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7 Comparative Analysis of Anemia in India and Kyrgyzstan: Medical and Social Perspective
Abjamilova Jazgul [ https://orcid.org/0000-0001-8028-3343 ], Samreen Rashid, Sadia Jamal, Preetha Jeni
International Medical Faculty, Osh State University,
Osh, Kyrgyzstan
Anemia, a global public health issue particularly prevalent in low-and middle-income countries, is primarily driven by iron and other micronutrient deficiencies, chronic illnesses, and inherited disorders, with wide-ranging effects on cognitive development, maternal and child health, and national productivity. This paper presents a comparative analysis of anemia in India and Kyrgyzstan, using WHO, NFHS-5, and NIMAS data to explore trends, causes, and responses. India shows significantly higher anemia rates—over 67% among children—largely due to poor dietary diversity, socio-economic disparities, and regional inequalities, while Kyrgyzstan, though facing a “triple burden of malnutrition,” has made progress through targeted nutritional interventions like flour fortification and micronutrient powders. The study also examines disparities in treatment access and cost, with India offering more advanced but costly care, and Kyrgyzstan providing more affordable yet limited options. Both countries have launched public health initiatives but face ongoing structural and socio-economic challenges. Future strategies should integrate anemia efforts with broader poverty and health reforms, leverage technology, and emphasize the multifactorial nature of the condition for more effective intervention.
Keywords: anemia, India, Kyrgyzstan, malnutrition, iron deficiency anemia, pregnant women.
A major worldwide public health issue, anemia primarily affects young children, menstruating adolescent girls and women, and pregnant and postpartum women. According to WHO estimates (2019), 29.9% of women aged 15–49, 36.5% of pregnant women, and 39.8% of infants aged 6–59 months are anemic globally.[1][2]
In 2019, WHO reported the prevalence of anemia between India and Kyrgyzstan, across four demographic groups: children aged 6–59 months, women of reproductive age (15–49), non-pregnant women (15–49), and pregnant women (15–49). India exhibits substantially higher anemia rates in all categories, with the highest prevalence seen in children (53.4%) and the lowest in pregnant women (50.1%).[2] In contrast, Kyrgyzstan reports significantly lower figures, ranging from 33.4% in children to 36.3% in pregnant women.[2] These disparities point to more severe nutritional and public health challenges, potentially linked to widespread micronutrient deficiencies, socio-economic inequality, and healthcare access issues. The stark contrast between countries highlights the varying impact of nutrition, public health policies, and healthcare access on anemia outcomes.
Anemia is a disorder characterized by a reduced number of red blood cells (RBCs) or low hemoglobin (Hb) concentration in them. Decreased Hb impairs delivery of oxygen to the body, resulting in symptoms such as fatigue, weakness, dizziness, drowsiness, and shortness of breath, etc. Factors such as age, sex, lifestyle, smoking habits, and pregnancy status affect the requirement of optimal haemoglobin concentration to meet physiologic demands.[3]
Anemia is primarily caused by nutritional deficiencies, which can result from inadequate nutrition or malabsorption of nutrients. Iron deficiency is the most prevalent cause of anemia, however, deficiencies in folate, vitamins B12, and A are also significant contributors. Other causes may include infections, inflammation, chronic diseases, gynaecological and obstetric conditions, and inherited red blood cell disorders.[4]
Anaemia is an indicator of both poor nutrition and poor health. It is problematic on its own, but it can also impact other global public health concerns, such as stunting and wasting, low birth weight, and childhood overweight and obesity due to a lack of energy to exercise. School performance in children and reduced work productivity in adults due to anaemia can have further social and economic impacts on the individual and family.[5]
Iron deficiency anaemia has also been shown to affect cognitive and physical development in children and reduce productivity in adults. Children and pregnant women are especially vulnerable, with more severe cases of anaemia leading to an increased risk of maternal and child mortality.[6][7]
Fig.1. Global Prevalence of Anemia for Males and Females, 2021[8]
Aim: This research paper aims to provide a comprehensive comparative analysis of anemia in India and Kyrgyzstan, focusing on its prevalence, underlying causes, and socio-economic implications. It also aims to explore the interventions adopted by both countries to address anemia and evaluate their effectiveness.
Data was extracted from various credible reports and surveys such as NFHS, WHO, UNICEF, NIMAS, and national health surveys as well as online published articles and databases (PubMed, ResearchGate, etc). Statistical data on anemia prevalence, health infrastructure, and nutritional status were compiled and analyzed.
Based on the collected data, a comparative analysis was conducted to determine similarities and differences in anemia prevalence, causes, and interventions in India and Kyrgyzstan.
