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Understanding Anemia: Guidance for Conducting a Landscape Analysis

Overview of the Landscape Analysis Guidance

Anemia is a major public health problem. It is characterized by low levels of hemoglobin, a protein that carries oxygen throughout the body. The effects of anemia include reduced cognitive and physical development in children, fatigue, and reduced physical stamina and productivity for people of all ages (Low et al. 2013; Lozoff 2007; Murray-Kolb 2013; Pasricha et al. 2014). During pregnancy, anemia increases the risk of preterm delivery, low birthweight, and maternal and neonatal mortality (Rahman et al. 2016).

Anemia disproportionately affects young children, pregnant women, and women of reproductive age. Globally, 43 percent of children under 5 years of age, 38 percent of pregnant women, and 29 percent of women of reproductive age are anemic (Kassebaum et al. 2014; Kassebaum and GBD 2013 Anemia Collaborators 2016). More information on the populations most affected by anemia is provided in the Step 1: Characterize Anemia Prevalence section of this guidance. Anemia is caused by multiple factors, with the main types of factors being infection, micronutrient deficiency, inflammation, and genetic blood variations. More information about the causes of anemia is provided in the Step 2: Establish Causes of Anemia section of this guidance. Recognizing the contributions from different sectors can better promote effective integration of anemia-related policies and programs. More information on the policies and interventions to reduce anemia can be found in the sections Step 3: Review Anemia Policies and Step 4: Assess Status of Anemia Interventions of this guidance.

What is a landscape analysis?

Landscape analyses have been conducted in many different ways and they are closely related to a context assessment or situation analysis. For this guidance, we define a landscape analysis as a detailed assessment that uses primary and/or secondary data to describe a problem and the policies and interventions already in place to address this problem, in a given setting.

While the final format and output of a completed anemia landscape analysis will vary, your landscape analysis should include, at a minimum—

  • introduction to the anemia situation in your country
  • description of the methods used to conduct the landscape analysis, including how you gather information to include in the landscape analysis
  • discussion of the risk factors for, or causes of, anemia that are present in your country
  • overview of the policy situation in your country, as it relates to anemia
  • discussion of the coverage and implementation of anemia prevention and reduction activities.

For country examples of anemia landscape analyses, please visit the Next Steps and Resources section.

Why conduct an anemia landscape analysis?

Tackling the problem of anemia—a major endeavor—requires policymakers and implementers across a country to be committed and to show leadership. The United States Agency for International Development’s (USAID) Integrated Anemia Prevention and Control Toolkit on the Knowledge for Health website identifies three key steps for developing a strategy for anemia prevention and control:

  1. Know the problem.
  2. Raise awareness and develop partnerships.
  3. Identify interventions and implementation plans.

Conducting an anemia landscape analysis will help stakeholders “Know the problem.” With this information, you can easily move on to the next two steps of strategy development. It is important to note that the three-step process can be circular. For example, participation in the process of “knowing the problem” may help raise awareness and develop partnerships with stakeholders not previously involved in anemia work.

Box 1: Navigating This Guidance Document

While the sections of this guidance are presented in order, you may want to explore them out of order, or return to completed sections as new information becomes available. Look for these sections in the key at the top of each page of the guidance:

  • Using the Anemia Landscape Analysis Tool: Provides an overview of the Excel-based tool for presenting information on your country’s anemia situation.
  • Gathering Information on Anemia: Outlines how to collect the prevalence, cause, policy, and intervention data you will need for your landscape analysis.
  • Step 1: Characterize Anemia Prevalence: Helps you understand the burden of anemia in your country for various target groups, as well as additional details on how anemia is measured.
  • Step 2: Establish the Causes of Anemia: Describes the multi-sectoral and multi-factoral nature of anemia, enabling you to explore the causes and risk factors of anemia and identify priority areas for intervention.
  • Step 3: Review Anemia Policies: Explains how to gather data on the anemia policy environment. This will enable you to illustrate the policy landscape in which your country’s anemia reduction interventions operate.
  • Step 4: Assess Status of Anemia Interventions: Provides more information on the various solutions for addressing anemia. Use this information to identify areas that will improve the reach and efficiency of anemia prevention and reduction activities.
  • Next Steps and Resources: Guides you to other resources and activities that will help translate your findings into action.

