76 per cent), and Jammu & Kashmir (73 per cent).
The states with the lowest prevalence of anaemia among children were Kerala (39 per cent), Andaman & Nicobar Islands (40 per cent), and Nagaland and Manipur (43 per cent each).
Meanwhile, 57 per cent of women and 25 per cent of men aged 15-49 years in India were found anaemic. The overall prevalence of anaemia was found consently high, at more than 50 percent, in almost all of the subgroups of women. For men, the prevalence is above 20 per cent in almost all of the subgroups.
Alternate-day dosing of Iron-Folic Acid (IFA) supplements is beneficial in increasing the iron absorption and may help in improving Hb levels as compared to daily dosing, experts said. “This may also have the potential to improve the uptake of IFA supplementation,” Dr Ghosh-Jerath said. She said that the correct method of estimation of anaemia prevalence is critical while maintaining strict quality control measures. “There is a possibility of underestimation of haemoglobin when assessed using capillary blood (as used in several rounds of NFHS survey) as compared to venous blood (used in CNNS [Comprehensive National Nutrition] survey). Due considerations may also be given to the cut-offs for Hb for determining iron status in different age groups,” she said.

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