Introduction

Recent discussions in India have brought anaemia to the forefront, with debates surrounding the measurement and management of haemoglobin levels.
The WOMAN-2 trial collaborators published a study in The Lancet, emphasizing the importance of anaemia in postpartum haemorrhage and calling for informed policy decisions in India.
Anaemia affects a significant number of women worldwide and is associated with high mortality rates in postpartum haemorrhage cases.

What is Anaemia?

Anaemia is a medical condition characterized by a decrease in the number of red blood cells or a deficiency in haemoglobin, the protein responsible for carrying oxygen throughout the body.
This condition can lead to a reduced capacity of the blood to deliver oxygen to tissues and organs.
The symptoms of anaemia can vary depending on the underlying cause and the severity of the condition.

However, some common symptoms of anaemia include:

Fatigue and weakness: Feeling tired and having a lack of energy is a common symptom of Anaemia. This occurs because the body’s tissues and organs do not receive enough oxygen.
Shortness of breath: Due to the reduced oxygen-carrying capacity of the blood, individuals with Anaemia may experience difficulty breathing, especially during physical activity or exertion.
Rapid or irregular heartbeat: In an attempt to compensate for the lack of oxygen, the heart may beat faster or irregularly. This symptom is particularly noticeable during physical activity or when the individual is at rest.
Dizziness and light-headedness: Anaemia can cause a decrease in blood flow to the brain, leading to feelings of dizziness and lightheadedness.
Cold hands and feet: Reduced blood flow can result in a sensation of coldness in the extremities, such as the hands and feet.
Headaches: Some individuals with anaemia may experience frequent headaches, which can be a result of the decreased oxygen supply to the brain.

Increased risk of complications: Anaemia during pregnancy raises the risk of preterm birth, low birth weight, and maternal mortality.
Fatigue and weakness: Anaemia can cause exhaustion, making it harder for pregnant women to handle physical demands.
Preeclampsia: Anaemia is linked to a higher likelihood of developing preeclampsia, a dangerous condition.
Postpartum haemorrhage: Anaemia increases the risk of excessive bleeding after childbirth.
Impaired immune function: Anaemia weakens the immune system, making pregnant women more susceptible to infections.
Iron deficiency Anaemia: Common during pregnancy, it can negatively impact maternal and fetal health.

Global anaemia burden: Over half a billion women of reproductive age suffer from anaemia worldwide.
Postpartum haemorrhage risk: Anaemia increases the risk of postpartum haemorrhage, a leading cause of maternal deaths, particularly in low- and middle-income countries.
WOMAN-2 trial: The trial examined the association between prebirth haemoglobin levels and postpartum haemorrhage risk in women from Pakistan, Nigeria, Tanzania, and Zambia.

Continuous relationship: Lower haemoglobin levels were directly associated with increased blood loss and clinical postpartum haemorrhage.
Impact on maternal function: Women with anaemia experience reduced oxygen-carrying capacity, leading to shock after smaller blood loss volumes.
Severity of anaemia: Severe anaemia was associated with higher odds of death or near-miss events compared to moderate anaemia.

Preventive treatment: Attention should be given to preventing and treating anaemia in women of reproductive age.
Existing initiatives: The Indian government provides iron and folic acid supplements to address anaemia, especially among adolescent girls.
Challenges and mission-mode approach: Rising levels of anaemia in India require an intensified public health approach to combat the issue effectively.
Cultural and social considerations: Public health programs should consider cultural attitudes and preferences regarding blood draws for accurate haemoglobin measurement.
Outreach program considerations: A comprehensive understanding of cultural and social realities is crucial to ensure the success of anaemia prevention initiatives.

The WOMAN-2 trial highlights the significance of anaemia in postpartum haemorrhage, urging policymakers in India to use evidence-based guidelines for anaemia management.
The Indian public health program should focus on prevention, treatment, and community engagement to combat rising anaemia levels effectively.
Cultural and social factors must be considered when designing outreach programs, ensuring their relevance and acceptance by the target population.