National Nutritional Anaemia Prophylaxis Programme (NNAPP)

Nutritional anaemia is a major public health problem in India. The NNAPP was started in 1970. It is a centrally sponsored scheme. Anaemia especially affect women in the reproductive age group and young children. It is estimated that over 50 per cent of pregnant women suffer from anaemia. Nutritional anaemia, due to iron and folic acid deficiency, is directly or indirectly responsible  for about 20 percent of maternal deaths. Anaemia is also a major contributory cause of high incidence of premature births, low birth weight and perinatal mortality. Presently, 22 million adult and 30 million child beneficiaries are being covered under the programme (Guidelines for National Nutritional Anaemia Prophylaxis Programme, Ministry of Health and Family Welfare, Government of India, 1990.) 

Objectives : The programme aims at significantly decreasing the prevalence and incidence of anaemia in women in reproductive age group, especially pregnant and lactating women, and preschool children. 

The specific objectives of the programme are : 

• to assess the baseline prevalence of nutritional anaemia in mothers and young children through estimation of haemoglobin (Hb) levels. 
• to put the mothers and children with low Hb levels (less than 10 g and less than 8 g respectively) on anti-anaemia treatment. 
• to put the mother with Hb level more than 10 g/dl and children with Hb more than 8 g/dl on the prophylaxis programme. 
• to monitor continuously the quality of the tablets, distribution and consumption of the supplements. 
• to assess periodically the Hb levels of the beneficiaries. 
• to motivate the mothers to consume the tablets through relevant nutrition education (and to give to their children also). 

Beneficiaries : The scheme beneficiaries are children in 1-5 years of age, pregnant and nursing mothers, female acceptor of terminal methods of family planning and IUDs. 

The target beneficiaries of the scheme are 50 per cent of total pregnant and nursing mothers and 25 per cent of total women acceptors of terminal methods and IUDs. The target child  population is 50 per cent of total population in the age group of 1-5 years. 

Activities : The programme focuses on the following activities: 

1)  Promotion of regular consumption of foods rich in iron. 

2)  Supply of iron and folate supplements in the form of tablets (folifer tablets) to the target group. 

3)  Identification and treatment of severely anaemic cases. The recommended daily dosages of iron and folic acid (IFA) tablets is as follows: 

Adult women              :  60 mg elemental iron  +  0.5 mg folic acid 

Children (1-5 years)   :  20 mg elemental iron  +  0.1 mg folic acid. 

For young children, who cannot swallow, liquid syrup containing the same amount of IFA was given (2 ml at a time). This has been discontinued since 1991. 

Organisation : The programme is implemented through the Primary Health Centres and its sub-centres. The multipurpose worker female and other para-medics in the PHC's are responsible for the distribution of IFA tablets (adult and paediatric doses) to beneficiaries. The functionaries of ICDS scheme assist in implementation of programme.