National Sickle Cell Anaemia Elimination Mission

Context: Prime Minister will attend a public programme in Shahdol on 5^th July, where he will launch the National Sickle Cell Anaemia Elimination Mission. He will also distribute sickle cell genetic status cards to the beneficiaries.

What is Sickle Cell Disease (SCD)?

Sickle cell disease is a group of inherited red blood cell disorders that affect hemoglobin, the protein that carries oxygen through the body. 

• Normally, red blood cells are disc-shaped and flexible enough to move easily through the blood vessels.
• If you have sickle cell disease, your red blood cells are crescent- or “sickle”-shaped. These cells do not bend or move easily and can block blood flow to the rest of your body.

The blocked blood flow through the body can lead to serious problems, including stroke, eye problems, infections, and episodes of pain called pain crises. which significantly impacts their quality of life.

About SCDs:

• Sickle cell disease is a lifelong illness.
• There are several types of SCD. The specific type of SCD a person has depends on the genes they inherited from their parents. People with SCD inherit genes that contain instructions, or code, for abnormal hemoglobin.
• If the sickle cell is inherited from one parent, it is called sickle cell trait or sickle cell carrier. If inherited from both the parents, it is called sickle cell disease or sickle cell anemia (homozygous sickle cell).
• Sickle cell disease exists in two forms within the human body.
  • One is the Sickle Cell trait, in which the individual does not exhibit any disease or symptoms and lives a normal life. 
  • The second form is characterized by the presence of symptoms related to sickle cell disease.
• If two individuals with Sickle Cell trait marry each other, there is a high probability that their child will have Sickle Cell disease.
  • By screening individuals for Sickle Cell trait before marriage, the spread of the disease can be prevented.

SCDs in Tribal: A serious health challenge for India

As per Census 2011, India has an 8.6% tribal population which is 67.8 million across the Indian states. The MoHFW tribal health expert committee report has listed sickle cell disease as one of the 10 special problems in tribal heath that affect the tribal people disproportionately.  

• In 13 states of the country, namely Rajasthan, Gujarat, Madhya Pradesh, Chhattisgarh, Jharkhand, West Bengal, Odisha, Telangana, Andhra Pradesh, Tamil Nadu, Kerala, Karnataka, and Maharashtra, there is a high prevalence of this disease, and in four states of the country, namely Bihar, Assam, Uttarakhand, and Uttar Pradesh, there is a partial prevalence of sickle cell disease.
• The prevalence of sickle cell carriers among different tribal groups varies from 1 to 40 per cent. Madhya Pradesh has the highest load.
• In Maharashtra, the sickle gene is widespread in all the eastern districts, also known as the Vidarbha region, in the Satpura ranges in the north and in some parts of Marathawada. The prevalence of sickle cell carriers in different tribes varies from 0 to 35 per cent. The tribal groups with a high prevalence include the Bhils, Madias, Pawaras, Pardhans and Otkars.
• In Gujarat, the Dhodia, Dubla, Gamit, and Naika tribes have a high prevalence of SCDs.
• Tribal population in the Wayanad district of Kerala was screened, followed by genetic counselling where carriers were advised not to marry carriers.

Approaches to Tackle SCDs

Efforts are being made to eliminate Sickle Cell Anaemia through two approaches:  

• The first approach focuses on prevention, ensuring that new cases are not born.
• The second approach involves managing the treatment and providing adequate healthcare facilities for individuals already affected by the disease. 

Government efforts to tackle the problem of SCDs

• Ministry of health under NHM initiated the work on hemoglobinopathies (Thalassemia & Sickle Cell Disease) in 2016 wherein comprehensive guidelines on prevention and management of heamoglobinopathies were released and provision of funds towards screening and management of Sickle cell disease were made.
• The Ministry of Health, in collaboration with the Ministry of Tribal Affairs and the states, has formulated a plan to screen approximately 70 million individuals aged 0-40 years belonging to tribal and other groups residing in nearly 200 districts of 17 states within the next few years.

Sickle Cell Anaemia Elimination Mission 2047

• Prime Minister, in the central Budget for the financial year 2023-24, announced the launch of the national campaign “Sickle Cell Anaemia Elimination Mission 2047” to eradicate the challenge of sickle cell.
• The government has allocated a sufficient budget, utilised advanced technology, provided training to healthcare workers, ensured necessary infrastructure, and made efforts in social awareness and participation to combat this disease.
• To implement this entire programme, monitoring mechanisms will be established at various levels to ensure participation and bring awareness on a large scale. Individuals identified with the disease through screening will undergo regular testing, receive treatment and medication, vaccinations for other diseases, get dietary support, and have access to timely counselling services.
• A comprehensive ecosystem is being developed to ensure access to proper healthcare and management for Sickle Cell Anaemia patients.
• A web portal has been created using digital technology to track and maintain a complete record of sickle cell patients.

Role of Ayushman Bharat in controlling SCDs

Through the Ayushman Bharat scheme, the country has established a network of 1.6 lakh Health and Wellness Centres since 2018, which has played a crucial role in combating epidemics like Covid19.

These centres will also play a significant role in eradicating sickle cell disease along with other diseases. Trained healthcare workers in these centers will provide better treatment for sickle cell patients.

The challenge of SCDs can also be addressed by:

• Increasing awareness about the disease in the community.
• Implementation of mass screening activities for early identification.
• Building a strong network of diagnosis and linkages.
• Implementing robust monitoring system.
• Strengthening the existing primary health care mechanism to incorporate SCD related strategies.
• Capacity building of primary, secondary and tertiary health care teams.
• Building cost-effective intensive interventions at higher care facilities.

Conclusion 

SCDs are commonly found among tribal communities in India. Indigenous Peoples help protect our environment, fight climate change, and build resilience to natural disasters, yet their rights aren’t always protected. SCDs pose a significant threat to the future and existence of our indigenous populations, and it is imperative to prevent the spread of this disease in a timely manner.