Anemia Resource Review

This study explored the determinants of hemoglobin and iron status in Bangladesh, as the prevalence of iron deficiency is quite low, according to the 2011-2012 National Micronutrient Survey. Findings suggested that iron-rich groundwater is associated with higher iron status for all groups and higher levels of hemoglobin for pre-school age children, illuminating iron in groundwater as a contributing factor for low levels of iron deficiency in this country. However, anemia prevalence is higher than that of iron deficiency, suggesting that other underlying causes require further investigation.

This study, conducted on anemic, pre-school aged children in China, analyzed the impact of single-dose albendazole for deworming and vitamin A supplementation on anemia status and iron metabolism. Results of the trial indicated that vitamin A coupled with albendazole lead to improved anemia-related indicators, as children in this intervention group experienced less vitamin A deficiency and iron deficiency, compared to the groups that received either the deworming medicine alone or no intervention at all. These findings suggest that the efficacy of deworming and vitamin A interventions, for improving vitamin A and iron status, may increase when implemented simultaneously.

Based on findings from the Global Burden of Disease 2013 Study, researchers sought to determine the levels and trends in the leading causes of death and disability among younger children (5 years), older children (5-9 years), and adolescents (10-19 years). They discovered that iron deficiency anemia was the number one cause of years lived with disability for children and adolescents. To see reductions in the mortality and morbidity of these groups, leaders and policymakers must understand the levels and trends in the burden of diseases and injuries affecting children and adolescents, and utilize the available proven interventions.

In this study, researchers evaluated the impact of the 1999-2010 scale-up of malaria control interventions in Tanzania. The authors were specifically interested in determining the relationship between increased malaria control efforts and under-five mortality and anemia during this time period. Largely attributed to insecticide-treated nets and artemisinin-based combination therapy, the authors concluded that there were substantial reductions in under-five child mortality (45 percent decline between 1995 and 2005), and severe anemia prevalence (50 percent decline between 2005 and 2010), with high-risk children seeing the greatest improvements.

The Uganda Sickle Surveillance Study introduced a simple yet innovative approach to screening infants for sickle cell disease – the most prevalent genetic disorder in the world, and a cause of anemia. Researchers used residual dried blood spots, collected for the Early Infant Diagnosis program for HIV from ten regions and 112 districts throughout Uganda, to determine the prevalence of the sickle cell condition. This type of integrated screening program offers a promising opportunity for an improved and timelier diagnosis of sickle cell in other sub-Saharan African countries, where early infant screening programs are already in place.

This systematic review and meta-analysis assessed the relationship between anemia in pregnancy and adverse birth outcomes. The authors found a higher risk of low birthweight, preterm birth, perinatal mortality, and neonatal mortality for anemic pregnant women. They also found a higher pooled anemia prevalence in South Asian, African, and low-income countries, compared to upper-middle-income countries, and other Asian countries. The proportion of adverse outcomes due to anemia was higher in low-income countries and the South Asia region.

In this qualitative study, the authors found that health personnel have a great deal of influence on caregivers’ understanding and acceptance of micronutrient powders (MNPs). Home visits contributed greatly to improved use of MNPs, as they present an opportunity to clarify misunderstandings on preparation, demonstrate correct practices, and stress the importance of consistency. When culturally sensitive and context-specific, counselling appears to play a critical role in the acceptability and use of MNPs.

The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial centers around the premise that environmental enteric dysfunction (EED) is a main underlying cause of child stunting and anemia, largely attributable to chronic inflammation, and is primarily caused by the ingestion of fecal matter due to poor water, sanitation, and hygiene (WASH). The trial is investigating the effects of a WASH intervention and an infant and young child feeding (IYCF) intervention, measured by child length and hemoglobin status at 18 months of age, among other biomarkers. Two causal pathways will be analyzed: the program impact pathway and the biomedical pathway. This article discusses the rationale, design, and methods of the trial.

To prevent pre-eclampsia, a major cause of maternal deaths, the World Health Organization (WHO) recommendations encourage integrating calcium supplementation into antenatal care (ANC). To identify potential strengths and barriers of an integrated calcium and iron and folic acid (IFA) supplementation program, and to gain insights from local experiences with IFA interventions, researchers in Kenya interviewed health workers, and pregnant or post-partum women. Through this formative research, the authors learned that most women and health workers were unfamiliar with the symptoms and risks of pre-eclampsia and anemia, and that most women had little experience with IFA supplements. These findings informed a multi-level behavior change strategy to promote antenatal calcium and IFA supplementation.

HarvestPlus is a global leader in the development of more nutritious and micronutrient-rich varieties of staple food crops. This process, known as biofortification, has proven to be an effective and economical intervention to improve nutrition globally. This brief presents key evidence to suggest that plant breeding can enhance nutrition through increased nutrient levels without compromising crop yield; higher levels of nutrients in the crops can lead to improved micronutrient status; biofortified crops are well-received by both farmers and consumers; and biofortification is cost-effective.

The Maternal and Child Survival Program (MCSP) developed a USAID guidance brief on malaria and anemia control during pregnancy. This brief discusses evidence around the WHO-recommended 0.4mg dose of folic acid in IFA as opposed to the previously recommended 5mg. This lower dosage has shown to be effective without interfering with the effectiveness of sulfadoxine-pyrimethamine (SP) as an antimalarial. The brief also reminds us that “an integrated package of interventions is needed to prevent malaria, iron deficiency, and anemia in pregnancy.” This guidance is intended to help program managers and policymakers as they develop health programs and policies.