Approximately 67% of children aged 6–59 months and 59% of adolescent girls aged 15–19 years suffer from anemia.[9][10] The prevalence of anemia among women aged 15–49 is approximately 57%, an increase from 53% in the previous survey.[10] Approximately 25% of men aged 15-49 are anaemic.[10]
Anaemia varies by maternity status—61% of breastfeeding women are anaemic, compared with 52% of pregnant women and 57% of women who are neither pregnant nor breastfeeding.[10]
A recent study indicates approximately 23.3% of elderly people in nursing facilities in southern regions are anemic.[11]
Among women of reproductive age (WRA)(ages 15-49), the anemia prevalence is reported at 35.8%.[7] In Kyrgyzstan, anaemia affects 14.6% of adolescent girls aged 10–19 years and approximately half of the pregnant women, increasing the risks associated with maternal and neonatal health.[12][13] The National Micronutrient and Anthropometric Survey (NIMAS) conducted in 2021 found that 20.9% of children under five years of age and 7.8% of children aged 5-9 years experience anemia. Nearly four in ten children in remote areas are at risk for anemia, highlighting regional health disparities.[12][13]
Fig. 4. Prevalence of Anemia in the Kyrgyz Republic. Source: NIMAS, 2021[12]
Anemia frequency is significantly impacted by diets lacking foods high in iron and by detrimental dietary choices. Socio-economic disparities exacerbate the issue, particularly among rural populations.[15] Only a portion of anemia cases in India is caused by iron deficiency, emphasizing the need for a more comprehensive strategy to treat hemoglobinopathies, micronutrient deficiencies, chronic illnesses, and anemia of unclear etiology.[16] With evidence that anemia has a complex aetiology, other factors, in addition to Iron deficiency, must be addressed. Importantly, according to one study[17] with children and adolescents, in older age groups, the majority of anemia (~25%) was caused by vitamin B12/folate insufficiency, in addition to other unknown reasons.[18]
The prevalence of anaemia is impacted by geographical variability. Prevalence in WRA ranges from 42.6% in Uttarakhand to 65.3% in Jharkhand[19], and is less than one-third in Lakshadweep (26%), and Nagaland and Manipur (29% each).[10]
The socio-economic determinants influencing anemia levels include wealth, education, food security, and urban amenities, which have improved over time; however, this has not corresponded with a decline in anemia rates.[20] Socio-economic inequalities significantly affect anemia prevalence, with poorer populations experiencing higher rates due to inadequate access to nutrition and healthcare. Addressing both anemia and poverty simultaneously is crucial for optimal improvements.[21]
Kyrgyzstan currently faces the "triple burden of malnutrition," a situation created by the coexistence of undernutrition, overnutrition, and micronutrient deficiencies, which can lead to worsening anemic prevalence. Altered dietary intake by the shift from traditional nomadic diets to more industrialized foods has resulted in widespread Iron-deficiency anemia.[22]
Implementing a national Infant and Young Child Nutrition (IYCN) program, including the introduction of point-of-use fortification with MNP, has shown relevant results. MNP (Gulazyk) showed a positive result for reducing iron deficiency and IDA in Kyrgyzstan.[23] A large-scale survey[24] for children 6-24 months of age indicated a significant drop in anemia prevalence from 50.6% to 43.8%, and iron deficiency anemia (IDA) decreased from 43.3% to 34.1% after intervention. A retrospective analysis[25] of the long-term trend of flour enrichment and IDA showed a significant decline by 44.8% from 2010 to 2018, highlighting the contribution of such interventions in strengthening the health of the nation by providing essential vitamins and minerals that are lacking in daily nutrition.
Geographical imbalances in health worker distribution and poor health infrastructure contribute to the high prevalence of anemia. Lack of clean water, sanitation, and energy deficits further aggravate the situation.[26]
The anemia situation in Kyrgyzstan is influenced by various socioeconomic factors, including poverty (reported at 16.7%) and the education level of household heads, which impacts health outcomes and nutritional status.[27] Socio-economic challenges such as poor infrastructure and limited access to healthcare and nutrition exacerbate anemia prevalence, particularly in rural areas. Efforts to improve these conditions are essential for reducing anemia rates.[28]
The issue of iron deficiency anemia (IDA) has been linked to a health-based poverty trap, particularly affecting poor households. This significantly reduces cognitive and physical capacities, thereby lowering economic productivity.[20]
Dosages and Duration of Therapy
Dosages and Duration of Supplementation/Prevention Programmes
● Linking anemia prevention with poverty alleviation programs could address the root causes more effectively.
● Both countries need to consider the long-term impacts of urbanization and climate change on anemia and incorporate adaptive strategies into their health policies.
● Tailoring interventions to cultural practices is crucial for both countries.
● Technological Integration of mobile health platforms for better implementation and monitoring of interventions.
● Extend integrated frameworks to maternal health for better anemia management outcomes.
Strengthen adherence support mechanisms for iron supplementation. Tailored behavior change communication strategies can improve adherence to nutritional recommendations and supplementation programs.
Enhance the integration of anemia control with other health programs
Expand research on locally acceptable iron-rich food alternatives
Develop domestic capacity for specialized anemia care and increase domestic investment in anemia prevention programs
Expand telemedicine services for remote areas to combat diminished healthcare access.
Enhance training programs for healthcare providers.
Anemia remains a significant medical and social problem in both India and Kyrgyzstan. While both countries face unique challenges, common factors such as inadequate nutrition, socio-economic disparities, and healthcare access issues contribute to the high prevalence of anemia.
The comparative analysis reveals that India faces a more severe anemia burden, with higher prevalence rates across all demographic groups compared to Kyrgyzstan. However, both countries have implemented various interventions with varying degrees of success. India's focus on nutritional programs and socio-economic interventions complements Kyrgyzstan's health system reforms and international collaborations.
The socio-economic impact of anemia in both countries is substantial, affecting health outcomes, economic productivity, and exacerbating poverty levels. The success stories of individuals who have effectively managed their anemia provide hope and demonstrate the importance of continued efforts in this area.
Moving forward, both countries should consider the policy recommendations outlined in this report, including integrating anemia prevention into broader policies, implementing behavioral interventions, and addressing urbanization and climate change. Additionally, leveraging new treatment developments and fostering cross-country collaborations will be crucial for achieving significant reductions in anemia prevalence and improving overall health outcomes in these regions.
By addressing these areas through comprehensive, culturally appropriate, and evidence-based approaches, both India and Kyrgyzstan can make significant strides in reducing anemia prevalence and improving the quality of life for their populations.
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