Anemia Resource Review

CORE Group’s Global Health Practitioner Conference brought together health advocates to collaborate, discuss ideas, and build partnerships to improve life-saving programs. This fall’s themes included adolescent health and nutrition. At the conference, SPRING introduced two new anemia-related tools: Understanding Anemia: Guidance for Conducting a Landscape Analysis, a resource to support policy makers and program implementers in gathering, understanding, and using anemia-related data, and the District Assessment Tool for Anemia (DATA), an Excel-based tool to raise awareness around anemia and help prioritize anemia-related actions at the district level.

The Micronutrient Forum Global Conference took place in Cancun on October 24 – 28, 2016. The theme of the event was prioritizing women’s nutrition in order to achieve the Sustainable Development Goals. The conference covered a broad range of topics related to micronutrients, including but not limited to transforming the enabling environment, innovative tools for collecting data, and program delivery. For more information posted by conference participants, check out the conference facebook page and twitter account.

The World Health Organization (WHO) released global, evidence-based guidelines on routine antenatal care (ANC) for pregnant women and adolescent girls receiving ANC in a healthcare or community facility and their unborn and newborn children. The guidance combines or supersedes a number of former guidelines into one comprehensive guideline for care during pregnancy. Some of the anemia-related recommendations include daily supplementation of 30-60 mg of elemental iron and 0.4 mg folic acid during pregnancy to prevent maternal anemia, as well as full blood count testing for diagnosing anemia in pregnant women. The new guideline is intended for a wide audience, including policymakers, health professionals, and program implementers.

Holly McKee, of Bioanalyt, tells of her experience supporting data collection to evaluate Helen Keller International’s Enhanced Homestead Food Production (EHFP) program in Indonesia. The EHFP Indonesia program addresses micronutrient deficiencies among children by educating families on nutrition, diet, and farming practices. During the program, over 4,000 households began growing their own gardens and teaching others in their community to do the same. To measure impact, researchers collected blood samples and data on participants’ nutritional status, but study participation was low. As an incentive, cards were provided to participants that detailed the results of the nutritional assessment, increasing participation to almost 100%, and allowing implementers to provide timely feedback to families.

The government of Uganda has rolled-out five high iron bean varieties in an attempt to address national iron deficiency anemia especially among women, children, and infants. In Uganda, beans are a main source of protein, making them ideal for biofortification. In the next season, HarvestPlus with support from USAID, Feed the Future, and other partners, plans to multiply the high iron bean varieties and disseminate the beans through government institutions, NGOs, and seed companies.

The Micronutrient Initiative (MI), in collaboration with the Government of Canada, launched the Right Start program in Senegal, with the goal of reducing anemia in women and adolescent girls—a group that is often overlooked in the dialogue on nutrition. The two major components of this program include weekly iron and folic acid supplements for adolescent girls at school and improved wheat flour fortification for both women and girls. With the Right Start program, the Government of Senegal has demonstrated its regard for a multisectoral approach to anemia programming, engaging various sectors that range from education to the private sector. The write-up includes a clear infographic promoting the program.

HarvestPlus and partners continue to promote biofortification as a sustainable and effective method for improving the nutrition of vulnerable populations through enhanced staple crops. Its updated 2016 map depicts 50+ countries that are using biofortified crops, and the map specifically indicates which crops are being tested and which ones have been released nationally. These biofortified crops offer improved levels of iron, zinc, or vitamin A, all of which can help address anemia. More and more countries are joining the movement; recent countries include Afghanistan, Eritrea, Chad, Gabon, Gambia, Morocco, Lebanon, South Sudan, and Tunisia. The goal is for these crops to reach a billion people by year 2030.

In Zimbabwe, the government has set national standards for food fortification to address micronutrient deficiencies, especially among children and pregnant women. Fortification efforts will target several commercial staples, including cooking oil, wheat flour, maize meal, and sugar. At the same time, the promotion of production and consumption of biofortified crops and dietary diversity will be combined with nutrition education and public health interventions for actions such as infection control to emphasize a comprehensive approach to addressing Zimbabwe’s widespread malnutrition.

This evaluation, conducted by the Comprehensive Initiative on Technology Evaluation (CITE) at the Massachusetts Institute of Technology (MIT), studied malaria rapid diagnostic tests from the perspective of suppliers in Uganda. These tests can serve as an easy-to-use, low-cost option for diagnosing malaria, but they are often underused in Uganda, and elsewhere. The evaluators found that retailers’ willingness to stock the tests was diminished by the time it takes to sell tests, and to train for administering them. The researchers recommend posing the tests as a service, rather than a product, and call for the design of incentive-based business models which share the risks presented by the tests’ short shelf lives across the supply chain.

This document provides the most recent WHO guidelines for use of iron supplementation in postpartum women. The guidelines review evidence on safety and effectiveness to support policy-makers, economists, and technical and program staff in making informed decisions on appropriate nutrition actions in-line with the Sustainable Development Goals. The evidence suggests that in settings where gestational anemia is 20% or higher, oral iron supplementation can be given to postpartum women for 6-12 weeks following delivery, to reduce the risk of anemia. The guidelines specify that high doses of folate should be avoided in malaria endemic areas using sulfadoxine-pyrimethamine, to not interfere with the efficacy of this antimalarial drug.

