Direction: Read the following passage and answer the following questions: The National Family Health Survey (NFHS) dropping anaemia from the survey to be launched on July 1 has stirred a controversy in the public health community with many questioning the intent behind the decision. The government has defended the decision stating that the survey on the prevalence of anaemia was being moved to another more comprehensive survey. However, this has raised several questions. The Comprehensive National Nutrition Survey (CNNS) 2016-18, in which blood samples were collected from almost 50,000 children and adolescents aged 1-19 years, showed lower prevalence of anaemia than the NFHS, which was attributed to the difference in the sample collection method. CNNS used blood samples drawn from the vein or venous samples while the NFHS uses samples from pricks on finger tips (capillary samples). A BMJ article on an international study conducted in Bangladesh and Malawi found that tests done in the laboratory using venous samples showed lower prevalence of anaemia (or higher haemoglobin level) than point-of-care (POC) tests using capillary samples. Since NFHS uses capillary samples tested with a POC instrument, HemoCue, several experts argued that this could be a reason for the survey showing high prevalence of anaemia. In the last survey, NFHS-5 (2019-21), the prevalence of anaemia showed a huge jump among almost all sections with the most dramatic increase (from 59% to 67%) among wchildren aged 6 months to five years. This was an embarrassment to the central government, which had launched Anaemia Mukt Bharat in 2018 and had been carrying out an iron and folic acid supplementation programme for several decades. Several experts said that the prevalence was 'inexplicably' high and blamed it on the method of using capillary samples and said that the high estimates were being used by many, including international organisations, to push fortification of food. In 2021, the government decided to distribute rice fortified with iron via government schemes, which came in for much criticism from public health experts, who pointed out that there was insufficient evidence of any benefit and sufficient evidence of the harm that could be caused by an overload of iron. Meanwhile, many public health experts have pointed out that the increase in overall prevalence of anaemia was no surprise as several surveys have also shown that people are eating less and eating poorer quality of food due to substantial increase in food prices and stagnation of incomes. From a public health point of view, it is important to be able to compare data sets from across the country at different intervals such as comparing the data from NFHS-3 to NFHS-4 or 5. This helps to understand how the condition has changed over the years. The Demographic Health Survey, supported by United States Agency for International Development (USAID), of which NFHS was also a part, is conducted in 90 countries and capillary blood method is used for all the international samples. "So at least we know if we are performing better or worse than other countries. Venous blood method requires skilled lab technicians and cannot be done in the field. So removing capillary blood estimates from large scale surveys offers no other alternative, so basically we will not have any large surveys on anemia in India. Screening tools are always less reliable than diagnostic. If someone is positive or negative on a screening tool they may still require diagnostic tests to confirm. So expecting an anemia screening tool such as capillary testing to have high sensitivity and specificity is a problem," said Dr Sylvia Karpagam, a public health expert. She added that similar issues had been raised about blood pressure that is checked manually showing higher BP. Does that mean even surveying BP will be dropped from NFHS, asked Dr Karpagam. Though anaemia is being dropped from the NFHS, it will be covered in a new survey which the health minister launched in December last year. The new survey called the Diet and Biomarkers Survey in India (DABS-I) is to be conducted by the Indian Council of Medical Research (ICMR) and the National Institute of Nutrition (NIN) and funded by ICMR. It is meant to map the diet, nutrition and health status, and provide a correct estimate of anaemia among urban and rural populations using venous samples and auto-analysers standardised in the ICMR-NIN labs. The study is expected to provide nutrient composition data on cooked and uncooked foods from all regions and states of the country by collecting food samples from households. It is expected to reflect not only intake but also nutrient metabolism, bioavailability, and effects of diet on physiological and disease processes. The pilot studies for DABS-I are ongoing in 12 states and the field work for the survey is expected to start in a few weeks' time. However, the protocol for this survey is yet to be made public. According to some experts, DABS is envisaged as a periodic survey, but there has been no firm commitment from the government on this. A lot could depend on the success or failure of the first survey. Why did the National Family Health Survey (NFHS) decide to exclude anaemia from its upcoming survey, leading to controversy?
Correct answer
C. Integration of anaemia data into a more extensive survey
Why
Integration of anaemia data into a more extensive survey. The passage mentions that the government defended the decision to drop anaemia from NFHS, stating that the survey on the prevalence of anaemia was being moved to another more comprehensive survey. This indicates that anaemia data is being incorporated into a larger survey, possibly to enhance the overall understanding of health-related issues.