Who should use this anemia guidance and tool?

The guidance is primarily directed at technical experts planning to carry out a landscape analysis; the guidance will also be of interest to anyone looking for a better understanding of anemia in their country: government staff in anemia-related ministries, nutrition program implementers, and planning staff in anemia-related sectors. The process of developing an anemia landscape analysis should include participation by multiple stakeholders working together to ensure all relevant and existing data are included and to build buy-in.

How do you use the anemia landscape guidance document?

The Guidance for Conducting a Landscape Analysis; and accompanying Excel-based Anemia Landscape Analysis Tool provide the reader with a guide and tool to develop an anemia landscape analysis that includes context-specific evidence, and it identifies areas that should be prioritized to guide anemia efforts in your country. You can also use this guidance document and/or the accompanying Excel-based tool to review an existing anemia landscape analysis.

This guidance leads you through the process of conducting a landscape analysis to understand the anemia situation in your country. Box 1 explains the information included in the guidance document. Throughout the guidance, we offer suggestions about how to use the information and incorporate it into your landscape analysis. In addition to the online version, you can download and print the guidance document for offline use. 

Who should be involved in developing a landscape analysis?

A variety of factors cause anemia and multiple sectors are involved in controlling and treating it, so this exercise will benefit from input from various sectors and stakeholder groups. Including multiple voices in this process, from the beginning, creates an awareness of the problem of anemia and ownership of the process of combating anemia. Conducting a landscape analysis should include staff from government, along with representatives of civil society, donors, academia, United Nations agencies, and the private sector who work in areas that include—

  • health
  • water and sanitation
  • education
  • agriculture
  • gender and social welfare
  • industry
  • finance
  • statistics


Kassebaum, Nicholas J. 2016. “The Global Burden of Anemia.” Hematology/Oncology Clinics of North America 30 (2): 247–308. doi:10.1016/j.hoc.2015.11.002.

Kassebaum, Nicholas J., Rashmi Jasrasaria, Mohsen Naghavi, Sarah K. Wulf, Nicole Johns, Rafael Lozano, Mathilda Regan, et al. 2014. “A Systematic Analysis of Global Anemia Burden from 1990 to 2010.” Blood 123 (5): 615–24. doi:10.1182/blood-2013-06-508325.

Lopez, Anthony, Patrice Cacoub, Iain C. Macdougall, and Laurent Peyrin-Biroulet. 2016. “Iron Deficiency Anaemia.” Lancet 387 (10021): 907–16. doi:10.1016/S0140-6736(15)60865-0.

Low, Michael, Ann Farrell, Beverley-Ann Biggs, and Sant-Rayn Pasricha. 2013. “Effects of Daily Iron Supplementation in Primary-School-Aged Children: Systematic Review and Meta-Analysis of Randomized Controlled Trials.” CMAJ 185 (17): E791-802. doi:10.1503/cmaj.130628.

Lozoff, Betsy. 2007. “Iron Deficiency and Child Development.” Food and Nutrition Bulletin 28 (4 Suppl.): S560-571.

Murray-Kolb, Laura E. 2013. “Iron and Brain Functions.” Current Opinion in Clinical Nutrition and Metabolic Care 16 (6): 703–7. doi:10.1097/MCO.0b013e3283653ef8.

Pasricha, Sant-Rayn, Michael Low, Jane Thompson, Ann Farrell, and Luz-Maria De-Regil. 2014. “Iron Supplementation Benefits Physical Performance in Women of Reproductive Age: A Systematic Review and Meta-Analysis.” Journal of Nutrition 144 (6): 906–14. doi:10.3945/jn.113.189589.

Rahman, Md Mizanur, Sarah Krull Abe, Md Shafiur Rahman, Mikiko Kanda, Saki Narita, Ver Bilano, Erika Ota, Stuart Gilmour, and Kenji Shibuya. 2016. “Maternal Anemia and Risk of Adverse Birth and Health Outcomes in Low- and Middle-Income Countries: Systematic Review and Meta-Analysis.” American Journal of Clinical Nutrition 103 (2): 495–504. doi:10.3945/ajcn.115.107896.