‘Local production of iron, folic acid supplements may curb anaemia in 15m Pakistani girls’

ISLAMABAD: The local production of Weekly Iron and Folic Acid Supplementation (WIFAS) in adolescent doses could prevent around 15 million adolescent girls in Pakistan from suffering from iron deficiency anemia as ensuring sustainable access to these supplements could significantly reduce costs and lessen reliance on expensive imports, according to officials and nutrition experts.

Iron deficiency anaemia is the leading cause of lost disability-adjusted life years (DALYs) among adolescent girls (10-19 years) worldwide. The World Health Organization (WHO) recommends WIFAS containing 60mg of elemental iron and 2.8mg of folic acid for menstruating adolescents and women (20-49 years) living in areas where anemia prevalence exceeds 20%.

Pakistan currently spends substantial foreign exchange on importing WIFAS tablets for adolescents, as no local pharmaceutical company manufactures them due to the lack of registration with the Drug Regulatory Authority of Pakistan (DRAP). Encouraging local manufacturers to register these supplements could help establish a sustainable and cost-effective domestic supply.

According to WHO and nutritionists, iron and folic acid supplementation is advised once a week, typically following the school semester, or in cycles of three months of weekly supplementation followed by three months without supplementation. This approach aligns with school schedules to ensure higher adherence rates.

Folic acid plays a crucial role in preventing neural tube defects (NTDs), including severe birth defects such as spina bifida and anencephaly. NTDs contribute to neonatal mortality, long-term disability, and significant healthcare costs due to the need for surgery, medication, and physiotherapy.

Dr. Mazhar Abbasi, National Programme Manager for Adolescent Nutrition at Nutrition International, said that despite enormous demand, Pakistan remains dependent on imports.

“The essential nutrition supplement for adolescents is not registered with DRAP, preventing local pharmaceutical production. As a result, the government and NGOs must import large quantities of WIFAS tablets to meet the needs of over 15 million adolescent girls who require the supplement weekly as a preventive measure against anemia,” Dr. Abbasi explained.

Anaemia among adolescent girls is a critical public health issue in Pakistan, affecting more than half (54.7%) of the country’s adolescent girls.

Renowned nutrition consultant Dr. Naveed Bhutto identified multiple causes, including nutritional deficiencies, poor dietary habits, and socioeconomic factors. “A major contributor is iron deficiency due to inadequate intake of iron-rich foods, increased iron needs during growth spurts, and menstrual blood loss,” he said.

Dr. Bhutto stressed that poverty and lack of awareness exacerbate the problem. “Low-income families have limited access to nutritious foods, and many adolescents are unaware of the importance of iron-rich diets. Additionally, infections like malaria and intestinal parasites further contribute to the high anaemia burden,” he noted.

Dr. Zulfiqar A. Bhutta, a leading expert in maternal and child health, cited the National Nutrition Survey 2018, noting severe anaemia prevalence in Pakistan. “In Balochistan, 73.7% of adolescents suffer from anemia, and 61.3% of women of reproductive age are affected,” he said.

He emphasized that while WHO estimates that 50% of anaemia cases globally stem from nutritional deficiencies, in Pakistan the proportion may be closer to 33-40%. “Inflammatory conditions, repeated infections, and poor healthcare access also significantly contribute to anemia in Pakistani adolescents,” Dr. Bhutta remarked.

Anaemia among adolescent girls also imposes a major economic burden. According to Nutrition International’s Cost of Inaction report, anaemia leads to an estimated $595 million in annual economic losses due to diminished productivity and human capital. The broader economic impact surpasses $3 billion annually, with around $2.5 billion attributed to anaemia in children.

Dr. Shabina Raza, Country Director of Nutrition International Pakistan and Executive Committee member for the Global SUN Movement, highlighted the significance of addressing anaemia through the WIFAS programme and emphasized the need for locally produced iron and folic acid supplements for adolescents.

“Anaemia is a serious public health concern in Pakistan, impacting more than half (56.6%) of adolescent girls. It has major consequences on their health and well-being, including decreased school performance, loss of productivity, and negative maternal and infant outcomes for adolescents who become pregnant.”

“WIFAS is a proven, cost-effective intervention to prevent and reduce anemia and improve adolescent health. It is one of the eight key nutrition interventions for adolescents recommended by WHO and is also included in Pakistan’s Adolescent Nutrition and Supplementation Guidelines. A wider and more readily accessible supply of WIFAS can prevent millions of adolescent girls from suffering from iron deficiency anemia,” Dr. Raza said.

She also stressed the importance of local production of the adolescent dose to ensure sustainability and affordability. “Investing in local manufacturing of iron and folic acid supplementation, in line with WHO guidelines, is a strategic way to ensure sustainable access in Pakistan. By reducing reliance on imports, it may be possible to make WIFAS more affordable and accessible to those who need it most,” she added.