Anemia Resource Review

On behalf of the U.S. Agency for International Development (USAID), SPRING organized a micronutritent powders (MNP) consultation to provide contextualized operational guidance on MNP programming to USAID missions.  On October 19 and 20, 2015, SPRING held a face-to-face meeting of 45 consultation members to discuss country experiences around 1) planning, coordination, and supplies; 2) delivery and social and behavior change communication; and 3) monitoring and supervision. The outcomes of the MNP consultation will include a journal supplement and a USAID Implementation Brief.

On October 14-16, 2015, FANTA, in collaboration with the International Lipid-Based Nutrient Supplements (iLiNS) Project, hosted a technical meeting, where program implementers and researchers convened to share evidence and operational lessons learned and discuss programmatic considerations regarding small quantity lipid-based nutrient supplements (SQ-LNS). The main issues that arose around SQ-LSN from the conference proceedings include uptake by target populations, social and behavioral change communication, economics, and logistics.

In September 2015, GAIN, the Scaling Up Nutrition (SUN) Business Network, and Devex teamed up to hold a high-level panel event titled “Harnessing the power of multi-stakeholder partnerships to achieve the Sustainable Development Goals in food and nutrition security.” This event took place during the week of the United Nations 70^th General Assembly and featured two panel discussions in which global thought leaders explored how to successfully create and maintain partnerships, as well as the vital role that they play in improving nutrition and food security as part of the post-2015 development agenda. A recording of the livestream event can be found here.

The Global Alliance for Improved Nutrition (GAIN) and the Government of Tanzania co-hosted a summit in Arusha, Tanzania, to reinvigorate interest, awareness, and investment in food fortification. H.E. Tumusiime Rhoda Peace, African Union Commissioner for Rural Economy and Agriculture, closed the summit with the Arusha Statement on Food Fortification, encouraging participants to create a more fortified future for all. For live interviews with Chris Elias of the Bill and Melinda Gates Foundation and Marc Van Ameringen of GAIN on the role of food fortification in the fight against hidden hunger, see the following link:

Fortification at scale: LIVE interviews with Chris Elias and Marc Van Ameringen

Interventions for neglected tropical diseases (NTDs) have proven to be a worthwhile public health investment, with significant and achievable returns in health and productivity. The latest progress report of the London Declaration on NTDs highlights examples of country leadership and collaboration, resulting in major progress toward elimination goals and coverage targets for NTD programs. The report includes targets to reduce visceral leishmaniasis and soil-transmitted helminths, which can lead to anemia.

SPRING has developed a series of National Anemia Profiles, which provide country-specific information on the causes and burden of anemia, the policy environment, and program indicators. The profiles can be used by country leaders, stakeholders, and the broader public health community to raise the visibility of anemia and encourage coordination of anemia efforts across multiple sectors. These interactive profiles can also be used to monitor country progress on anemia-related targets over time.

According to the 2013 National Nutrition Survey, the prevalence of anemia among young children in the Philippines remains high, but there have been significant declines over the past several years. In this article and accompanying video, nutritionists discuss a series of nutrition education sessions, conducted by the Nutrition Center of the Philippines (NCP). These sessions focus on topics such as complementary feeding, dietary diversity, and the benefits and proper use of micronutrient powders (MNPs).

Despite the World Health Organization’s (WHO) recommendations on daily iron and folic acid (IFA) supplementation during pregnancy, many women are still not receiving or taking the recommended dose of IFA supplements. In addition, recent research has shown that multiple micronutrient supplements may have additional benefits beyond those offered by IFA supplements. In either program, it is important to note that it is not enough to only provide the supplements; women must also have timely access to the product through antenatal care or community-based delivery platforms.

Malaria is one of the leading causes of anemia globally. The President’s Malaria Initiative (PMI) has released updated, redesigned country profiles for the 20 focus countries in Africa and the Greater Mekong Subregion of Southeast Asia. The profiles document the current state of malaria in these countries, as well as the contributions of PMI in reducing the malaria burden, both in the year 2014 and cumulatively.

The Food Fortification Initiative conducted a study to evaluate the impact of flour fortification programs on anemia prevalence in non-pregnant women in twelve countries. Findings indicated that fortification was associated with a decline in anemia prevalence. However, for fortification programs to have a greater impact on iron deficiency anemia, they must utilize a bioavailable form of iron and should ensure it is used at recommended concentrations.

The World Health Organization (WHO) published a report, documenting estimates of the prevalence of anaemia for the year 2011 in preschool-aged children (6-59 months) and women of reproductive age (15-49 years). These target groups are analyzed according to pregnancy status, regions of the United Nations and World Health Organization (WHO), and by country.

Intestinal parasitic worms affect roughly 2 billion people and can lead to a number of detrimental health outcomes, including anemia, loss of iron, and poor absorption of nutrients. Controversy has emerged around an influential study on the positive benefits of mass deworming. Recently a reexamination of the data found gaps and errors, indicating some but not all of the original benefits of deworming programs. Heated debates, or “worm wars,” ensued over social media and other online venues regarding the new evidence.

