Anemia Resource Review

An enhanced homestead food production (EHFP) program for mothers and children in Nepal resulted in lower rates of anemia at follow-up, compared to those who did not receive the interventions. The components of the EHFP program were home gardening, poultry-raising, and nutrition education over a span of 2.5 years. Multi-sectoral interventions, including both agriculture and nutrition, appear to have potential for addressing anemia.

Researchers assessed malaria infection and its health consequences among schoolchildren in Rwanda. While the vast majority of children were asymptomatic at examination, almost a quarter were diagnosed with malaria infection and 41% of these cases were submicroscopic. Malaria infections were associated with negative health outcomes, including but not limited to anemia, fever, underweight, and clinical malnutrition. These results indicate there is a need for improved malaria surveillance and interventions for this population.

This study, conducted in The Gambia, explored the protective nature of iron deficiency anemia against malaria. Findings showed that anemia, more so than sickle-cell trait, hindered the growth of P. falciparum in vitro. After 49 days of iron supplementation through micronutrient powders, malaria parasite growth more than doubled compared to baseline. These results have programmatic implications: iron supplementation should be accompanied by strong malaria control measures.

The effects of delayed umbilical cord clamping, compared to early clamping, on iron stores and anemia status in high-risk infants were studied in a randomized control trial in Nepal. The authors found that delayed cord clamping resulted in higher levels of hemoglobin, lower anemia prevalence, and lower risk for iron deficiency at both 8 and 12 months of age, compared to the early clamping group. It is concluded that delayed cord clamping is an effective preventive intervention against anemia, potentially supporting infants for 12 months after delivery.

Researchers sought to determine the most effective regimen of intermittent preventive treatment (IPT) against malaria for schoolchildren in the Democratic Republic of Congo. The children were given sulfadoxine/pyrimethamine (SP), SP plus piperaquine (SP/PQ), or no intervention. The SP group saw a reduction in anemia (10%), malaria parasitemia (19%), and clinical malaria (25%), while the SP/PQ group experienced an even greater reduction of 28%, 40%, and 58%, respectively. Findings suggested that SP, and even more so SP/PQ, may be a promising option for IPT in schoolchildren.

The Let’s be Well Red study was conducted to determine the effect of iron-supplement bars (containing 14 mg Fe) on anemia status in urban Indian women of reproductive age. The intervention group was given one daily iron-supplement bar and the control group received none, while both groups received anemia education. After 90 days, researchers found that hemoglobin increased and anemia was reduced among participants who received the iron-supplement bar.

Researchers investigated the efficacy of Vita Mamba, a fortified peanut butter snack, in reducing anemia in school-aged children in rural Haiti. The findings indicated that children were more likely to experience an increase in hemoglobin levels and a decrease in anemia when they consumed Vita Mamba. This study provides support for the integration of fortified foods with deworming in school feeding programs as an effective anemia intervention in rural settings in Haiti.

This study evaluated three arms of combined preventive malaria and deworming treatment and their effect on anemia and learning outcomes for schoolchildren in Northern Ghana. In Arm 1, children received preventive medication for malaria and helminths; Arm 2 was given malaria, helminth, and schistosomiasis medication; and Arm 3 received only helminth and schistosomiasis medication. It was found that the combination of intermittent preventive treatment for malaria and parasitic worms resulted in a reduction of anemia incidence and enhanced attention and recall for schoolchildren.

This study examined how preconception weekly iron-folic acid (IFA) and multiple micronutrient (MM) supplements, compare to folic acid (FA) alone during and shortly after pregnancy in Vietnamese women. Pre-pregnancy IFA or MM led to greater iron stores for both mother and child than did FA alone, but did not have any effect on anemia. More research is needed to examine the causes of anemia and interventions for improving anemia status during pregnancy and postpartum.

Current efforts for controlling soil-transmitted helminths, a risk factor for anemia, have focused on deworming school-aged children, as they tend to be the most vulnerable. However, there may be a more effective approach – expanding deworming programs beyond schools and into the whole community. Anthelmintic treatment expanded to all community members, may result in fewer worms being released into the environment, and therefore a reduced risk of exposure, infection, and reinfection. Deworming programs are urged to reexamine their approach to maximize protection.

