1

2

AREAS OF PILOT PROJECT

3

EXECUTIVE SUMMARY

A beautiful quote of Swami Vivekananda encapsulates the spirit of Ekal movement’s

eventful journey-“Arise, awake and stop not till the goal is reached.”

Ekal movement, with the vision and passion of few compassionate and patriotic people,

aimed to reach, uplift, nurture and empower the most unreachable, neglected and

impoverished tribal and rural areas, spread across the remote corners of our otherwise

progressive Bharat. This noble thought and mission led to the development of ‘One teacher

schools’ (Ekal Vidyalaya) to make primary education as the starting point of growth in

remotest villages. Gradually, as the movement gained momentum and support of society

at large, other vital development parameters became the focus areas of Ekal and the vision

got enlarged from just education to integrated rural development.

One such key focus area of Ekal is rural and tribal health through its wing- Arogya

Foundation. The niche knowledge and experience of the health conditions of the rural –

tribal Bharat led to the need of a health project or do something measurable, achievable,

having far reaching impact on the overall health scenario in villages of Bharat. This led to

the start of the flagship Anaemia Control Pilot project of Ekal in 2013.

Anaemia or lack of blood in human body, came to be recognized as a silent killer, having

a negative ripple effect on the overall health of an individual.

Iron deficiency is thought to be the most common cause of anaemia globally, although

other conditions, such as folate, vitamin B12, vitamin A deficiencies, chronic

inflammation, parasitic infections, and inherited disorders can all cause anaemia.

But, the most disastrous consequence of Anaemia is its role in maternal mortality and

infant mortality in India. The girl child would grow to an anaemic adolescent and due to

an early marriage would again give birth to an anaemia impacted generation. This would

result in not only a slowed productivity and economic progress of a nation, but also a black

mark in the human and social development of a country.

World Health Organization’s (WHO) global database on Anaemia estimated the

prevalence of anaemia worldwide at 25 per cent, with India, being, one of the countries

with very high prevalence of anaemia in the world. Almost 58 per cent of pregnant

women in India are anaemic and it is estimated that anaemia is the underlying cause

for 20–40 per cent of maternal deaths in India. The National Family health surveys of

Government of India have also pointed at this grim reality from time to time.

All the above factors made Ekal take up a pilot programme to combat Anaemia in 8 blocks

(sanch/block is a cluster of 30 villages) in four Indian states, namely, U.P, Rajasthan,

Odisha and Jharkhand under the leadership of qualified and dedicated team of doctors,

supported by a team of trained Arogya Sevikaas (health volunteers). The target population

was 10-45 yrs of females and 2-10 yrs of children. The remedies used were both, the

curative measures of medication and preventive measures such as diet counselling and

raising health awareness among rural folks for a sustainable solution to Anaemia. A

4

rigorous follow up of Hb levels after six months of intervention was done to compare the

results and judge the improvement from the baseline status.

The women tested for haemoglobin were classified into anaemic and non-anaemic.

Further, the Anaemic were classified into Mild anaemic, Moderate anaemic and severe

anaemic as per the reduced Hb levels respectively.

Through the intervention of Ekal under the pilot project, the no. of women in severe

and moderate category (<7% and upto 10% Hb) has reduced from 6,221 to 3,946

achieving reduction in anaemic patients by 37%. Improvement achieved in the no. of

women in the mild category (>10% and upto 12% Hb) is from 9,563 to 11,838 i.e. by

24%.

To understand the true impact of Ekal’s pilot project as shown above, not only one needs

to appreciate the successful increase in the Hb levels of women, health and development

of children in villages but also growth in the overall awareness towards their own health

and surroundings. The most noticeable and commendable change also is in the

empowerment of and immense respect for rural women who as health volunteers became

catalyst in the health revolution of their fellow sisters and children. This has been a big

achievement in a male dominated social structure of village.

But the very nature and characteristic of Anaemia is such that it cannot be just considered

as an isolated health problem. Without ensuring better nutrition and environmental

conditions to the villagers, mere medication, no matter how good and effectively

administered, is unlikely to solve the problem.

In fact a permanent cure of Anaemia lies in making it a part of a holistic health awareness

programme, encompassing personal hygiene, rural sanitation, balanced diet, behavioural

change communication through lifestyle and food style changes ,emphasis of health

regulation through traditional home remedies/therapies and even empowerment of women

to end the gender inequality and discrimination.

And, this is a uphill but very much possible task which needs constant drive and motivation

of not only Ekal, but the society at large in form of medical fraternity, students, corporates

and the biggest contributor can be the Government which needs to be partnered for a

common objective of a better, healthier and capable Bharat.

As quoted in the words of Mahatma Gandhi- “The difference between what we do

and what we are capable of doing would suffice to solve most of the world’s

problems.”

5

INDEX

Chapters Pg. no. /s

1. Introduction 6

2. Meaning, Causes & Effects of Anaemia 6-9

3. Rationale of Ekal’s focus on Anaemia Control 9-10

4. Impact of Anaemia on Maternal/infant mortality & development 10-12

5. Prevalence of Anaemia in India 12-14

6. Government’s initiatives for Anaemia control and the gaps therein 15-16

7. Ekal’s pilot programme on anaemia control 17-23

• Objective & Scope

• Areas under Pilot

• Methodology of intervention

8. Baseline and final Hb testing: comparative data & highlights 24-29

9. Financials of the Pilot project 30

10. Challenges, award of certificate by RIMS and future strategies 30-32

11. Conclusion 32

12. Acknowledgement 33

13. Annexures 34-40

Annexure 1 - States Wise IMR & MMR targeted under 12th Five year plan

Annexure 2 - Key personnel involved in Anaemia Pilot project

Annexure 3 - Specimen Block (Sanch) Survey Report

Annexure 4 - Health Volunteer (Arogya Sevika) training cum feedback form

Annexure 5- Certificate of Ethics Committee of RIMS

14. Appendices 41-42

Appendix A- Photographs and names of Iron rich foods

Appendix B- Additional photographs of Anaemia control programme

15. References 43

6

1. INTRODUCTION

1.1 Ekal, in its spirit to make the most vulnerable and neglected segments of rural and tribal

India, become both a beneficiary of and a catalyst in Bharat’s progress , started its journey

with providing basic, non- formal education through its one teacher schools. Basic health

and hygiene awareness was already an integral part of the curriculum but, having

recognized the widespread impact of diseases on both children and other villagers, Ekal

formed a specialized health-wing called as Arogya Foundation of India in the year 2003.

1.2 Arogya Foundation is a dedicated step to provide cost effective quality health care

services to all the Ekal Vidyalaya villages, in an attempt to bridge the gap between remote

areas and modern health facilities. It stands as a significant milestone in Ekal’s journey

from school development to integrated village development.