The World Health Organization (WHO) released global guidance documenting the recommended daily iron supplementation in menstruating adult women and adolescent girls as an intervention for preventing anemia and iron deficiency. The new guideline recommends a daily supplement of 30-60 mg of elemental iron for three consecutive months in a year, for all menstruating women and adolescent girls where the prevalence of anemia is 40 percent or higher. The guideline summarizes those recommendations and supporting evidence, as well as other considerations and research priorities. It is intended for a wide audience, including policymakers, technical staff at government institutions, and program implementers.

The World Health Organization (WHO) published global guidance on the recommended daily iron supplementation in infants and children as an intervention for preventing iron deficiency and anemia. It recommends daily iron supplementation for three consecutive months in a year in areas where anemia prevalence is 40 percent or higher, for children 6-23 months (10-12.5 mg), 24-59 months (30 mg), and children over 60 months (30-60mg). These regimens are to be carried out in conjunction with prevention, diagnosis, and treatment of malaria. This guideline summarizes those recommendations and supporting evidence, as well as other considerations and research priorities. It is intended for a wide audience, including policymakers, technical staff at government institutions, and program implementers.

The new eLENA app for iPhone and Android smartphones allows users to access much of the content of eLENA, the World Health Organization (WHO)’s e-Library of Evidence for Nutrition Actions, right from a mobile phone. Now, the latest WHO nutrition guidelines, recommendations, and related information for nutrition interventions, can be accessed from anywhere – no internet connection required. This increased ease of access will expand the reach of this tool beyond website users, to those without a regular or reliable internet connection.

There is emerging evidence to suggest that safe water, sanitation, and hygiene (WASH) practices play an imperative role in improving nutrition outcomes, including the treatment and prevention of anemia. The WHO, UNICEF, and USAID developed a document presenting current evidence on the positive impacts of WASH on nutritional status, as well as how an integrated approach can be used to enhance the benefits of WASH interventions. The document examines how context-specific integration into existing nutrition programs can lead to a more effective and sustainable impact, with monitoring and evaluation as a key component of program design.

Bollywood actress, Priyanka Chopra, is participating in a nationwide campaign to spread awareness around adolescent anemia. The Weekly Iron and Folic Acid (IFA) Supplement awareness campaign kicked off in New Delhi on December 23, 2015, with the actress in attendance, as well as Health Minister J.P. Nadda. As part of this initiative, free IFA tablets are being distributed to teenagers across the country and short informational videos have been released, in which Chopra encourages adolescents to be proactive about preventing anemia through weekly IFA supplements, an iron-rich diet, and deworming every six months.

In November 2015, the Scaling Up Nutrition (SUN) Movement Secretariat, in collaboration with the Emergency Nutrition Network (ENN), launched an online discussion forum called “en-net” as a platform for sharing knowledge, resources, and experiences in nutrition. This online space encourages informal discussions and sharing of technical support on nutrition issues, approaches, and successes for both global implementers and country-level stakeholders.

SPRING, UNICEF, and the World Food Program (WFP), in collaboration with the Ugandan Ministry of Health (MOH), launched a home fortification program as a strategy to combat micronutrient deficiencies, including anemia – a major public health concern in this country. Each pilot program partner is distributing micronutrient powders (MNPs) through different channels in eight districts of the country. Lessons from this pilot distribution will be used by the MOH to design its national program, which is anticipated to improve infant and young child feeding practices more broadly in Uganda.

As part of the home fortification series, HF-TAG, in collaboration with UNICEF and the Centers for Disease Control and Prevention (CDC), hosted their sixth webinar, titled “Learnings from Madagascar: Using Market-Based Approaches to Increase the Reach of Micronutrient Powders.” Ietje Reerink presented on the Madagascar MNP project, discussing how and why a market-based approach was used, how social marketing approaches were applied, and lessons learned around scale-up. A recording of the webinar, as well as the Powerpoint presentation are available for viewing.

The WHO currently recommends ferritin as the best biomarker for measuring the iron status of populations; however, the recommendation is currently being reviewed and updated. Thus, the “WHO guideline development group – ferritin” was established. This guideline development group will convene from June 15-17, 2016, in Geneva, Switzerland. The main objectives of this meeting include finalizing guidance on the use of ferritin concentrations to assess iron status in populations, discussing both strengths and challenges of the recommendations, and determining implications for further research.

Professionals, organizations, and stakeholders will come together for the Micronutrient Forum Global Conference on October 24-28, 2016, in Cancun, Mexico. The focus for this year’s forum will be women’s nutrition, within the broader context of micronutrients, as women are both a major target audience of nutrition interventions and key players in program delivery. This conference aims to bridge state-of-the-art research and program design and delivery across different sectors to improve the health and well-being of women and girls.

In April, the World Health Organization and the Food and Agriculture Organization of the United Nations will convene a technical consultation on Staple crops biofortified with vitamins and minerals: considerations for a public health strategy. Discussions will revolve around biofortified crops, with topics ranging from nutrient bioavailability and acceptability of the foods, to equitable marketing approaches and country-level lessons learned.