GAIN shares recent findings on the coverage of fortified foods in Côte d’Ivoire, Ghana, and India. In Côte d’Ivoire, Nutribon, a complementary fortified food product for low income children, had high recognition, but low rates of use and coverage. In Ghana, behavior change communication was effective in supporting delivery of supplementary food. In Rajasthan, India, coverage of fortified atta wheat flour, oil, and salt increased among micronutrient deficient populations, but in Telengana, India, large-scale market-based rice fortification would not be effective, as many households produce their own rice.

The UN Network for the SUN/REACH Secretariat has created the Compendium of Actions on Nutrition (CAN). This collection of possible nutrition actions aims to support countries in prioritizing impact-oriented nutrition. The CAN examines a number of actions that can help combat anemia, including family planning, delayed cord clamping, deworming, malaria control, consumption of animal sourced foods, fortification of complementary foods, micronutrient powders, mass fortification, and iron-folic acid supplementation, among others.

A new trial has been designed to examine how the timing of micronutrient powder (MNP) interventions can impact iron absorption and consequently iron and anemia status in infants. The studies will focus on the differences between morning and afternoon absorption, as well as consecutive versus alternate-day absorption. Researchers hope that the study outcomes will help implementers effectively time the delivery of MNP.

The World Health Organization released global guidance on the fortification of maize flour and corn meal with vitamins and minerals as a feasible and cost-effective intervention for combating micronutrient deficiencies that may result from inadequate diets. Though evidence is limited, the guideline recommends the fortification of maize flour and corn meal with iron to prevent iron deficiency, especially in women and children. Fortification with folic acid in these same foods is also recommended in order to prevent neural tube defects at birth.

This Sight and Life magazine article discusses the multiple causes of anemia and the risks associated with iron supplementation in populations where anemia is prevalent, but iron deficiency is not. Other possible causes include infections/inflammation, other micronutrient deficiencies, and genetic factors. Given the potential risks of iron supplementation in iron-replete populations, country context must be taken into consideration when determining or re-evaluating national anemia-reduction policies and programs.

This video details the history, biology, and characteristics of sickle cell anemia, a lack of healthy red blood cells caused by genetic mutations. A molecular biologist, Anthony Allison, studied 5,000 people throughout East Africa and discovered that there was a direct relationship between sickle cell anemia, living in an area with high prevalence of malaria, and vulnerability to malaria.

HarvestPlus commissioned a systematic review on the proportion of anemia associated with iron deficiency. They found that, contrary to previous belief that iron deficiency accounts for 50% of anemia, the proportion attributed to iron deficiency is actually 25% and 37% in young children and women of reproductive age, respectively. In response, nutrition experts weighed in on the conclusions from this review, implications for national anemia reduction programs, and recommended next steps.

The Sackler Institute for Nutrition Science has released a request for proposal for a research activity on the effective delivery of nutrition interventions for adolescent girls and young women, with an emphasis on low and middle income countries. Proposals should focus on two areas of research: 1) how the occupational and economic status of adolescent women influences their nutrition and how this relationship can inform more impactful interventions; and 2) how the timing of interventions at various points in the reproductive cycle affects health outcomes. The deadline for proposals is April 15, 2017.

In Thailand, many of the local source foods do not meet the nutritional needs of children, which can lead to deficiencies in micronutrients such as iron – a major cause of anemia. Thai Scientists, in collaboration with the International Atomic Energy Agency, have found a way to analyze micronutrient intake, absorption, and usage in children, using isotopic techniques. The results are being used to inform nutrition guidelines and programs, such as the implementation of food fortification with essential vitamins and minerals, to prevent micronutrient deficiencies and consequential diseases like anemia.

The World Health Organization released global guidance on micronutrient powders (MNP) for children aged 6-23 months and 2-12 years. The guideline recommends MNP with complementary foods for infants and young children at 6-23 months of age, and MNP with foods for children at 2-12 years of age, to reduce anemia and iron deficiency in areas where anemia prevalence is high. The recommended interventions and supporting evidence are summarized in this guideline to inform policymakers, health professionals, and program implementers.

The 2016 World Malaria Report highlights several positive trends over the last five years, including better testing of children reporting fevers, expanding access to disease-treating tools, a five-fold increase in 3 dose IPTp delivery, and an increase of over 75% in the number of people sleeping under insecticide-treated bed nets. At the same time, millions still lack needed resources, and progress is inhibited by inadequate funding. The report also mentions the WHO’s recommendation for IPTp during pregnancy as a method for preventing maternal anemia and mortality.