1.3 It was noticed during the regular Arogya village camps that majority of females across

age groups complained common symptoms of weakness, body ache and loss of appetite.

Also the children were found to be suffering from malnutrition, parasitic infections and

impaired growth. The underlying cause was identified as Anaemia- a silent but grave killer

with a ripple negative effect on the human body and a flagship pilot programme of

Anaemia control was undertaken. A project well in time, much in lines with the Persian

proverb, “A stone thrown at the right time is better than gold given at the wrong time.”

2. WHAT IS ANAEMIA

2.1 Anaemia, in simple terms means lack of blood in the body. It is a condition in which

the number of red blood cells (RBCs), and consequently their oxygen-carrying capacity, is

insufficient to meet the body’s physiological needs. Not only oxygen, blood is a carrier of

all vital nutrients in the body so lack of blood means lack of nutrition in the body. Anaemia

can result from defective red cell production, increased red cell destruction or blood

loss.The function of the RBCs is to deliver oxygen from the lungs to the tissues and carbon

dioxide from the tissues to the lungs. This is accomplished by haemoglobin.

2.2 Symptoms of anaemia include numbness, dryness of skin, lack of interest, loss of

appetite and low blood pressure due to lack of oxygen. In its severe form, it is associated

with fatigue, weakness, dizziness, drowsiness and menstrual pain in women.

2.3 Reduced levels of haemoglobin in the blood evidence the presence of anaemia.

World Health Organization (WHO) has given standardized estimates of haemoglobin

for detection of Anaemia as in the table below:

7

2.4 CAUSES OF ANAEMIA

Iron is necessary for synthesis of haemoglobin. Iron deficiency is thought to be the most

common cause of anaemia globally, although other conditions, such as folate, vitamin B12,

vitamin A deficiencies, chronic inflammation, parasitic infections, and inherited disorders

can all cause anaemia.

Causes of Anaemia in Women:

Insufficient quantity of iron-rich foods and iron enhancers”in the diet (foods rich

In vitamin C such as citrus fruits), and low bioavailability of dietary iron (e.g. foods

containing only non-haem iron)

Excessive quantity of “iron inhibitors” in diet, especially during mealtimes (e.g.

tea, coffee, calcium-rich foods)

• Iron loss during menstruation

• Poor iron stores from infancy, childhood deficiencies and adolescent anaemia

• Iron loss from post-partum haemorrhage

• Increased iron requirement due to tissue, blood and energy requirements during

pregnancy

• Teenage pregnancy

• Repeated pregnancies with less than 2 years’interval

• Iron loss due to parasite load (e.g., malaria, intestinal worms)

• Poor environmental sanitation and unsafe drinking water

Causes of Nutritional Anaemia in children:

• Low iron stores at birth due to anaemia in mother

• Non-exclusive breastfeeding

• Too early introduction of inappropriate complementary food (resulting in

diminished breast milk intake, insufficient iron intake, and heightened risk of

intestinal infections)

• Late introduction of appropriate (iron-rich) complementary foods

8

• Insufficient quantity of iron and iron enhancers in diet, and low bioavailability

of

dietary iron (e.g. non-haem iron)

• Increased iron requirements related to rapid growth and development during

infancy and childhood

• Iron loss due to parasite load (e.g. malaria, intestinal worms)

• Poor environmental sanitation, unsafe drinking water and inadequate personal

hygiene

Anaemic/ malnutritioned infants

Anaemia is an indicator of both poor nutrition and poor health. Infectious diseases – in

particular malaria, helminth infections and other infections such as tuberculosis and

HIV/AIDS – are important factors contributing to the high prevalence of anaemia in many

populations. Anaemia is not only caused by imbalanced and insufficient nutrient intake but

is also a result of cultural and social factors like gender discrimination, child marriage,

female foeticide, illiteracy, low wages and domestic violence.

Early marriage & Neglected rural woman Gender Discrimination

early pregnancy

2.5 EFFECTS OF ANAEMIA

Pregnant women and children are particularly vulnerable to Anaemia.

Among women, iron deficiency prevalence is higher than in men due to menstrual iron

losses and the extreme iron demands of growing foetus during pregnancies, which are

approximately two times the demands in thenon-pregnant state. First, anaemia reduces

9

women’s energy and capacity for work and can therefore threaten household food security

and income. Second, severe anaemia in pregnancy impairs oxygen delivery to the foetus

and interferes with normal intra-uterine growth, resulting in intrauterine growth

retardation, stillbirth, lower birth weight and neonatal deaths. Therefore, anaemia is a

major contributor to poor pregnancy and birth outcomes in developing countries as it

predisposes to premature delivery, increased perinatal mortality and increased risk of death

during delivery and postpartum.

Iron deficiency anaemia (IDA) results in impaired cognitive and motor development in

children and decreased work capacity in adults. The effects are most severe in infancy and

early childhood. Anaemia in mother can lead to mental retardation in child or delayed

milestone (delayed brain development), disability in children and jaundice at the time of

birth, leading to death of the infant.

Iron deficiency anaemia also adversely affects the body’s immune response.

3. WHAT MADE EKAL FOCUS ON ANAEMIA CONTROL

Anaemia is not a disease in itself, but, it is the crucial underlying cause of many chronic

ailments, as it affects both the nutritional aspect of the body and reduces immunity

levels. Thus a focussed programme on Anaemia can lead to a holistic health programme

with far reaching results.

As per World Health Organization (WHO), Anaemia is the world’s second leading

cause of disability and thus one of the most serious global public health

problems.Globally, anaemia affects 1.62 billion people, which corresponds to 24.8%

of the world population (Source: Worldwide prevalence of anaemia 1993-2005 WHO

Global Database on Anaemia Geneva, World Health Organization, 2008).

10

But, it is the intergenerational, self-perpetuating vicious cycle of Anaemia

characterised by maternal mortality and infant mortality that is most serious and root

cause of Ekal’s special focus on Anaemia. Control of anaemia is not just a control of a

disorder but a major step in ensuring the health of both present and the future generation.

3.1 Maternal iron deficiency and anaemia render the offspring vulnerable for developing

iron deficiency and anaemia right from infancy. Poor iron content of complementary food

and family food consumed by the young child results in further increase in prevalence of

anaemia in childhood. With the onset of menstruation and associated blood loss, there is a

further rise in prevalence and severity of anaemia in adolescent girls. Early marriage and

adolescent pregnancy aggravate anaemia and result in poor iron stores in the offspring.

4. MATERNAL MORTALITY AND ROLE OF ANAEMIA IN MMR

4.1 MATERNAL MORTALITY RATIO (MMR) is defined as the number of maternal

deaths per 100,000 live births due to causes related to pregnancy or within 42 days of

termination of pregnancy, regardless of the site or duration of pregnancy.

