PE13.1-2 | Iron Nutrition — Summary & Reflection

KEY TAKEAWAYS

Iron Nutrition — Key Takeaways:

• IDA is the commonest nutritional anaemia in India — 67% of children 6–59 months (NFHS-5). Cognitive impairment can precede anaemia.

• RDA: 9 mg/day (1–3 yr), 13 mg/day (4–6 yr), 16 mg/day (7–9 yr). Haem iron (meat/fish, ~25% bioavailable) vs non-haem iron (plant foods, 1–10%; vitamin C enhances, phytates/tannins inhibit).

• Three stages of iron deficiency: Stage 1 = depleted stores (↓ferritin only) → Stage 2 = latent (↓serum iron, ↑TIBC, normal Hb) → Stage 3 = manifest IDA (↓Hb, microcytic hypochromic anaemia).

• Hb cut-offs: <11 g/dL (6mo–5yr), <11.5 g/dL (5–11yr), <12 g/dL (12–14yr).

• Therapeutic dose: elemental iron 3–6 mg/kg/day in 2–3 doses; continue 3 months AFTER Hb normalises to replenish stores.

• NIPI/Anaemia Mukt Bharat:
• 6–59 months: IFA syrup 1 mL (20 mg Fe + 100 mcg folate) BIWEEKLY
• 5–9 years: IFA pink tablet (45 mg Fe) WEEKLY
• 10–19 years: IFA blue tablet (60 mg Fe + 400 mcg folate) WEEKLY

• Key trap: programme doses are prophylactic — treat established IDA with the full therapeutic dose (3–6 mg/kg/day), not the programme dose.

REFLECT

Consider the systemic challenge:

• An Anganwadi worker in your block reports that fewer than 30% of children actually take their IFA syrup biweekly, citing taste, side effects, and mothers forgetting. What are the practical barriers to IFA compliance, and as the block medical officer, what interventions would you implement to improve adherence?

• The NFHS-5 shows anaemia prevalence actually increased in some Indian states between 2015–16 and 2019–21, despite years of NIPI implementation. What structural, dietary, and programmatic factors might explain this, and what would a more comprehensive approach look like?

• A 10-month-old infant comes with Hb 7.8 g/dL. She has been exclusively breastfed without complementary feeding. The mother is proud that she has successfully breastfed. How do you counsel the mother about the transition to iron-containing foods while affirming the value of breastfeeding?

Write your reflections in your clinical log.