After scores of schoolchildren in Haryana were taken ill post-consumption of iron and folic acid supplements during the anti-anaemia drive of the state government, HT talks to noted paediatrician Dr Dinesh Khosla, MBBS, DCH, MD, about the ongoing controversy.
Dr Khosla had been called by the state government for expert opinion at its high-level task-force meeting on October 23, 2012, during the brainstorming session on countering anaemia in the state. Dr Khosla has also trained hundreds of frontline health workers in nutrition under the Breast Feeding Promotion Network of India.
Children were administered supplements to combat anaemia, but were hospitalised. What is the real problem?
The National Iron Plus Initiative Programme (NIIP), being run under the National Rural Health Mission (NRHM) in the state, is excellent in its original form, but there are gaps in the implementation of the programme.
How is the programme's implementation affecting children's health?
According to the NIIP, the government should have launched the curative programme before preventive programme to counter anaemia. A survey has revealed that 82% children in the state are anaemic. If anaemia is not cured, how can it be prevented? The government has launched the preventive programme and is claiming that they have launched the curative programme.
Though the state government is calling the pills completely safe, students are still being taken to hospitals. Currently, seven from Jind are being treated at the Post-Graduate Institute of Medical Sciences in Rohtak.
According to the NIIP, iron and folic acid tablets are to be distributed in three dosages' quantity - 100mg for 10 to 19 years, 45mg for 5 to 10 years and 20mg/1ml syrup for kids aging between 6 months and 5 years. All dosages are to be given by the ASHA (Accredited Social Health Activist) workers who are given incentive for the purpose. But, the state government appointed teachers to do the task, which is creating problem.
The government is yet to administer supplements to children aging between 6 months and 5 years.
This is where the government is lacking vision. The correction of anaemia in this age group will save the present generation as the cognitive brain growth takes place in first two years after taking birth.
What about the government's claim that the tablets have no side-effects?
Side-effects are there and children being admitted to hospitals are proof of that. But if the state government adopts two ways, they will be able to reduce the toxicity of tablets. First, tablets containing iron sulphate should be replaced with iron fumarate. Second, the dosage should be according to the weight of the child, not according to the age, a blunder the state government is committing. The dosage should not exceed 2-3 mg/kg/day on a single child.
Is it true that iron and folic acid tablets should not be consumed empty stomach, as advised by the state government?
No. According to the principles of pharmacology, it should be given empty stomach. If it is given full stomach, then iron absorption will be low and anaemia correction will not take place.
Please elaborate on the reason.
Generally, in Haryana, we consume wheat which contains phytates, tea which contain tannins and milk which contains calcium. If iron tablets are given full stomach, they get mixed with these products and pass through stool, leaving low impact of dosage.
Any advice for those who can't afford iron-rich fruits such as pomegranate, as advised by the state government, to combat anaemia?
Pomegranate does not contain iron. The government should know why they are advocating consumption of pomegranate to a common man, most of who can't afford it. The government needs to address the food myths in public to make them aware as to which food contains iron. Traditional food such as mustard, carrot, raddish leaves, spinach, bathua, chulai, dhania and pudina and inn cereals such as bajra are best iron-rich food. And, they should not forget to consume jaggery (gur).
Top iron-rich diet: Egg yolk, dry beans, dry fruits, bathua and gur.
Medium iron-rich diet: Spinach and banana
Low iron-rich food: Milk and its products