Anemia Resource Review

On January 30, 2016, Peru’s Ministry of Health came together with the Ministry of Education for an event on anemia prevention. The event targeted mothers who coordinate communal kitchens in Lima and was comprised of training workshops. The main purpose of the training was to highlight the importance of dietary diversity, handwashing, and micronutrient supplements in anemia prevention. The training was part of a series of workshops developed by the Ministry of Health under the 2014–2016 National Plan to Reduce Chronic Child Malnutrition and Prevent Anaemia.

In September 2015, GAIN and the Government of Tanzania co-hosted the first ever Global Summit on Food Fortification in Arusha, Tanzania. This supplement summarizes the proceedings of the Summit and provides recommendations for food fortification programs. The Arusha Statement on Food Fortification, a global consensus document on fortification, is also included. The supplement is meant to assist donors, policymakers, and program implementers in improving coordination among the nutrition and food sectors. 

In the fight against Neglected Tropical Diseases (NTDs), the focus has historically been on low-income countries. However, researchers are finding that the poor in middle-income countries are increasingly shouldering the burden. Advocacy and technical capacity are critical for confronting the unique barriers in middle-income countries, which make it difficult to provide resources to the most disadvantaged populations. Such interventions and actions against NTDs would have an impact on anemia efforts, as soil transmitted helminths are a leading cause of anemia globally.

Malaria is a major contributor to the global burden of anemia and must be addressed to maximize anemia reduction efforts. The President’s Malaria Initiative (PMI) has released updated, comprehensive technical guidance for a wide range of topics related to malaria prevention and control. This document serves as a resource for PMI country teams, national malaria control programs, and other implementing partners of PMI-funded malaria activities. It is updated annually to reflect the latest global policies and practices for malaria control. 

Teenage pregnancy poses a double burden for young women, putting both mother and child at risk of negative nutritional outcomes. The Philippines’ 8^th National Nutrition Survey (NNS) indicated a higher rate of anemia in pregnant adolescents than adult pregnant women. Per WHO guidelines, women are urged to take iron and folic acid supplements to prevent anemia, iron deficiency, and birth defects. However, the NNS found that a lower proportion of teenaged pregnant women (79 percent) were taking supplements compared to adult pregnant women (85 percent). 

In this video, Binu Cherian and Parminder Virk of HarvestPlus discuss why biofortification can be an effective measure to help address micronutrient deficiencies, especially as a complementary approach to other interventions. They highlight three advantages of biofortification: sustainability, cost effectiveness, and ability to reach consumers in rural areas. They also note several biofortified crops that Indian consumers can expect in the near future.

GAIN and the Business for Social Responsibility Change Associates are testing scalable solutions to reduce malnutrition among garment factory workers in Bangladesh. They believe that providing healthy, diverse foods in the workplace will improve nutrition and reduce anemia prevalence, thus increasing energy levels and productivity. Using a toolkit for factory managers, several factories have implemented the pilot, which will be scaled up to additional factories. With more focus on prioritizing nutrition in the workplace, strides can be made in women’s health and wellbeing, and for the progress of the entire garment sector.

The World Health Organization (WHO) published global guidance on micronutrient powders (MNP) for point-of-use fortification of foods consumed by pregnant women. The guideline recommends that MNP should not be used in place of standard iron and folic acid supplementation during pregnancy. This guideline summarizes the WHO’s recommendation and supporting evidence, as well as other considerations and program implications. 

The 2016 Global Nutrition Report sheds light on recent successes and shortcomings in reaching global nutrition targets and provides recommendations for further action to accelerate progress. The theme of the report is making and measuring specific, measurable, achievable, relevant, time-bound (SMART) commitments to nutrition and identifying the necessary steps for ending malnutrition by 2030. The report states that nearly all countries are off track for achieving anemia targets. Given data from 2011, at current rates, we will reduce anemia in women of reproductive age by 50 percent by 2130 rather than by 2025 (the WHO’s target).

A working paper in the GAIN Infant and Young Child Nutrition (IYCN) series, entitled "Strengthening the enabling environment for scaling up access to good quality complementary foods," discusses lessons learned about infant nutrition guidelines and product standards. To strengthen the enabling environment, GAIN has focused on building consensus on IYCF practices based on evidence and research. To sustain these efforts, we must develop a shared understanding of the nutritional needs of young children and use this understanding to inform our policies and programs. 

