Overview of 12 by 12 initiative

Anemia is the commonest medical disorder in pregnancy having a high prevalence in developing countries like India. Iron deficiency is the most common and widespread nutritional disorder and the most common cause for anemia during pregnancy. It is a public health condition with epidemic proportions (nearly 75-90% are anaemic).

The true toll of iron deficiency anemia lies in hidden ill effects on maternal and fetal health. Maternal effects include: a high maternal morbidity and mortality with reduced physical capacity and work performance, impaired immune response making her prone to infections, decrease in paripartum reserve, risk of cardiac failure and increased need for blood transfusions.

Fetal ill effects include: adverse pregnancy outcome with high perinatal morbidity and mortality, increase risk of intra-uterine growth restriction and prematurity, abnormal feto-placental development and birth of low weight baby who subsequently suffers from impaired psychomotor and cognitive function, has lower school achievement, a reduced physical and exercise tolerance and poor immune response.

Poor nutritional status and anemia in pregnancy have consequences that extend over generations. Girls born underweight are at risk of producing small, premature infants themselves.

There are several national programmes targeted at control and treatment of anemia during pregnancy. Indian Government started a national anemia prophylaxis programme in 1970 targeting pregnant and lactating women. Subsequently the programme was modified renamed the National Anemia Control Program (NACP) in 1991 for Control and Prevention of anemia in-women of reproductive age and pre-school children, by distributing iron and folic acid tablets to pregnant and lactating women and pre-school children. These programmes have been operational for over 35 years, but have made a little dent on the overall prevalence of anemia during pregnancy. Several other programmes focusing on issue of anemia include: ICDS, Mid-day meal programme, Kishori Swasthya Yojna, Matri Suraksha Abhiyan, IMA Anemia free India, as a Public Private Partnership and Anemia Chale Jao etc.

However, most of these programmes have not had anticipated success, as majority of women president late in pregnancy with moderate or severe anemia, when very little time is left to take corrective measures and fetal ill effects have already occurred.

Justification for targeting adolescent anemia

Adolescence is a period of rapid growth, when iron requirement for both girls and boys increases. The incidence of iron deficiency amongst adolescents is rising. The awareness regarding anemia and appropriate diet is extremely poor in adolescents, further propagated by lucrative promotional campaigns of various junk foods. An assessment of nutritional status of adolescents in India revealed that almost half adolescents of both sexes consume inadequate iron proteins in their diet.

Anemia is adolescent girls will have for reaching implications, as they will grow up to be anemic women with all complications during pregnancy and child birth. Appropriate anemia prevention and control programme for adolescents do not exist in any country.

Overall goals of 12 by 12 initiative and implementation strategies

• To decrease the prevalence
• To decrease the prevalence of anaemia in adolescents to ensure healthy parenthood
• To decrease adolescent awareness about anemia and appropriate nutrition.

Specific objectives

• To determine prevalence of low Hb in children between 10-12 years
• To provide nutritional guidelines to these children.
• To treat those detected to be anaemic.
• To deworm all adolescents and to vaccinate all girls against rubella.
  

Overall strategy

• Health and nutrition education
• Capacity building
• Increasing iron intake - by improving dietary pattern which would include diet rich in iron and other nutrients, improving bioavailability of dietary iron, increasing ascorbic acid intake, not taking iron with phytates and /or calcium , tea or coffee and food fortification etc.
• Iron supplementation - by improving dietary pattern which would include diet rich in iron and other nutrients, improving bioavailability of dietary iron, increasing ascorbic acid intake, not taking iron with phytates and/or calcium, tea or coffee and food fortification etc.
  
• Control o infection - deworming by single dose Albendazole 400 m three times in a year and treating malaria etc.
  
• Immunization - Rubella/TT vaccination

Proposed time frame

• Initial enrolment children and in first six months (Hb testing , check up)
• Follow up in next 12 months for improvement in haemoglobin status.

Conclusion
Anaemia is a silent epidemic; however it is a preventable condition. 12 by 12 initiative for controlling adolescent anaemia is a an implementable, effective and sustainablea nation building exercise with far reaching benefits in terms of safe motherhood and healthier future generations.