The Home Fortification Technical Advisory Group (HF-TAG) has released a revision to their Toolkit, which guides program planning for Micronutrient Powders (MNP). The toolkit complements their MNP Implementation Manual and walks users through the planning, policy development, program management, procurement, supply and distribution, behavior change interventions and monitoring of MNP programs with checklists, guidance, and resources. This compilation of resources is best suited for contexts in which it has already been decided to implement an MNP program.

This study examined the impact of a food-assisted program on hemoglobin and anemia in children and their mothers in eastern Burundi, and explored impact pathways. The program included food rations, strengthening and promotion of use of health services, and behavior change communication. Although hemoglobin levels declined over the course of the program, they deteriorated more quickly in the control group, and the program improved hemoglobin status in children and mothers who had delivered in the previous three months. The project also had positive intermediate impacts on anemia determinants: greater consumption of iron-rich foods, dietary diversity, bed-net use, and morbidity. The study highlights the importance of a multifactorial approach to combat anemia.

This study analyzes data from Demographic and Health Surveys conducted between 2003 and 2014 in sub-Saharan Africa (SSA) to examine associations between prenatal iron supplementation and/or deworming and anemia in children 6-23 months. Researchers found that risk of moderate or severe anemia among the children was reduced when mothers took iron for at least six months, deworming medicine alone, or deworming medicine with iron. Prenatal anemia control interventions, however, were not associated with reduced risk of mild anemia in young children in SSA. Authors concluded that prenatal iron supplements should be taken for at least 6 months or with deworming drugs to reduce the risk of moderate/severe anemia in children.

This study assessed the role of sanitation on nutrition outcomes and anemia status in pregnant Cambodian women. The authors found that women who used an ‘improved’ sanitation facility had higher Body Mass Index (BMI), as well as higher hemoglobin concentration, compared to women who used ‘non-improved’ facilities. Likewise, poor sanitation was linked to higher rates of anemia, even after adjusting for parity, week of gestation, demographic variables, source of drinking water, and iron folic acid supplementation. This observed correlation highlights the value of sanitation in addressing anemia.

This study investigated whether text message reminders improved the efficacy of micronutrient powder in western China. Children 6 to 12 months were assigned to receive MNP and text message reminders, receive MNP and no text messages, or no intervention. Findings showed a small increase in compliance in the text message group relative to the no message group. The text message group had a decrease in anemia prevalence compared to the control group but there was no difference between the no message and control group. In was concluded that text message reminders enhanced caregiver compliance to the home fortification program, consequently improving children’s nutrition.

In this study, researchers sought to determine if a malaria care improvement intervention had an impact on health outcomes for young children in Tororo, Uganda. The intervention group of community health centers received training in areas such as fever case management using malaria rapid diagnostic tests (mRDTs), patient-centered practices, health center administration, and assurance of adequate supplies. Findings indicated that there were no notable differences in anemia prevalence (or parasitemia) in children that received the intervention, countering common assumptions that improving the quality of care results in improved health outcomes.

This study investigates the impact of anthelminthic treatment on the prevalence and intensity of intestinal helminth infection, hemoglobin levels, and prevalence of anemia among school-age children in Ethiopia. Children in the study area who tested positive for helminth infection were given one of three treatments: albendazole for soil-transmitted helminths, praziquantel for H. nana, T. saginata or S. mansoni infection, and both treatments for those infected with two or more species. Findings showed that infections with helminths are associated with increased risk for anemia, and that anthelminthic treatment significantly reduced the prevalence of helminth infections and increased hemoglobin levels one month after treatment.

This paper describes an effective method for diagnosing iron deficiency anemia in low-resource settings using aqueous multiphase systems (AMPS). AMPS is low-cost and rapid, and is more accurate than diagnosis by hemoglobin alone. The method requires a preloaded microhematocrit tube, a drop of blood from a fingerstick, and a low-cost centrifuge. The study showed improved diagnosis of iron deficiency anemia sensitivity and specificity, as well as the ability to predict several important red blood cell parameters. 

In this study, researchers assessed absorption of therapeutic iron among children in Uganda that were given antimalarial treatment. Children aged 6-59 months with both malaria and anemia were randomly assigned to (1) iron therapy along with anti-malaria treatment, or (2) iron therapy 28 days after malaria treatment. Results showed that for children with malaria and anemia, delaying iron therapy improved iron absorption but resulted in comparable hematologic recovery by 56 days. The authors conclude that the results do not demonstrate a clear, short-term benefit of delaying iron.

In this study, the authors tested the effectiveness of iron-biofortified beans to improve the iron status of women in Rwanda. The authors found an increase in hemoglobin and body iron during the 128 day trial. At the beginning of this study, the vast majority (86%) of the population was iron-deficient and over a third of the population was anemic. The findings indicate that iron-biofortified beans can serve as an effective strategy for improving the iron status of women in Rwanda.

This systematic literature search explored whether children aged 6 to 23 months can fulfill their nutrient needs by consuming locally sourced foods. The results suggested that complementary feeding diets composed of local foods generally yielded adequate sources of protein, while calcium, iron, and zinc requirements were not met for this age group. Optimizing diets using modeling techniques (“modeled intake”) can help children meet most of their nutrient requirements; however, there is still a need for cost-effective interventions, especially to achieve adequate iron and zinc levels.