Anaemia is a widespread condition in India. The biggest cause is malnourishment and iron-poor diets. Though the best remedy is a good diet, anaemia has spawned a huge market for iron supplements, usually of the expensive variety (see box:
Market slice).
A 2006 market survey by the Drug Action Forum-Karnataka (
daf-k), an
ngo campaigning, in their words, for rational drugs and policies, showed that cheaper versions of iron supplements are not available.
Ferrous fumarate tablets with a 200-mg strength, on the Union ministry of health and family welfare's list of essential drugs as an anti-anaemic, was not available because, at 13 paise a pop, manufacturers were not interested in producing it.
In the absence of this, and other cheap alternatives, doctors are forced to prescribe the few that are readily available--which happen more often than not to be combination drugs. This turns out to be expensive for patients. A month's treatment with ferrous fumarate costs Rs 3.90-11.70 compared to the Rs 540.00 incurred on the most expensive drug in Dharwad.
Crazy combination
Apart from surveying iron supplements available in Karnataka's Dharwad district to identify available anti-anaemia drugs, the
ngo analysed the 338 prescriptions for iron-deficiency anaemia mentioned in the October 2005 issue of the
Current Index of Medical Specialities, the standard reference while prescribing drugs. What emerged from the analysis was that iron supplements in the market are expensive because they are combinations, often containing unnecessary elements. In many pills, for instance, iron is combined with substances such as copper, pyridoxine, riboflavin, vitamin
b12 and folic acid. These combinations are devised without any reference to actual needs. For example, copper deficiency is rare. The amount present in normal diets satisfies requirements. "Such irrational combinations should not have been approved and should be banned," says C M Gulhati, editor of the
Monthly Index of Medical Specialities.
Anaemia is common in poor countries. According to the National Family Health Survey, conducted in 2005-2006, 79.2 per cent of children between 6 and 35 months, 56.2 per cent of women between 15 and 49 and 24.3 per cent of men between 15 and 49 were anaemic. Anaemia is a major cause of maternal mortality and iron tablets are given to pregnant women under the National Rural Health Mission. Every pregnant woman gets 100 tablets of iron/folic acid to prevent anaemia and pregnant women who are already anaemic are given an additional 100. Anaemic children are also given 100 tablets of an iron supplement. During 2006-2007, Rs 264.82 crore was set aside for drugs and medicines, of which Rs 40.85 crore was earmarked for iron supplements. But shortages have been reported in the country due to procurement failures.
Iron deficiency lowers the quality or quantity of red cells. Iron is an important component of the haemoglobin in the red blood cell. When its levels are low, the capacity of red blood cells to carry oxygen is reduced and causes tiredness, palpitation, shortness of breath and dizziness.
Dietary solution?
The solution proposed by
daf-k is that the Union ministry of chemicals and fertilisers should make it mandatory for every drug company to manufacture some amount of these cheap medicines. "The state governments should also make it mandatory for all chemist stocks these medicines," says Gobal Dabade, president,
daf-k.
The group has written to the central government asking it to ensure that effective and cheap iron supplements are available in the market. But other solutions have also been suggested. "The best way to control anaemia is to provide food rich in iron and an effort to make them available should be made," says Mira Shiva, a public health expert. Cereals, legumes, green vegetables, jaggery, meat, fish and eggs are rich in iron.
