250 health practitioners argue against lowering anaemia cut-offs

Doctors, researchers, nutritionists and activists have written to the World Health Organization and other medical institutions opposing the lowering of the minimum haemoglobin levels to diagnose anaemia in India. This comes after the disease was removed from the National Family Health Survey this year. The letter argues that lowering the levels will lead to an underestimation of anaemia in the country and the absence of a standard for international comparison. The medical implications of untreated anaemia can be grave, including fatigue, fainting, blood diseases, swelling in legs, breathing problems and anxiety.

Mumbai: More than 250 clinicians, researchers, nutritionists and activists have endorsed a letter arguing against lowering the minimum haemoglobin (Hb) levels to diagnose anaemia, a point of debate in the country after the disease was removed from the National Family Health Survey (NFHS) this year. According to Dr Sylvia Karpagam, who penned the letter, this will lead to an underestimation of anaemia in the country and the absence of a standard for international comparison.

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The letter is addressed to the World Health Organization (WHO), Indian Council of Medical Research (ICMR), National Institute of Nutrition (NIN), etc.

The letter comes in response to the article, ‘Anaemia, a weak case,’ in a national daily, which based its argument on a paper in the Lancet Global Health journal by Sachdeva and other authors, “Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1 to 19 years in India: a population-based study.” The article and paper contend anaemia levels in the country are inflated, as the international standard for its diagnosis does not match the healthy standard as seen among the Indian population.

“The article draws on a single paper, unlike other multidisciplinary work that looks at multiple sources. The scientific validity of the research paper is also in question,” said Sunita Sheel, from the Forum for Medical Ethics Society (FMES), Mumbai chapter, and signatory to the letter. “It would be unethical and problematic to base policy decisions on it.”

According to the NFHS-5 survey, conducted between 2019-20, the prevalence of anaemia in children between ages 6 to 59 months is 65.6% in Mumbai Suburban, and 72.8% in the island city. Its prevalence in women aged 15 to 49 is 50% in the suburban district, and 45.9% in the city. The brunt of the deficient population within this age is found between the ages of 15 and 19, for whom the cut-off rate used is 12 g/dl. For children, it is 11 g/dl.

“The government is keen to change the methodology used to calculate anaemia, considering India is a very diverse country with different temperature conditions and dietary patterns. Over time one has to update,” says Suryakant Yadav, assistant professor in the Department of Biostatistics and Epidemiology at the International Institute for Population Sciences (IIPS), which carries out the NFHS survey.

“Gradually this narrative will become mainstream, and anaemia will become less of a public health problem. But it will show up in other places, like maternal mortality,” said Sylvia. This runs the risk of reducing the programs tackling anaemia across the country. Already, according to Rane, a core team member of Jan Swasthya Abhiyan, national programs to tackle anaemia are underfunded. The fortification of rice, another method to reduce levels, also has little evidence backing it.