4.2 In India, Anaemia is directly or indirectly responsible for 40 per cent of maternal

deaths. There is 8 to 10-fold increase in MMR when the Hb falls below 5 g/dl. (Source:

Prevalence & consequences of anaemia in pregnancy, a report by National Institute of

Health & Family Welfare, April 24, 2009)

4.3 As can be seen from the figure below-haemorrhage accounts for more than one- third

of all deaths followed by puerperal sepsis and abortion. Besides these, anaemia which has

been included in “other conditions” is a major contributory factor.

11

Note: SRS is Sample Registration System of India

MMR IN INDIA declined from 560 deaths

per 100,000 live births in

1990 to 190.

4.4 CHILD MORTALITY LINKED TO MATERNAL MORTALITY

Infant mortality rate (IMR) is the number of deaths of children less than one year of age

per 1000 live births. IMR, according to SRS 2010 at national level was 47 per 1000 live

births in 2010 as compared to 50 in 2009. The IMR is higher in respect of Female (49) as

compared to Male (46). IMR was also higher in rural areas (51 per 1000 live births) as

compared to urban areas (31 per 1000 live births) during 2010.One in every21 infants, one

in every 20 infants in rural areas and one in every 32 infants in urban areas still dies, within

one year of life in our country (SRS, 2010).

12

4.5 ANAEMIA- AN OBSTACLE TO NATIONAL DEVELOPMENT-POOR HDI

Anaemia reduces the work capacity of individuals, bringing serious economic

consequences.

UNITED NATIONS HUMAN DEVELOPMENT INDEX (HDI) is a summary measure

of average achievement in key dimensions of human development, including a long and

healthy life. India ranks 135th position among 187 countries as in 2014 in the UN Human

Development Index (HDI). (Source: YouTube video link

https://www.youtube.com/watch?v=Ur4pvqXKCDs)

5. PREVALENCE OF ANAEMIA IN INDIA

5.1 The WHO Global Database on Anaemia for 1993–2005, covering almost half the

world’s population, estimated the prevalence of anaemia worldwide at 25 per cent. India

is one of the countries with very high prevalence of anaemia in the world. Almost 58 per

cent of pregnant women in India are anaemic and it is estimated that anaemia is the

underlying cause for 20–40 per cent of maternal deaths in India. India contributes to

about80 per cent of the maternal deaths due to anaemia in South Asia, as depicted below:

5.2 The National Family Health Survey-3 (NFHS-3),carried out in 2005-2006 by the

Ministry of Health And Family welfare, Government Of India ,suggests that anaemia

is widely prevalent among all age groups, and is particularly high among the most

vulnerable – nearly 58 per cent among pregnant women, 50 per cent among non-pregnant

non-lactating women, 56 per cent among adolescent girls (15–19 years), 30 per cent among

adolescent boys and around 80 per cent among children under 3 years of age – as shown

below:

13

The statistics on Anaemia in women as per NFHS-3 is shown below:

5.3 BASED ON NATIONAL FAMILY HEALTH SURVEY (NFHS-3) INDIA

2005-06, NUTRITION IN INDIA report August 2009, the following facts emerge:

Seven out of every 10 children aged 6-59 months in India are anaemic as shown in the

figure below:

14

An intergenerational examination of anaemia shows that the likelihood of a child being

anaemic is strongly related to the mother’s anaemia status.

The prevalence of anaemia in children age 6-59 months increases steadily with the

mother’s level of anaemia, reaching 83 percent for children of mothers who are severely

anaemic, as shown below:

In 2014-15, India will implement the fourth National family Health survey-4.

15

6. GOVERNMENT’S INITIATIVES FOR ANAEMIA CONTROL

6.1 GOI has started National Iron+ Initiative to prevent and control iron deficiency

Anaemia, a grave public health challenge in India. Besides pregnant women and lactating

mothers, it aims to provide IFA supplementation for children, adolescents and women in

reproductive age group.

National Iron+ Initiative reaches the following age groups:

• Bi-weekly iron supplementation for preschool children 6 months to 5 years

• Weekly supplementation for children from 1st to 5th grade in Govt. & Govt. Aided

schools

• Weekly supplementation for out of school children (5–10 years) at Anganwadi Centres

• Weekly supplementation for adolescents (10–19 years)

• Pregnant and lactating women

• Weekly supplementation for women in reproductive age

6.2 As per ADOLESCENT GIRLS ANAEMIA CONTROL PROGRAMME –UNICEF

report 2011, India is home to nearly 113 million adolescent girls and the prevalence of

anaemia in adolescent girls is estimated at 56 per cent. In view of the scale of the problem,

the Government of India and state governments with technical support by UNICEF and

partners have been implementing for over a decade the Adolescent Girls Anaemia Control

Programme. The main objective of the programme is to reduce the prevalence and severity

of anaemia in school-going adolescent girls using schools as the delivery channel and in

out-of-school adolescent girls using the community anganwadi centre of India’s Integrated

Child Development Services (ICDS) programme as the delivery platform.

6.3 The programme strategy for the initial phase was built around three essential

interventions: 1) weekly iron and folic acid supplementation (WIFS) comprising 100 mg

of elemental iron and 500 μg of folic acid; 2) bi-annual deworming prophylaxis (400 μg of

albendazole) six months apart for the prevention of helminth infestations; and 3)

information, counselling and support to adolescent girls on how to improve their diets and

how to prevent anaemia.

6.4 The coverage of the programme doubled as the number of adolescent girls benefiting

from the Adolescent Girls Anaemia Control Programme increased from 8.8 million by the

end of 2005 to 14.5 million by the end of 2010.

6.5 One of the goals for the 12th Five Year Plan 2012-17 is to reduce anaemia in girls

and women by 50 per cent.

Current figures of IMR & MMR and the targeted estimates under twelfth plan are available

in Annexure 1

16

6.6 WHY STILL A GAP?

Even after decades of implementing the national nutritional anaemia control programmes

by the Government of India, it is astonishing to see that 50% of pregnant women are still

anaemic, as per WHO norms.

IMP REASONS WHY GOVERNMENT AID NOT REACHING TRIBAL POPULATION AS

PER MINISTRY OF HEALTH & FAMILY WELFARE:

Difficult terrain and sparsely distributed tribal population in forests and hilly

regions.

Locational disadvantage of sub-centres, PHCs (Public Health centres), CHCs

(community health centres).

Non availability of service providers due to vacant posts and lack of residential

facilities.

Lack of suitable transport facility for quick referral of emergency cases.

Lack of appropriate HRD policy to encourage/motivate the service providers to

work in tribal areas.

Inadequate mobilization of NGOs.

Lack of integration with other health programs and other development sectors.

