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How many times have you seen someone fainting in a school assembly?

If the memory and the subsequent ripple of hushed whispers are still fresh in your mind, you’re not alone. It’s almost like morning assembly mishaps are part of national experience.

While the causes for this could be skipped meals or the general heat, one of the other main reasons for general fatigue could be anemia. According to a study, 46% of all Indians experience anemia and it is prevalent especially in women and children.

While anemia is often equated to iron deficiency, it’s much more complex than that.

It’s a condition where a person’s blood doesn’t contain enough healthy red blood cells to carry out oxygen to various parts of the body. Without enough oxygen in the body, the tissues and organs have a hard time serving its primary functions. This is why symptoms like fatigue and shortness of breath occur.

But India’s anemia crisis is far bigger and has prevailed over 50 years of government programs that have tried to minimize its damage. To trace this, it’s important to understand the different forms of anemia.

Understanding anemia in its different forms

Reduced hemoglobin levels in the body can cause anemia, but there are a number of other reasons why this condition occurs. There are over 400 different types of anemia, but based on the root cause, it is usually classified into six types:

• Aplastic Anemia is caused by bone marrow damage and can cause fatigue, uncontrolled bleeding, and a lowered immune system leading to a higher risk of infections. This can occur to anyone, at any age and can become lethal if left untreated. The treatment for this condition involves medication, blood transfusion, and even a stem cell or bone marrow transplant in severe cases.
• Iron Deficiency Anemia is the most common type and is caused by the lack of iron intake, especially due to poor diet, certain drugs, or drinks. It can also be due to conditions such as Crohn’s disease or pregnancy and breastfeeding using up all the iron in the body. This condition can be corrected by taking supplements and does not pose a high risk unless left untreated. But in children or pregnant women, this condition can lead to further complications. Especially in the latter, it can have an impact on the unborn child and cause premature births, low birth weight, and postpartum depression in the mother.
  
• Sickle Cell Anemia is a genetic condition that can cause the shape of the red blood cells to distort and attain a sickle-like shape. This condition will cause a red blood cell to die within 10 to 20 days, as opposed to the usual 120 days it lives. Inheriting this trait from one parent might not pose a high chance of exhibiting the disease. But if both the parents carry the trait, the child can experience pain and swell in the limbs, delayed growth, frequent infections, and even vision problems. There are no known treatments for this condition, but treatment plans are provided to better deal with the pain.
• Thalassemia is also a genetic disorder caused by a gene mutation. This condition can lead to low red blood cell count and pose difficulty in carrying oxygen through the body. This can leave a person feeling fatigued and generally being weak. Telltale signs also include pale or yellowish skin, abdominal swelling, and dark urine. In minor cases, this condition can be managed with diet and exercise. But severe cases require blood transfusions. If left unaddressed, it can impact other organs such as the heart, spleen, and bone.
• Vitamin Deficiency Anemia is the last type of anemia that is caused by dietary deficiency or the ineffective absorption of necessary nutrients. A lack of folate, Vitamin B-12, and Vitamin C can cause this condition and can usually be corrected by the following diet and taking supplements. If left unchecked, this variant of anemia can lead to nervous system disorders, scurvy, and premature births in pregnant mothers.
• Blood Loss Anemia is said to happen when a person loses red blood cells due to excessive bleeding. This can be due to ulcers, gastritis, post-surgical, or even due to a woman’s period, especially if they have heavy bleeding.
  

The symptoms for anemia are often so mild that it goes unnoticed. But being aware of its symptoms, and getting tested can help in early detection and treatment. 

The common symptoms are fatigue, dizziness, headache, unexplained pain in the bone, chest, and joints. Shortness of breath, pale skin, cold limbs, and general weakness are also telltale signs of anemia. 

But anemia doesn’t affect everyone equally.

While anemia affects a large number of India’s population, the disease isn’t distributed equally across the demographic. Children and women often experience higher risk factors for the condition. In the case of the former, timely interventions, dietary supplements, deworming and full immunization can address the condition. 

Iron deficiency anemia poses a complex problem in women and even more so in pregnant mothers. Periods and the resultant blood loss is often what puts women at risk. Women in the menstruating age lose a lot of blood every month, along with necessary iron. Especially for those who experience heavy bleeding, the risk of anemia becomes higher. Uterine fibroids can also cause women to bleed slowly for a longer period of time, and lose iron from their body. 

During pregnancy and breastfeeding, women face an increased need for more iron and this can also contribute to the prevalence of iron-deficiency. Women may also lose a significant amount of blood during childbirth. Usually, they need an additional 50% iron more in situations like this. Usually, prenatal vitamins that contain iron can supplement these nutrients and prevent low iron levels and pregnancy-related anemia. But there is an apparent healthcare and awareness gap in India, especially in rural areas that add to this public health problem. 

In addition to this, the vegetarian diet prevalent among Indians put all Indians at higher risk for iron deficient or vitamin deficient anemia. There is also a genetic proneness towards Sickle Cell Anemia and Thalassemia. Due to all these factors, it is important for Indians, especially women to pay more attention to their iron levels and to keep their doctors informed about any symptoms of anemia. 

Why does India have this unique problem?

While anemia, like any disease, is a personal healthcare problem, the sheer impact of it has made it into a public health concern. Low hemoglobin levels from anemia can lead to increased fatigue, weakness, and productivity, which has an economic impact as well. 

For half a century, the Indian government has been taking various approaches to tackle this, and yet the high number of cases persist. 

According to a report in the Business Standard, lack of priority is the biggest reason why anemia still continues to be a problem. Lack of awareness and education among women come in as the second reason. Without anemia being taken seriously enough, there have been very few attempts at active campaigns to enhance the intake of iron and vitamin-rich food, in addition to supplementation. 

While the National Nutritional Anemia Control Programme exists, there are discrepancies between the distribution of necessary supplements and the actual consumption of them by the people. Even worse, there is a vast difference between the availability of these supplements between urban and rural communities. The latter of which is where anemia is prevalent. 

Currently, anemia is considered a top healthcare priority in India and those involved in the campaign are hoping for an annual decline of 5%. To do this effectively, the government is conducting surveys, distributing deworming tablets, as well as iron and folic supplements. The ministry plans to utilize the school mid-day meal program to execute this vision among children. 

But according to a study published in the medical journal BMJ Global Health, education of women is the most effective way to better handle the Indian anemia crisis. With better awareness among women, children, adolescents, and future pregnant mothers all take better care to prevent anemia. 

When they are educated and aware, it is possible for them to overcome the barrier of poor health and nutrition knowledge in the country and get ahead of the problem. 

By ensuring better awareness among women and children, and a focussed attempt at reducing anemia by everyone, this problem can be better handled. 

While people often take for granted the availability of health information at their disposal, there is still a public health fight that is being fought. Learning more about anemia, and educating more people about it is one of the ways in which we can all contribute to the bigger picture and healthier future.

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