To the distinguished scientists of WHO, UNICEF, MoHFW, ICMR and NIN,
We are writing to you to raise concerns about the current debate in India on revising the Hb cut-offs for anemia in the Indian population. A paper by_Sachdeva_et_al (2021), published in the Lancet Global suggests that the current WHO standards, which show a high prevalence of anemia in the country, can be lowered. This has caused much concern and alarm among practicing clinicians, activists and public health persons.
Using several biochemical markers and ignoring many other determinants of anaemia, the paper has drawn a supposedly ‘healthy population’ from the large national survey – the Comprehensive National Nutrition Survey (CNNS) 2019. Critiquing existing WHO cut-offs as not being representative enough of India, the authors show that hemoglobin standards can be lowered by 1.5 gm. Alarmingly, clinicians have had no say in any of these discussions or planned decisions.
In reality, these reduced cut-offs would mean that, on paper, women with haemoglobin levels of 9.5gms would come under the ‘normal’ category, and the percentage of people in the country with anaemia would drop significantly.
The CNNS data predominantly comprises a poor, undernourished population whereas standards have to be drawn from populations that have had no constraints to adequately diverse diets. The consequences of reducing cut-offs in already malnourished and vulnerable populations would be huge.
We are sharing this note, endorsed by more than 250 clinicians, researchers, nutritionists and activists, which explains why the study by Sachdeva et al is flawed in terms of methodology as well as the unwarranted conclusions reached.
We urge you to take serious cognizance of this concern and issue a scientific statement regarding your position on these planned attempts to lower haemoglobin cut-offs.
With regards,
Dr. Veena Shatrugna (Retd. Deputy Director, National Institute of Nutrition)
Dr. Sylvia Karpagam (Public health doctor and researcher)
Siddharth K Joshi (Researcher, Ahara Namma Hakku – Our nutrition, our right)
On behalf of the ‘Working Group on Health and Nutrition’
https://drive.google.com/file/d/1FQfqpNIPIahoCmIMwmVGYlKU9AVEIgoG/view