Activities not tuned to the tribal idioms, beliefs and practices.

Services not being client friendly in terms of timing, cultural barriers inhibiting

utilization.

Weak monitoring and supervision systems.

Besides the above listed reasons, The Government health workers are more engaged in

distribution of IFA medicines for Anaemia, they are not focussed on increasing the

villagers awareness about this disease .The doctors and other medical practitioners lack in

the very motivation to reach those, who are suffering the most.

Corruption is another major reason which is quoted as to why the benefit of Government’s

efforts does not reach the grassroots as medicines get expired even before they reach the

health centres.

But in a country like India with world’s second largest population and widespread diversity

in geographical, demographical and cultural terms, is it right to just blame the

Government for not coming up to the expectations of its people?

Or is it better to initiate steps in that direction and in fact become a partner with the

Government towards a more healthy and capable India?

Ekal’s Anaemia Control programme aims to do just that.

17

7. EKAL’s PILOT PROGRAMME ON ANAEMIA CONTROL

7.1 Initially the focussed programme on Anaemia started in 2010 through medical camps,

but experiencing the high dropout rate of women, a pilot programme was launched in 2013

where the focus got shifted to door to door evaluation and treatment of Anaemia in order

to reach all concerned.

Ekal’s Pilot programme on Anaemia control aimed for the following transition in the life

of every woman and child in the village:

PRESENT SCENARIO EKAL’S ANAEMIA CONTROL PROGRAM

TO HELP MOVE TO

TARGET SCENARIO

You tube video link of Ekal’s Arogya Anaemia control programme

https://youtu.be/ToAH_zXor8U

18

7.2 OBJECTIVES OF EKAL’s ANAEMIA PILOT PROJECT

To make Anaemia control its flagship health programme and eradicate the

moderate to severe levels of Anaemia completely in target group of women and

children in all Ekal villages in next 5-10 years.

To replicate the pilot model in rest of the country.

To make the most vulnerable rural girls/women and children healthy and contribute

in reducing the mortality rates such as MMR &IMR, due to Anaemia, thereby

ensuring the health of both the present and future generation.

To capitalize on its strength in terms of strong manpower, Ekal started a pilot

programme on Anaemia, on the basis of which a holistic health programme can be

launched.

To focus on a person centric programme by way of tracking the improvement in

health on the basis of follow up and comparative analysis.

To do something measurable in health, having far reaching favourable effect on the

village community to encourage our generous donors to contribute in our health

initiatives.

To create awareness among the community to utilize the locally available resources

to combat problems like Anaemia through food &life style changes.

7.3 SCOPE OF PILOT PROJECT

Total eight blocks, (each comprising of 30 villages), were selected in four states of

U.P (3 blocks), Rajasthan (1 block), Odisha (2 blocks) and Jharkhand (2 blocks).

Pilot areas selected based on the high anaemia prevalence, as per national statistics.

The process would include both curative health service in terms of Allopathic

treatment and preventive services in terms of counselling and awareness

programmes.

Target population is girls/women of reproductive age of 10-45 years age group and

children of 2-10 years age group (most affected set of people).

Availability of workers (karyakartaas), area coordinators and doctors to monitor

and train them on a regular basis was duly considered.

19

7.4 AREAS OF PILOT PROJECT

SAMBHAG(state) BHAG(division) ANCHAL(district) SANCH(block)

JHARKHAND Ranchi Ramgarh Gola

Lohardaga Lohardaga Bhandra

ODISHA East Odisha Keonjhar(kendujhar) Telkoi

West Odisha Rourkela Jarangloi

EAST U.P Vindhyachal Mirzapur Rajgarh

Sonbhadra Gurmura

Renukoot Myorpur

RAJASTHAN Udaipur Udaipur Jhadol

7.5 METHODOLOGY OF INTERVENTION

Arogya Samitis at Sambhag, Bhag, Anchal and Sanch (State, division, district and block

respectively) were constituted to guide and control the program. These Samitis comprised

of personnel related to medical field viz. doctors, paramedics, pharmacist and some

socially oriented persons. These Samitis with the help of CTO(central team members),

Bhag and Anchal Arogya Pramukh selected 6 heath volunteers in a block. Each was to

deliver the planned services in a group of nearly 5 villages. Most of these volunteers were

12th standard pass.

Detailed list of key personnel involved in pilot project is available at Annexure 2.

A standard set of procedures were followed in all the pilot areas, as follows:

A. TRAINING- It had two components:

Training of CTOs (Central team members), Bhag and Anchal Arogya Pramukhs:

delivered at two levels, namely Naishnatya Varg (training of trainers) and Naipunya

Varg (skill development), prevalent in Ekal Movement. In these camps (besides

other topics) the participants were taught the whole methodology, documentation

and reporting systems of Anaemia Control Programme.

20

Training in Session –Udaipur

Training of health volunteers: the health volunteer was a female from a village

(preferably married) who commits to volunteer for taking care of the health of her

village and the training she receives from Arogya Foundation. Initially 2 day

training of these health volunteers was conducted at block of district headquarters.

They were trained

- To test the blood of women for Hb gm%,

- To diagnose Anaemic women with the help of digital haemoglobinometer.

- To deliver medicines to women and children

- To visit the women at home and counsel them about diet and other

precautions to protect and treat anaemia, also to advise them to grow

nutritional garden comprising of green leafy vegetables

- To conduct group meetings in village to arouse awareness about anaemia

and its related social reasons.

- To document the whole activity.

Health volunteers training at Lohardaga

B. Survey:-

In these blocks (cluster of 30 villages), where the program was initiated, first a survey was

conducted to register all women of child bearing age (10-45 yrs.) residing in Ekal village

which usually comprises of less than 100 homes. All the children (2-10 yrs.) were also

registered. The survey was conducted by Anchal Arogya Pramukhs with the help of

Acharyas of Ekal Vidyalaya. Documentation of survey report was done in a particular

format.

21

Target Population- woman and children

Sample report of block(sanch) survey is available in Annexure 3

C. Blood Testing of Women and delivery of medicines:-

- The registered women were tested for Hb gm%

- Those found to be anaemic were delivered Iron, folic acid and B12 capsules-

Once a day for 100 days.

- All the registered Women irrespective of anaemia and all the registered

children were given tablet or Syrup of Albendazole (wormicide) on the spot.

The women found to be anaemic were

divided into three groups as follows:

• Mild - 10 to 12 gm/dl

• Moderate - 7 to 10gm/dl

• Severe - below 7gm/dl

Haemoglobinometer- Hb testing machine

Deviation from the standard in testing:

In Gola Sanch in Jharkhand, after initial survey the medicine distribution was initiated

without estimating the Hb% of women as the understanding at that time was that, it is a

known fact that anaemia in India is stated to be between 60 – 80% in women, testing is not

needed initially and will be done after 6 months.