The 10th World Congress on Nutrition and Food Sciences will take place in Osaka, Japan, on May 29 – 31, 2017. This conference will provide a platform for stakeholders to discuss innovations in Nutrition, Food Sciences, and Public Health. Participants will have the opportunity to explore the latest advancements, challenges, and new directions in various subject areas, many of which are relevant to anemia prevention and control. Such topics include food security, micronutrient deficiency, food fortification, nutrient bioavailability, nutritional supplementation, maternal and child nutrition, and nutrition in developing countries, among others.

CORE Group will host the Spring 2017 Global Health Practitioner Conference, Integrated Approaches: The Social and Behavior Change (SBC) Key to Community Health, on April 20 – 21, 2017 in Washington, D.C. Community health advocates will come together to discuss the key role of integration in health and nutrition programs. At the conference, working groups will collaborate on a range of topics, including nutrition and reproductive, maternal, newborn, and adolescent health, among others.

From April 22 – 26, 2017, the Experimental Biology 2017 Conference will take place in Chicago, Illinois. Organized by six host societies, including the American Society for Nutrition (ASN), the conference will be centered on the themes of professional development, education and public engagement across disciplines. The ASN program will feature scientific sessions and exhibits, oral and poster presentations, and notable lectures on several topics, ranging from global and community nutrition to nutritional epidemiology and education.

The Food and Agriculture Organization and the World Health Organization organized an International Symposium where stakeholders could share country experiences, challenges, and solutions around implementing sustainable food systems to improve nutrition. Ensuring access to healthy and diverse diets is one step to tackling micronutrient deficiencies. The symposium’s three sub-themes focused on the supply side, the demand side, and actions for reinforcing accountability, resilience, and equity within the food system.

The Sokoto and Keppi States’ Ministry of Health hosted a workshop to promote Iron Folic Acid (IFA) Supplementation as a protective measure against anemia for pregnant women and women of reproductive age. At this workshop, participants called for nutrition education for expectant mothers and fathers, as well as behavior change around acceptance of medical assistance. Adolescent girls are also urged to take IFA with future pregnancies in mind.

The Accelerated Reduction Effort on Anaemia (AREA) Community of Practice (COP), facilitated by the United Nations System Standing Committee on Nutrition (UNSCN) and moderated by the U.S. Agency for International Development's (USAID’s) SPRING project, was launched in June 2015. The AREA COP provides a unique opportunity to connect with other professionals and stay abreast of the latest developments in anemia-related research, policy, and implementation. Since the AREA COP’s creation in May 2015, it has grown to more than 750 members from over 65 countries. The COP webinar series presents cutting-edge and timely topics to members based on their feedback and the latest happenings in the field.

On April 18, 2017, the COP hosted its sixth webinar, Reviewing Hemoglobin Thresholds for the Determination of Anaemia. Dr. Sant-Rayn Pasricha presented the ongoing work conducted alongside the World Health Organization that will inform new guidelines for how haemoglobin thresholds should be used and interpreted to detect and diagnose anaemia. The slides and recording are available online.

In addition to hosting webinars, the COP disseminates anaemia-related vacancy and conference announcements, recent publications, and reports, many of which are then discussed among members. On average the COP circulates 6 discussion topics per month, which aim to keep members abreast of the science and programming behind multi-sectoral anaemia control. In the last six months, the following were some of the topics which were shared among the group:

• Members who are part of the USAID Anemia Task Force provided information on the discussions and resources shared during the last meetings
• The annual AREA CoP Community Effectiveness Survey was circulated among members in order to seek feedback on how to best serve the needs of the community. Almost 80 members provided feedback which was then reported back to the community.
• The World Health Organization extended an invitation to AREA CoP members to participate in an online consultation to define the scope and outline of a WHO Policy Brief on weekly iron and folic acid supplementation (WIFS).
• An informative debate was held among members on the effectiveness and relevance of current vitamin A supplementation programs, which ultimately play a role in anemia control.
• A brief on the programmatic implications of the BRINDA project was shared with members. The brief aimed to bridge the gap between science and programming.

If you are not already a member, please join us by clicking the link below. You can also reach out on twitter: @AREAnaemia