In a study conducted at Rice University, bioengineers discovered that hemoglobin concentrations (used to measure anemia severity) produced from a single drop of blood varied widely, and that samples of six to nine drops of blood were needed for more consistent results. It is not immediately clear if discrepancies are due to issues with the experiments themselves or if the variation exists within the individual droplets of blood, but the researchers stress the need for fingerprick tests to be administered with great care to ensure accuracy.

Researchers have developed a diagnostic blood test for micronutrient deficiencies, or “a bacterial litmus test,” that measures levels of zinc in the blood using genetically modified bacteria. This breakthrough has broad-reaching implications—it could enable nutritional epidemiologists and nongovernmental organizations to use simple and portable technology to conduct community-level testing in remote regions where nutritional deficiencies are common.

Research has shown that Vitamin D and iron deficiencies frequently co-exist and potential overlapping metabolic pathways may need to be taken into account when designing programs. This study explored the links between iron and vitamin D status and their regulatory hormones in pregnant adolescents—a vulnerable group that is at risk of both vitamin D and iron deficiency. The findings indicated that vitamin D deficiency increases the risk of being anemic at delivery. Additional studies are needed to identify potential mechanisms that impact the relationship between vitamin D status and anemia. The authors recommended screening for multiple nutrient deficiencies during pregnancy to determine an appropriate course of action for prenatal supplementation. 

In this community-based study, researchers used a behavior change communication approach to examine the effectiveness of “Trials of Improved Practices (TIPs)” on dietary and iron-folate intake during pregnancy in Varanasi, India. The TIPs based strategies included interpersonal communication, encouraging the active participation of family members, and promoting reminder materials in the home. Given the positive impact found in the study on hemoglobin levels, anemia reduction, weight gain, iron-folate compliance, and protein intake, the authors concluded that TIPs is an effective programmatic approach to improve the nutritional status of pregnant women.

In tropical regions, high rates of iron deficiency and malaria are common, both of which contribute to higher anemia prevalence. This study examined whether iron fortification combined with intermittent preventive treatment (IPT) of malaria would have a greater impact on reducing anemia than either intervention alone in young children. The authors found that while IPT modestly decreased anemia and iron-fortified complementary food improved iron status, neither intervention significantly improved hemoglobin concentration, nor did IPT enhance the effect of iron-fortified complementary food at the completion of the study. To develop comprehensive strategies to prevent and treat anemia in malaria endemic regions, further research is recommended.

This study examined predictors of both initial and repeat micronutrient powder (MNP) coverage by comparing two delivery models piloted in rural Nepal: distributing MNPs by female community health volunteers (FCHV) or at health facilities (HF). It was discovered that both attendance at an FCHV-led mothers’ group meeting where MNP was discussed and the perception of positive effects in the child had an impact on MNP initial coverage in both models and repeat coverage in the HF model. The authors concluded that in MNP programming, more than one delivery model may be needed to maximize coverage and avoid overburdening the system.

This study sought to evaluate the safety and efficacy of iron supplementation during pregnancy in Dar es Salaam, Tanzania, an area affected by malaria. The authors not only found that iron-replete, nonanemic women receiving supplementation had improved hematologic and iron status at delivery, but also that the risk of placental malaria was not increased by maternal iron supplementation.

In this study, researchers sought to further explore the association of anemia with Schistosoma mansoni and hookworm infections in individuals aged 5-90 in Uganda. The authors found that anemia was more prevalent in both children and adults affected by intestinal schistosomiasis and hookworm infections.

This systematic review examined the efficacy and safety of intermittent preventive treatment in schoolchildren (IPTsc). The authors found that overall, most IPTsc regimens provided significant protection against malaria parasitaemia, but no IPT method resulted in a protective effect over 50 percent for anemia. Although IPTsc may be an effective malaria control intervention for schoolchildren, it was determined that there is a need for more studies, especially regarding malaria-related anemia and clinical malaria in schoolchildren.

This study investigated the effect of antenatal iron supplementation on maternal Plasmodium infection risk, maternal iron status, and neonatal outcomes in rural Kenya. It was concluded that pregnant women who received daily iron supplementation experienced no significant differences in overall maternal Plasmodium infection risk. The study also found that iron supplementation during pregnancy led to a substantial increase in birth weight.

Maternal anemia prevents oxygen and nutrients from reaching the placenta-fetus unit, which can lead to obstetrical complications and poor birth outcomes. This cross-sectional study explored the magnitude of maternal anemia and its relationship to obstetrical complications and birth outcomes. The findings demonstrated an association between maternal anemia and pre-pregnancy factors (age  18 or ≥35 years, single status, previous miscarriage, grand multiparity, diabetes in family, previous prematurity, overweight/obesity, previous cesarean section and previous pre-eclampsia), malaria, urinary tract infection, and a greater risk of a cesarean section and stillbirths. Offspring of anemic mothers were more likely to be premature, or small for gestational age.