22

Health Volunteer Haemoglobin testing by health volunteer

Telkoi block Hb testing: Adolescent girls Distribution of Iron folic acid tablets

D. COUNSELLING AND AWARENESS

Counselling was given to villagers both in respect of the dangers of Anaemia, the changes

that they should do in their diet and lifestyle to have a balanced, nutritional food.

Also, the awareness aspect covered the socio –cultural aspect to combat gender

discrimination and similar evils.

Diet counselling was customized as per the needs of that area, to make the villagers aware

of the locally available resources and efficiently use them to combat Anaemia. Stress was

laid on eating green leafy vegetables like bathua, palak, moonga saag etc. and Gur

(jaggery)-Chanaa, rich in iron content. Where even these were not available, cooking in

utensils made of iron was popularised.

Good sources of Iron:

Chana Sag Palak Daals Gur- Chana diet

23

Jhadol block diet awareness programme Anaemia awareness Camp

Also , as a health awareness initiative to improve the

overall nutrition of the villagers, they were taught to

cultivate nutritional gardens or ‘Poshan Vatikaas’, as

popularly called under Gramothan Yojana of Ekal, in

the areas surrounding their homes. In Telkoi Sanch

alone, as reported in Ekal Parinaam Kumbh, March

2015, by Bhag Arogya Yojana Pramukh- Jharna, 464

Poshan Vatikaas were planted.

Anaemia Counselling

Follow up and evaluation

The follow up was done by regular visits of health volunteers to each village, for observing

the diet pattern and correcting the same, checking the medicine consumption, awareness

talk and gaining knowledge of any major illnesses in this period. After six months the Hb%

of the women was to be retested. All target children and women were delivered

Albendazole again and only those women, who were still anaemic, were given iron folic

acid. The same regime was to be followed with counselling until all are brought out of the

clutches of anaemia.

A sample health volunteer training cum feedback form is available at Annexure 4

24

8. BASELINE AND FINAL Hb TESTING: COMPARATIVE DATA & HIGHLIGHTS

8.1 Area wise baseline survey of total no. of women registered

15,784 women were thus covered under baseline survey with their Hb tests.

8.2 Block wise Final Evaluation : The comparative number of women under

anaemic categories based on Hb levels before (Test 1) and after intervention

(Test 2):

Odisha

Sanch- Telkoi

Sambhag(state) Bhag(division) Anchal(district) Sanch(block)

No. of

Registered

Women

Odisha E.Odisha Keonjhar Telkoi 1487

Odisha W.Odisha Raurkela Jarangloi 2702

Rajasthan Udaipur Udaipur Jhadol 2004

East UP

Vindhyachal

Mirjapur Rajgarh 1736

Renukut Myorpur 1077

Sonebhadra Gurmura 1361

Jharkhand Lohardaga Lohardaga Bhandra 2567

Jharkhand Ranchi Ramgarh Gola 2850

Total Women - 15784

138

485

721

143

11

267

1039

170

Severe Moderate Mild non anemic

<7 7 to 10 10 to 12 >12

Keonjhar, TelkoiTEST 1 TEST 2

25

The no. of women in severe and moderate categories reduced to 278 which was 623 in the

beginning showing reduction by 55.3%. Improvement in the no. of women above 10gm%

is from 864 to 1209 i.e. 39.9%.

Sanch- Jarangloi

The no. of women in severe and moderate categories reduced from 1226 to 888 achieving

reduction by 27.5%. Improvement in the no. of women above 10gm% was from 1476

earlier to 1864 i.e. by 26.2%. In this Sanch one important reason of Hb% improvement

was that due to special effort of GRC Jarangloi, nutritional gardens had been developed

by most of the families.

RAJASTHAN Sanch- Jhadol

90

11361277

1995

883

1569

295

Severe Moderate Mild non anemic

<7 7 to <10 10 to< 12 >=12

Rourkela, Jarangloi

TEST 1 TEST 2

215

793

636

360

29

408

950

617

Severe Moderate Mild non anemic

<7 7 to 10 10 to 12 >12

Udaipur,Jhadol

TEST 1 TEST 2

26

The no. of women in severe and moderate categories reduced to 437 from 1008 in the

beginning, amounting to a reduction in anaemic patients by 56.6%. Improvement in the

no. of women above 10gm% was from 996 to 1567 i.e. 57.3%.

UTTAR PRADESH

Sanch- Rajgarh

The no. of women in severe and moderate categories reduced to 358 from 596 in the

beginning, amounting to a reduction in anaemic patients by 33.9%. Improvement in the

no. of women above 10gm% was from 1140 to 1378 i.e. 20.87%.

Sanch- Myorpur

59

537

863

277

13

345

894

484

Severe Moderate Mild non anemic

<7 7 to 10 10 to 12 >12

Mirzapur,Rajgarh

TEST 1 TEST 2

45

428

498

106

32

419

497

129

Severe Moderate Mild non anemic

<7 7 to 10 10 to 12 >12

Renukoot,Myorpur

TEST 1 TEST 2

27

The no. of women in severe and moderate categories reduced to 451 from 473 in the

beginning amounting to reduction in anaemic patients by 4.6%. Improvement in the no.

of women above 10gm% was from 604 to 626 i.e. 3.6%.

Sanch- Gurmura

The no. of women in severe and moderate categories reduced to 200 from 449 in the

beginning amounting to a reduction in anaemic patients by 55.4%. Improvement in the no.

of women above 10gm% was from 912 to 1161 i.e. 27.3%.

JHARKHAND

Sanch- Bhandra

46

403

647

265

9

191

742

419

Severe Moderate Mild non anemic

<7 7 to 10 10 to 12 >12

Sonebhadra, Gurmura

TEST 1 TEST 2

112

1005 1039

411

35

725

1275

532

< 7 7 - 10 10 to 12 12<

Lohardaga,Bhandra

TEST 1 RETEST

28

Bhandra in Jharkhand is 80% tribal block. The no. of women in severe and moderate

category reduced to 760 from 1117 in the beginning amounting to a reduction in anaemic

patients by 35.52%. Improvement in the no. of women above 10gm% was from 1450 to

1807 i.e. 24.62%.

Sanch- Gola

The no. of women in severe and moderate category reduced to 624 from 729 in the

beginning amounting to a reduction in anaemic patients by 14.8%. Improvement in the no.

of women above 10gm% was from 2121 to 2225 i.e. 4.9%.

In Gola Sanch, the intervention was designed with slight variation. Here, initially after

wormicide Albandazole, 100 days of Iron+Folic Acid+B12 regimen was administrated

without testing Hb%. 3 months after the last day of the above regimen first test for Hb%

was performed followed by diet counselling associated with administering herbal

preparations which were prepared from plants found in vicinity to the villages. The health

volunteers were specially trained for this.

