Eleventh Five Year Plan

144 Eleventh Five Year Planand children. This task could be assigned to theNational Institute of Nutrition, Hyderabad.MICRONUTRIENT MALNUTRITION CONTROL:CURRENT SCENARIO4.1.70 The National Nutrition Monitoring Bureau(NNMB) Report of December 2006 reveals that theconsumption of protective foods such as pulses, greenleafy vegetables (GLV), milk, and fruits was grossly inadequate.Consequently, the intakes of micronutrientssuch as iron, vitamin A, riboflavin, and folic acid werefar below the recommended levels in all the age groups.The data from nutritional survey of children underfive years shows that the prevalence of signs of moderatevitamin A deficiency (VAD) (Bitot spots onconjunctiva in eyes) and that of B-complex deficiency(angular stomatitis) was about 0.6% and 0.8% respectivelyamong the preschool children. Among the schoolage children, Bitot Spots were found in 1.9%, and theprevalence of B-complex deficiency and of mottlingof teeth (dental fluorosis) was 2% each.4.1.71 We look at some of the specific micronutrientdeficiencies in the country that are of a magnitude thatcauses public health concerns.Anaemia4.1.72 IDA is the most widespread micronutrientdeficiency in the world affecting more than a billionpeople. It affects all age groups irrespective of gender,race, caste, creed, and religion, with higher incidenceamong vulnerable groups in developing world.Anaemia is associated with increased susceptibilityto infections, reduction in work capacity, and poorconcentration. In India, this silent emergency isrampant among women belonging to reproductiveage group, children, and low socio-economic strataof the population. IDA reduces the capacity to learnand work, resulting in lower productivity and loss ofwages, limiting economic and social development.Anaemia in pregnant women leads to adverse pregnancyoutcomes such as high maternal and neonatalmortality, LBW, increased risk of obstetrical complications,increased morbidity, and serious impairmentof the physical and mental development of the child.Anaemia remains one of the major indirect causesof maternal mortality in India. In children, anaemiacauses low scholastic skills leading many of them tobe below average in classes or premature dropping outfrom schools. It also triggers increased morbidity frominfectious diseases.4.1.73 It is also seen that children born to motherswho were illiterate or who belonged to scheduledcastes/tribes were more likely to be anaemic than theircounterparts. Further, children born to moderately andseverely anaemic mothers were also anaemic, reflectingthe consequences of poor maternal health statuson the health of the children. Research studies havesuggested that severe IDA during the first two years oflife, when the brain is still developing, may causepermanent neurologic damage adding further senseof urgency to the current efforts to prevent IDA inchildren.4.1.74 As per District Level Health Survey (DLHS)(2002–04), the prevalence of anaemia in adolescentgirls is very high (72.6%) in India with prevalence ofsevere anaemia among them much higher (21.1%)than that in preschool children (2.1%). In adolescentgirls, educational or economic status does not seem tomake much of a difference in terms of prevalence ofanaemia. Prevention, detection, or management ofanaemia in adolescent girls has till now not receivedmuch attention. In view of the high prevalence ofmoderate and severe anaemia in this group and thefact that many of them get married early, conceive,and face the problems associated with anaemia inpregnancy, it is imperative to screen them for anaemiaand treat them.4.1.75 Low dietary intake and poor iron and folic acidintake are major factors responsible for high prevalenceof anaemia in India. Poor bioavailability of ironin Indian diet aggravates the situation. High levels ofinfection such as water—and food-borne infections,malaria, and hook worm infestations further aggravatethe situation.4.1.76 Prevalence of anaemia is very high amongyoung children (6–35 months), ever married women(15–49 years), and pregnant women (Annexure 4.1.3).Overall, 72.7% of children up to the age of three inurban areas and 81.2% in rural areas are anaemic.