Researchers examined how anthropometry, iron biomarkers, and serum selenium are linked to cognitive performance in preschool-aged children in rural Ethiopia. Two cognitive tests revealed that children who were stunted, anemic, or selenium deficient did not perform as well as their peers. The relationship between cognitive deficits, micronutrient deficiency, and chronic undernutrition suggest a need for more effective intervention programs.

This paper reviewed income, anemia status in women, and livestock ownership in Afghanistan. Higher economic status, certain ethnicities, and a central geography were all associated with a reduced risk of anemia, but sheep ownership was particularly protective against anemia, even after controlling for income. The research suggests this link is likely due to sheep ownership resulting in increased consumption of mutton, which contains substantial levels of iron. Similar relationships did not seem to exist for other livestock assets, but the primary role of these other livestock assets was not providing meat, but rather milk and eggs.

This study examined the impact of nutrition and hygiene interventions on stunting in full-term low-birthweight infants. Researchers found that hand sanitizer, combined with nutrition, health, and hygiene education, did not reduce infection in infancy or the chance of stunting at 12 months postpartum. However, micronutrient powders, with or without hand sanitizer, lead to significantly lower rates of stunting in low-birthweight infants at 12 months, compared to controls.

Certain tropical infections are present throughout much of Africa and Asia and can lead to blood-related disorders, such as anemia. Each of these disorders has unique and complex health implications; for example, decreased production of red blood cells may occur as a defensive reaction to infection. In this publication, the characteristics of a number of infections are discussed, including malaria, hookworm, and HIV. Malaria is considered the most important parasitic infection because of its prevalence and high likelihood of resulting in anemia. 

This report summarizes the global state of anemia from 1990 to 2013 for 23 different etiologies in 188 countries, 20 age groups, and in both males and females. The authors looked at mean hemoglobin levels, anemia incidence by severity, disability due to anemia, and underlying causes of anemia. The authors concluded that the worldwide burden of anemia is high, with developing countries assuming the majority of anemia-induced disability, and that iron-deficiency remains the leading cause of anemia.

This study found that anti-malarial IPTp-SP and iron folic acid supplementation compliance among pregnant women remains low in the Simiyu Region of Tanzania. In interviews with women who were pregnant or 12 months postpartum, researchers learned that 89 percent of women who received IPTp-SP took only one or two doses and 29 percent of women who received iron folic acid supplements did not take any at all. Reasons for non-compliance included disliking the medications and disapproval from male partners. The authors call for stronger community education efforts, qualitative research, and directly-observed medication administration. 

This study assessed the diets and iron status of pre-school aged children in rural Ethiopia. The authors found that dietary diversity was quite low and that the children consumed primarily plant-based foods and few animal-source products. Surprisingly, the study found that while stunting was high, the prevalence of iron deficiency anemia was low. 

Although the rate of sickle cell anemia (SCA) at birth is high in Tanzania, there is little information on either the severity of its associated complications or options for treatment, particularly in regions where the condition is most common. In this study, the authors surveyed the spectrum of clinical afflictions associated with SCA in children at a regional medical center, as well as the interventions provided to them. They discovered that children are diagnosed late, frequently suffer severe complications, and rarely receive appropriate interventions. The findings highlight the need to improve care by expanding access to screening and enhancing coordination. 

This study examined the effects of screening for anemia during well baby clinic visits and providing iron supplementation to anemic children in low-resource settings in the Dominican Republic. After reviewing health records, the authors found no relationship between children receiving iron during a previous wellness visit and improvements in anemia. They advocate further studies on quality of services and outcomes in health service settings.

The World Health Organization’s (WHO) Haemoglobin Colour Scale serves as an affordable, quantitative tool for diagnosing anemia as an alternative to clinical methods. This systematic review of the Haemoglobin Colour Scale suggests that it is more sensitive and specific for diagnosing both anemia and severe anemia than clinical diagnosis. The authors note that combining the two methods could result in an even higher sensitivity, although at a reduced rate of specificity, and suggest future research on training, clinical outcomes, and cost.