20

709

1744

377

14

610

1785

440

< 7 7 - 10 10 to 12 12<

Ramgarh,Gola

TEST 1 RETEST

29

8.3 Combined Impact in all blocks by comparison of no. of women under different

Hb levels before (Test 1) and after intervention (Test 2):

The no. of women in severe and moderate categories reduced from 6221 to 3946 achieving

reduction in anaemic patients by 37%. Improvement in the no. of women above 10gm%

was from 9563 to 11838 i.e. by 24%.

8.4 Highlights of Hb Test Results

86.5% of rural women initially suffered from anaemia, of which 47% women were

suffering from mild anaemia (Hb gm% between 10-12) who can be brought out of

anaemia by diet counselling associated with control of other factors like, hygiene,

sanitation, gender discrimination etc.

Only 4.5% women were found severely anaemic (below 7gm%Hb), who improved

considerably as after second test only 0.9% are left in this category.

Majority of women having 7-10gm% Hb improved considerably. Those improved

in this category were 89.1%.

The experience in Gola block gives us an extra scope of improving anaemia without

medicines in most of the anaemic women except those having very severe anaemia.

The results fortify the theory that lower is the haemoglobin better is the

improvement ratio in Hb gm %. In below 7% category the women showing

improvement were 97% while it reduced gradually viz. in 7-10gm% category the

same was 89% and in 10-12gm% category it was still lower-71%.

725

5496

7425

2138

148

3798

8751

3087

Severe Moderate Mild non anemic

<7 7 to 10 10 to 12 >12

All blocks compiled no. of women as per Hb%

Test 1 Retest

30

9. FINANCIALS OF PILOT PROJECT ON ANAEMIA

9.1 COST PER BLOCK(SANCH)

(total villages-30, total women-5000, total children-2000 approx)

Sr. No. Cost Rs.

1 Survey 4,000

2 Medicines:

Albendazole & Iron/folic acid 8,49,000

3 Hb Testing 2,50,000

4 Travelling 72,000

5 Training 60,000

Total Cost per block(for 30 villages) 12,35,000

Total Cost per village 41,167

Note: Owing to wide variation in number of targeted persons in each village, it was not

appropriate to work out cost per person separately for each block. However, based on

total number of women and children covered, the average cost per person per year came

in range of Rs. 200 per annum.

9.2 SOURCE OF FUNDS FOR PILOT PROJECT

Out of the total cost on Anaemia Control under the pilot project, the funding was available

from two sources, 24% arranged from within Bharat and 76% from USA, as donations.

10.1 Challenges/Problems in the Execution of Pilot Project

• Availability of educated manpower in terms of minimum qualification of at least

10th standard pass female workers in village on a continuous basis.

• Continuous training requirements of health volunteers due to their marriage and

migration from villages.

• Due to cultural factors like ghoonghat /pardaa(veil) system, especially in Rajasthan,

availability and mobility of females was a challenge.

• Availability of abundant and dedicated team of doctors to supervise, monitor and

train the team of karyakartaas was the most critical part of a successful health

programme on Anaemia.

31

• Slow progress in areas where karyakartaas were ineffective .In this respect, an

active role of Anchal Arogya Pramukh was very crucial for effective functioning of

health volunteers.

• Underutilization of funds allocated for Anaemia due to an over- frugal attitude to

save on cost of project e.g. buying less Hb testing machines.

• Scepticism about Government support and absence of liasioning with the

Government.

• Initial resistance from male members or families of the health volunteers and of the

beneficiaries.

• Initial resistance and lack of awareness of rural women to take medicines.

• Systematic and detailed record and compilation of essential information/facts by

karyakartaas at various levels e.g. training data, expenditure data, necessary to

analyse crucial aspects of pilot programme.

10.2 Certificate of Ethics Committee of RIMS

In spite of the above challenges, the project was appraised and has been awarded a

certificate by Rajendra Institute Of Medical Sciences (RIMS), Ranchi for the scientific

research project on Anaemia Control entitled “Evaluation of the effectiveness of the

preventive measure of iron deficiency anaemia control programme of Arogya Foundation

Of India, Jharkhand branch.”

The certificate of RIMS is available at annexure 5

10.3 Future Strategies on Anaemia Control Programme:

• Tie ups with Local Government bodies /similar NGOs to collaborate towards a

common health goal.

• Involvement and partnership of ASHA workers of Government and health

volunteers in Ekal’s Anaemia awareness programmes.

• Tie ups with government schools/aanganwaadi centres for spreading Anaemia

awareness, especially in children and adolescent girls.

• Increasing awareness of villagers by participation in village haats (melas) through

announcements about our medical camps/awareness camps for Anaemia.

• Screening specially designed short videos on Anaemia awareness and control on

projectors in villages during trainings of sevikaas and counselling camps in villages.

• Inclusion of medical students and social work students in Ekal’s Anaemia

programme, as part of their internship or research projects.

• Increasing the role of NMO- National Medicos Organization- a voluntary

organisation of doctors and students for social service, presently only active in

medical camps but not involved in Anaemia control project.

32

• Make short feedback videos /documentaries of villagers who are benefited by this

pilot project to bring about the impact generated. Dedicated funding for this purpose

is needed from donors.

• Raising dedicated funding from Corporates for Anaemia control under their CSR

funding schemes.

• Encouraging the use of RTI (Right to Information Act) through Ekal’s Jaagran

initiative, as a means to make the implementation of Government policies on

Anaemia Control more effective.

• To eradicate the socio-cultural causes of Anaemia, empowerment of rural women

is most essential .E.g. Ekal Mahila Samiti in Jharkhand is active in sensitizing the

villagers about gender discrimination. More such initiatives are needed.

• Anaemia control programme should be expanded not only in more Sanchs in

present four states of pilot but in all areas where there is presence and involvement

of Central Toli (CTO) of Karyakartaas.

• Ekal’s Anaemia programme, on the basis of successful pilot models, should reach

the most neglected and vulnerable pockets of tribal India, for e.g. the tea garden,

remote areas of Assam.

• Also needed is an operational surveillance system with reliable, affordable and

easy-to use methods for assessing and monitoring anaemia prevalence and the

effectiveness of interventions. Effective usage of information technology can be an

answer.

11. CONCLUSION

Anaemia is a major health problem which engulfs both mother and child and hence an

effective control and preventive strategy of Anaemia will ensure a healthy present and

future generation.

