and dabs due to differing methodologies is a certain recipe for policy confusion and generating acrimonious debates considerations beyond science will direct allegiance to the accuracy of one over the other estimaterepeating capillaryblood estimates nfhs will not be a good way to compare with the past noisy data since the margin of error is unpredictable the bias can occur in either direction and vary substantially across settings and surveys so a correction factor cannot be applied to the capillaryblood sample for determining the true haemoglobin level the level varies with the blood drop used first or second or later drops whether the finger is squeezed or not temperature and time of the day etc in latin america venousblood estimates showed a consistent decline in anaemia burden over time whereas concomitant capillaryblood estimates revealed static or occasionally worsening rates thereby misinforming policyif we only do dabsi which uses venous samples will our data be comparable to data from 125 countries which are using capillary sample testingthe accuracy of anaemia estimates is of paramount importance to inform policy meaningfully instead of focusing on crosscountry comparisons slowly all countries are likely to move towards the goldstandard venousblood sampling in fact neighbouring sri lanka has been using venousblood estimates for several years which partly explains their relatively lower anaemia burdenfor countries where transition to venous method is not feasible pooled capillaryblood sample method is being tested which has shown some promise pooled capillaryblood sample means that once you prick the finger under ideal conditions without squeezing the four or five drops that come out are collected in a capillary tube mixed and then tested for haemoglobin not choosing one or the other drop randomly it is something like a venousblood sample at a mini scalewhy is the increase in the prevalence of anaemia a surprise or illogical when many surveys have shown worsening dietary intake as people battle unemployment and food inflation this is a plausible hypothesis anaemia has several causes among which insufficient intake of haematopoietic haemoglobinforming nutrients like iron folate vitamin b12 protein and infections inflammation are important contributors however an adverse impact on anaemia prevalence will occur only if the nutrient inadequacy afflicts a substantial proportion of the population and is of a magnitude that overwhelms the individuals adaptive mechanisms more efficient utilisation better absorption and decreased excretion and ongoing interventions in this context ironfolic acid supplementation and other anaemia control programmes were in operation and did not worsen between the last two nfhs surveys thus in the absence of robust data at individual level on relevant variables it would be unreasonable to confirm or refute this hypothesiswhat about your lancet article suggesting that india could have a lower cut off for haemoglobin level to determine anaemia prevalencean insufficiency in red blood cell mass haemoglobin to adequately deliver oxygen to peripheral tissues is defined as anaemia from a functional perspective for several reasons the who cutoffs for haemoglobin to diagnose anaemia are statistical instead of functional cutoffs this means that haemoglobin