Breaking the anaemia cycle: Bangladesh still to go a long way

• WHO sets target to reduce anaemia by 50%  among reproductive age by 2025
• 51.6% of adolescent girls were found suffering from some forms of anaemia
• WHO recommends prioritising early interventions for adolescent girls
• In the NPAN2 2016-2025, Bangladesh has set a target to reduce anaemia to below 25% among pregnant women only

Anaemia remains a persistent issue in Bangladesh, as the country struggles to reach its target of reducing the condition among reproductive-aged women by 50% by 2025 set in the Global Nutrition Target. 

In 2004, the country set a goal to reduce anaemia in pregnant women from 46% to 35%, in non-pregnant women from 33% to 25%, and in adolescent girls from 30% to 23% by 2015, according to state-owned statistics bureau data, but there has been a lack of progress in this area.  

According to a 2017 study, 51.6% of adolescent girls in Bangladesh were found to be suffering from some form of anaemia. 

The World Health Organisation (WHO) reports that the prevalence of anaemia among reproductive-aged women (15 to 49 years) was 37% in 2019, compared to 36% in 2000 – indicating a degradation in healthcare progress over the years.

The Bangladesh Demographic and Health Survey of 2011 found the prevalence to be 42%.

Dr Nusrat Jahan, a public health expert, told The Business Standard that the major causes of anaemia are inadequate iron intake, blood loss during menstruation, pregnancy, and lactation. 

According to the WHO, the recommended daily iron intake for women aged 15 to 49 is 18 mg. 

The WHO also recommends prioritising early interventions for adolescent girls to prevent iron deficiency anaemia, especially in areas with high adolescent birth rates and early marriages. 

But in its Second National Plan of Action for Nutrition (NPAN2) 2016-2025, Bangladesh has set a target to reduce anaemia to below 25% among pregnant women only.

In areas where the prevalence of anaemia in pregnant women is less than 20%, non-anaemic pregnant women are advised to take intermittent iron and folic acid supplements to prevent anaemia and improve pregnancy outcomes.

Health experts say that while anaemia can develop at any stage of life, children, adolescent girls, and reproductive-aged women are high-risk groups. Anaemia is particularly concerning for adolescent girls aged 10-19, as this is a time of intense growth with higher iron requirements and frequent menstrual blood losses.

Guesswork leads to obscure data 

During a recent visit to Mollahat upazila in Bagerhat, local healthcare authorities estimated the prevalence of anaemia to be around 55%. But what was alarming was that the estimate was based solely on guesswork, instead of confirmation through proper blood diagnosis. 

Upazila Health and Family Planning Officer Dr Mahfuza Khatun said iron deficiency anaemia is the most common type of anaemia among women of reproductive age.

Though the distribution of iron tablets to women in the area is widespread, the root cause of the anaemia remains elusive due to the lack of awareness and dietary habits.

Unfortunately, the Bangladesh National Nutrition Council (BNNC) reports that there is a scarcity of accurate data on anaemia as only 20% of cases are confirmed through confirmatory blood testing. Instead, doctors often rely on examining the eyes and palms of patients, which may not provide an accurate picture of anaemia.

A health directorate official, who wished to remain anonymous, expressed concern over the current strategies and processes in place to reach the target of reducing the incidence of anaemia in half by 2025. 

The official stressed on proper diagnosis, such as blood testing or complete blood count, to accurately diagnose the type and severity of anaemia. This is important as incorrect diagnosis may lead to wrong treatment.

Furthermore, the official emphasised the importance of understanding the reasons behind a patient's anaemia, whether it be due to iron deficiency or non-absorption of iron. 

Empower women to ensure their nutrition  

Adequate protein intake, a healthy diet, and women's empowerment can play a critical role in preventing anaemia, according to nutritionists and health experts. 

A study published in the Journal of Medicine in 2022 revealed that 56% of reproductive-aged women in Bangladesh have insufficient protein intake. 

Currently, there is no large-scale intervention aimed at controlling anaemia among adolescent girls in the country.

Manish Kumar Agrawal, country director of Concern Worldwide, stated that it requires considerable attention to all the deep-rooted factors contributing to malnutrition for women, gender inequality, gradually shifting norms and values that affect maternal and child malnutrition.