Anaemia cannot be considered in isolation but has to be viewed as a part of a

comprehensive health programme focusing on nutrition, hygiene, sanitation and

awareness. In the long run, only treatment with medicines is not a sustainable solution but

diet counselling and awareness in the villages, even empowerment of women to end the

gender inequality and discrimination is necessary. Knowledge and training of developing

PoshanVatika for growing green leafy vegetables and medicinal herbs is needed.

Health care education and BCC- behavioural change communication through lifestyle and

food style changes is the permanent cure of Anaemia. Traditional Home

remedies/therapies should also be popularised, especially in tribal areas, where local herbs

are readily available.

Such pilot projects like Anaemia control will play a pivotal role in making Ekal movement

move from an Ekal Vidyalya movement to an Integrated Village development model.

To be effective and sustainable, Anaemia control strategies must be led with firm political

commitment and strong partnerships involving all relevant sectors.

33

12. ACKNOWLEDGEMENT

We would like to express our sincerest gratitude to all those who have contributed

towards the successful completion of this Pilot project, with a special mention of:

Secretary, RIMS Ranchi

State health authorities of respective states

Local donors for various kinds of support

USA based donors

Senior karyakartaas of Ekal Abhiyaan at various levels including Arogya

karyakartaas at the field levels.

34

35

ANNEXURE 1 State wise IMR & MMR targeted under 12th Five year plan

36

Annexure 2- Key personnel involved in Anaemia Pilot project

Category Sr.

No.

Names Details

Patrons 1 Dr.Krishna Kumar Ayurvedic Medicine,Padmashree,

Coimbatore

2 Dr.(Prof.) Ghanshyam

Das

Retd.HOD. RIMS

3 Dr.(Prof.) Janardan

Sharma

HOD, RIMS

Guides 1 Dr.(Prof.) M.S.Bhatt Retd.HOD,RIMS

2 Dr.UmashankarKesari Asso. Prof., RIMS,Incharge Anaemia

Control Program

3 Dr.Vishwambhar Singh BHU, Varanasi

4 Dr.O.P.Agarwal Retd. Director,Bokaro and Rourkela

Hospitals

5 Dr.AK Agrawal Asso.Prof.RIMS

6 Dr.R.N.Chourasia Assit.Prof,BHU, Varanasi

7 Dr.Anjali Rani Assit.Prof,BHU, Varanasi

8 Dr.Debashish

Bhattacharya

HMBS, Secretary ,Arogya Foundation,

Keonjhar

9 Dr.Piyush Ranjan Sahu Odisha Health Services,Keonjhar

10 Dr. Debabrat Sahani Prof.Hitech Medical

College,Bhubaneswar

11 Dr.Arun Kumar Sahu MD Odisha Health Services, Keonjhar

12 Dr.Prabhas Ranjan Asso.Prof.Govt.Medical

College,Bhubaneswar

13 Dr.HK Mittal HOD, ESI Hospital, Delhi

14 Dr.Manoj Singh BHMS,UP State Health

Services,Mirzapur

15 Dr.(Vaidya)Shivnarayan

Pathak

BAMS, Udaipur

16 Dr.Kusum Chopra Retd. From National Institute of Health

and Family Welfare, Delhi

17 Dr. Harishanand BMS,Arogya Foundation of India

18 Dr.C.Satish BAMS, Joint Coordinator,

AFI,Coimbatore

19 Dr.O.P.Mahatma Retd. Civil Surgeon,State Health

Services,Udaipur

20 Dr. (Prof.) YN Verma HOD, RNT Medical College,Udaipur

21 Dr. (Prof.) Krishna

Prasad

BAMS, HOD, Ayurvedic

Medicine,RVS Medical

College,Coimbatore

22 Dr.Pradip BAMS ,Ooty, Tamilnadu

37

23 Dr.H.P.Singh MD ,Prakash Pali Clinic, Sonebhadra

24 Dr. M. Krithika MD, Ayurveda ,Prof. Ayurveda

College,Coimbatore

Trainers 1 Dr. Mukul Bhatia MS (Surgery),ArogyaYojana Pramukh,

Ekal Abhiyan

2 Dr. T.N. Satapathy BAMS,Sah-ArogyaYojana

Pramukh,Ekal Abhiyan

3 Dr. (Prof.) Vivek

Kashyap

Prof.PSM Dept.RIMS

4 Dr.Sandeep Agrawal Asst.Prof.Surgery,RIMS, Ranchi

5 Dr.Bhupendra Singh Asso.Prof, Forensic Medicine

&Toxicology, RIMS Ranchi

6 Dr.Sarita Mittal MOIC, Mother and Child Welfare

Centre, SDMC Hospital,Delhi

7 Dr.Suresh Agrawal MS, Surgery,Specialist in

AyurvedicMedicines,Ranchi

8 Dr.Vivek Sharma MD(Ayurvedic Medicine)

Associates 1 Dr.(Prof.) Omprakash HOD,OMF Surgery,Dental College,

Hazaribagh

2 Dr.(Prof.) Usha Rani Retd.HOD, obs. &Gynae RIMS

3 Dr.Jamuna MBBS, State Health

Services,Lohardaga

4 Dr.Ramesh Ranjan MD (Pathology), Ranchi

5 Dr.S.K.Jamuar MBBS,Ramgarh, Jharkhand

6 Dr.D.C.Ram Retd. Deputy Director,State Health

Services, Ramgarh, Jharkhand

38

Annexure 3 –Specimen Block (Sanch) Survey Report

Bhag-West Odisha Anchal-Rourkela Sanch-Jarongloi

Sl N

o.

village name To

tal M

em

ber

Mal

e

Fem

ale

0 to 2 Years

3 to 9 years

Tota

l

Women 10 to 20 Years 21 to 45 years

Tota

l

BP

L

Mal

e

Fem

ale

Mal

e.

Fem

ale

Mar

ried

(N

on

PG

)

Mar

ried

(P

G)

Un

mar

ried

Mar

ried

( N

on

PG

)

Mar

ried

(P

G)

