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Resource centre on India's rural distress
 
 

Empty panic over iron pills-Shonali Ghosal
-Tehelka.com


The media went on a overdrive and misreported facts.

Hundreds of children fell sick in the last two weeks in Haryana, Delhi and Maharashtra after consuming iron and folic acid supplements given to them under under state sponsored programmes to combat anemia. Though the authorities later clarified that mild side-effects like abdominal pain and nausea were expected - there are few takers for this explanation, especially in the backdrop of the recent Bihar mid-day meal disaster, where 23 children died after eating contaminated food. Public health activists and doctors, however, second the public health officials' views saying that there is little or no cause for panic.

"We've seen in our experience that human body requires time to get used to iron tablets. The 130 children in Maharashtra, or the 200 in Delhi or 1000 in Haryana should not be alarming as the percentages of those with medical complications is negligible when you see that 16-18 lakhs other students received the same tablets in each state," says Dr YK Gupta Professor & Head of the Pharmacology Department at the All India Institute of Medical Science (AIIMS). Similarly, renowned public health activist, Dr Mira Shiva said, "iron pills are knows to cause discomfort. The government would have definitely stopped if it was the tablets making kids sick as they simply cannot afford that especially after the recent accident in Bihar."

According to Anuradha Gupta, Director, National Rural Health Mission (NRHM), scientific studies show that side effects are observed in 5 percent cases. " Nearly, 18 lakh children in Delhi were given the tablets. Two hundred of them complained of distress. The comparative numbers give perspective, but that's not what the media reported," she says adding that the scheme has successfully been running in Odisha for a year and it was most recently implemented in Karnataka too.

The tablets are procured by individual states and given on one day of the week to children from classes 6 to 12 in government schools and to adolescent girls at Anganwadi centres. Allaying fears of spurious medication, Dr Siddarth Ramji, Professor of Pediatrics at the Maulana Azad Medical College said that the batch of medicines for Delhi were manufactured in June 2013 and would expire in 2015. "Other states have the same quality control standards. One problem though is that if you chew instead of swallowing the tablets, the chances of side effects go up. Their consumption must be properly supervised," he says. A large majority of the children taken ill were girls, a problem Ramji attributes to the fact that there is a greater impact on those who may be menstruating and already having stomach ache, which may get more severe.

The lack of counseling plays a major role in creating panic, says Dr Vandana Prasad a community pediatrician and member, National Commission for the Protection of Child Rights (NCPCR). "When we prescribe iron tablets, we tell the child and family of the expected difficulties like iron can initially cause gastritis or diarrhea or constipation or even vomiting. I suspect there was a lack of communication because with a public system, they are just told to take it and not about the possible side effects and what to do if you feel this or that." Dr Abhijit Das, Director, Centre for Health and Social Justice reiterates the need for counseling saying that "iron does cause problems but people need to be told that you may have diarrhea or even black stool which is a regular response but for someone who doesn't know, it's alarming."

Rakesh Gupta, director of the NHRM, Haryana states that out of the 16 lakh students in 8400 schools who took the tablet, only 1,300 showed side-effects. Out of those, 100 had effects like vomiting or diarrhea and the rest experienced nausea and abdominal pain. Two thirds of the 1,300 were girls who are more prone to anemia because of periods. "As a measure, the dosage for these 1,300 kids has been reduced to 50mg from 100mg for six weeks," he says.

There are some factors that need to be carefully looked at and addressed like the dose which should be with respect to body weight (not the age) and the dilemma of eating on an empty or full stomach since "taking the pill on an empty stomach creates nausea but having it on a full stomach reduces absorption," says Prasad. What is crucial is to ensure proper supervision, counseling and monitoring -widespread panic may not be the best supplement.