Un

Mar

ried

1 Bhangamunda 422 211 211 9 4 29 20 62 0 0 54 69 0 17 140 54

2 Jarangloi 143 73 70 2 2 3 9 16 0 0 11 38 4 7 60 24

3 Jharmunda 308 162 146 2 5 26 1 34 0 0 25 55 2 10 92 48

4 Beheramal 365 182 183 8 5 23 21 57 4 3 36 45 11 15 114 54

5 Baliposh(goud para) 149 85 64 1 3 8 4 16 0 1 10 25 0 2 38 18

6 Kustuna 369 176 193 4 7 25 21 57 1 0 48 63 3 10 125 41

7 Beldihi 328 166 162 3 5 23 12 43 0 0 39 58 1 11 109 49

8 Bagbud 330 163 167 5 4 13 20 42 0 0 31 84 7 21 143 31

9 Banki 299 155 144 1 2 21 14 38 0 1 36 48 2 12 99 46

10 Bijadihi 273 124 149 4 8 18 13 43 0 0 33 38 0 19 90 31

11 Salbira 322 170 152 3 1 22 19 45 0 1 37 84 2 8 132 39

12 Nakti 245 121 124 8 5 10 9 32 0 1 34 71 1 1 108 46

13 Bhikhampur 241 118 123 10 4 8 16 38 0 0 25 46 1 8 80 30

14 Jharmunda (itma) 307 148 159 5 6 11 16 38 1 0 36 44 4 13 98 21

15 Tiklipara 251 134 117 6 5 14 9 34 0 0 30 53 2 1 86 42

16 Gariamal 198 105 93 5 1 4 6 16 2 1 22 42 1 8 76 25

17 Jambahal 273 137 136 6 7 12 16 41 1 0 24 43 5 6 79 46

18 Itma 377 190 187 12 9 15 21 57 1 1 30 53 2 4 91 42

19 Pandripali 289 147 142 4 8 16 12 40 0 0 19 69 3 2 93 44

20 Karla 236 120 116 3 4 18 13 38 0 2 15 71 1 9 98 42

21 Mundagaon 259 135 124 3 2 11 15 31 0 0 28 39 4 9 80 34

22 Tileimal 376 209 167 4 6 26 13 49 1 1 37 53 0 9 101 43

23 Jamudia (jamarla) 221 109 112 5 1 10 18 34 0 0 26 60 2 2 90 30

24 Patuabeda 347 177 170 5 7 23 19 54 2 2 26 48 26 5 109 54

25 Manharpur 282 145 137 9 6 13 10 38 1 0 32 42 3 15 93 29

26 Kulga (basti) 360 189 171 9 6 20 18 53 11 0 25 65 1 16 118 25

27 Kulga (Jamtola) 194 103 91 3 3 16 14 36 0 0 20 39 0 8 67 26

28 Talimunda 189 97 92 3 1 7 5 16 0 0 23 44 2 9 78 17

29 Veluabahal 314 152 162 8 0 14 21 43 0 0 40 50 0 13 103 18

30 Kusum Munda 212 104 108 4 5 20 22 51 0 0 32 35 1 1 69 32

Total 8479 4307 4172 154 132 479 427 1192 25 14 884 1574 91 271 2859 1081

39

Annexure 4 - Health Volunteer (Arogya Sevika) training cum feedback form

Sevika Abhyaas Varg-:Telkoi, Month-:February-2015

Sambhag-: Odisha Bhag- East Odisha

Date Of AbhyaasVarg

Name Of Sevika

Sevika Present

Total Women

Personal Contact

Awareness Pragram

Participant No

H.b% Testing

Anaemic Testing

IFA Supplied

Albendazole Supplied

26.02.15 PrakasiniSahu Yes 126 126 5 51 0 0 98 0

MeeraSahu Yes 175 175 5 36 0 0 112 0

RasmitaGiri Yes 140 140 5 48 0 0 87 0

TulamaniNayak Yes 115 115 5 45 0 0 76 0

Sumitra Nayak (B) No 120 120 5 51 0 66 68 0

TriveniSahu Yes 205 205 5 51 0 0 85 0

TOTAL 6 6 881 881 30 282 0 0 526 0

Given Tablets Total 0

Last Month Tablets receive 0

Remaining Tablets 50

Next month's Requirements 2063X100 IFA

Medicine received for next month

108000 IFA RECEIVED

Goura Ch. Jena

GourangaNayak Dr.Debashis Bhattacharya

Anchal Abhiyan Pramukh Anchal Arogya Yojana Pramukh Anchal Arogya samiti

40

Annexure 5- Certificate of Ethics Committee of RIMS

Certificate of Ethics Committee of RIMS, Ranchi for Research granted to Arogya

Foundation of India on Iron Deficiency Anaemia

41

Appendix A- Photographs and names of Iron rich foods

Iron rich foods

Kantewali Chaulai Sarson ka sag Methi Kala chana

Soyabean Til Seethaphal KucchaKela

Water Melon

42

Appendix B- Additional photographs of Anaemia control programme

Medical Camps

Hb Testing Awareness speech in Gola Jhadol block Hb testing

43

REFERENCES

1. Recent annual reports of Arogya Foundation of India

2. Presentations of Dr.Sarita Mittal and Dr.Mukul Bhatia

3. Medical Camp reports of Arogya Foundation

4. Compiled write ups/reports/data on Anaemia by Dr.Mukul Bhatia ji

5. Website of ministry of health and family welfare India –http://mohfw.nic.in/

6. Annual Report 2013-14, Maternal health programme

7. Annual report 2013-14 of National Health Mission

8. Journal of Obstetrics and Gynaecology, February 2010: Maternal risk factors and

anaemia in pregnancy

9. Report on prevalence & consequences of anaemia in pregnancy K. Kalaivani

Department of Reproductive Biomedicine, National Institute of Health & Family

Welfare, New Delhi, India April 24, 2009from the website of ICMR-

http://icmr.nic.in/ijmr/2009/november/1125.pdf (ICMR)

10. National family health survey (NFHS-3) INDIA 2005-06, NUTRITION IN

INDIA report August 2009, from the website www.nfhsindia.org

11. The national guidelines by Ministry of Health & Family Welfare for control of

iron deficiency anaemia, in January, 2013 from the website link

http://nrhm.gov.in/nrhm-components/rmnch-a/child-health-immunization/child-

health/guidelines.html

12. Excerpts from 12th five year plan : social sectors from the website

http://planningcommission.gov.in

13. Concept of Human Development Index and India’s ranking from website link-

http://hdr.undp.org/en/content/human-development-index-hdi

14. Human Development Report 2014: Sustaining Human Progress:Reducing

Vulnerabilities and Building Resilience from UNDP website

15. India factsheet :Economic and Human Development Indicators, from UNDP

website

16. Adolescent girls anaemia control programme –UNICEF report 2011

17. Concept of Millennium Development Goals from the website link

http://www.unicef.org/mdg/maternal.html

18. Trends in Maternal Mortality: 1990 to 2013 Estimates by WHO(World Health

Organization), UNICEF(United Nations Children’s Fund), UNFPA( United

Nations Population Fund) The World Bank and the United Nations Population

Division(UNPD) REPORT –from the website link:

http://www.unfpa.org/sites/default/files/pub-pdf/9789241507226_eng.pdf

19. World Health Organization(WHO) report from the website

http://www.who.int/topics/anaemia/en/

20. Joint statement by WHO and UNICEF

http://www.who.int/nutrition/publications/micronutrients/WHOandUNICEF_statemen

t_anaemia/en/

21. World bank 2014 report on health , nutrition and population, November 2014