Anemia Resource Review

The Anemia Resource Review is a selection of materials that will help you keep on top of research and developments related to strengthening multisectoral approaches to preventing and controlling anemia. To see materials from earlier editions, or to view resources from across SPRING's technical areas, visit the Resource Review.

Research Articles
Recent findings from academic and peer-reviewed journals

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Goheen, M., et. al., EBioMedicine (December 2016).

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.

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Sifft, K., et. al., Malaria Journal (November 2016).

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.

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Osei, A., et. al., Food and Nutrition Bulletin (November 2016).

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.

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Ashish, K., Rana, N., Malqvist, M., et. al., JAMA Pediatrics (March 2017).

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.

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Matangila, J., et. al., International Journal of Antimicrobial Agents (January 2017).

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.

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Mehta, R., et. al., American Journal of Clinical Nutrition (January 2017).

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.

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Iannotti, L., et. al., PLoS One (December 2016).

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.

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Opoku, E., et. al., Global Health Action (September 2016).

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.

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Nguyen, P., PLoS One (December 2016).

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.

Reports, Tools, and Other Related Materials
A diverse collection of programmatic materials and news

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The Conversation, December 2016.

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.

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GAIN, November 2016.

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.

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UN Network for SUN/REACH Secretariat, November 2016.

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.

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BioPortfolio, December 2016.

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.

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World Health Organization, October 2016.

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.

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Sight and Life, January 2017.

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.

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Medical Videos, November 2016.

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.

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HarvestPlus, January 2017.

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.

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New York Academy of Sciences, March 2017.

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.

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International Atomic Energy Agency, January 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.

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World Health Organization, October 2016.

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.

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WHO, 2016.

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.

Events
Links to presentations, proceedings, and other meeting materials

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May 29 – 31, 2017

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.

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April 20 – 21, 2017

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.

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April 22 – 26, 2017

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.

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December 1 – 2, 2016

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.

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December 13, 2016

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.

Online Community Corner
Discussions and resources from communities of practice and professional networks

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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

Websites to Watch
Places to keep checking for the information you need

Feed the Future
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Feed the Future works across sectors and levels to improve incomes and nutrition, with a stated goal of reducing by 20% each the prevalence of poverty and the prevalence of stunted children in the areas in which they work.

FAQR homepage
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FAQR, a USAID-funded project hosted at Tufts University, provides actionable recommendations on ways to improve nutrition among vulnerable people for whom the direct distribution of food aid can make a significant impact.

FANTA
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Working at country and global levels, FANTA provides comprehensive technical support to USAID and its partners. FANTA supports the design and implementation of programs in focus countries and strengthens the evidence base, methods, and global standards for food security and nutrition programming.

FFI homepage
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FFI is a multi-sector partnership helping countries plan, implement, and monitor grain fortification programs. FFI aims to use industrial food fortification to prevent neural tube defects and anemia caused by nutritional deficiencies.

GAIN
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GAIN is an alliance driven by the vision of a world without malnutrition and a mission to reduce malnutrition through sustainable strategies aimed at improving the health and nutrition of populations at risk.

Global Atlas of Helminth Infections homepage
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The Global Atlas of Helminth Infections (GAHI) shows the geographical distribution of neglected tropical diseases transmitted by worms: soil-transmitted helminthiasis, schistosomiasis, and lymphatic filariasis. All GAHI resources are available on an open access basis.

Helen Keller International (HKI)
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HKI is a partner on SPRING and has a long history of working in anemia control as part of their larger portfolio in reduction of malnutrition.

The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program
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Established by CDC in 2000, the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) program works with global partners to contribute CDC skills and resources to eliminate micronutrient deficiencies (especially iron, vitamin A, iodine, folate, and zinc deficiencies) among vulnerable populations throughout the world.

MCSP front page
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MCSP advocates for greater attention to major and neglected barriers to optimal maternal and young child nutrition. Through different sectors and influential community members, MCSP works to identify new channels to increase the reach and scale-up of nutrition interventions within countries.

K4Health Toolkit page
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The Knowledge for Health (K4Health) Project aims to improve family planning and reproductive health services in low- and middle-income countries by working to change the way family planning knowledge is accessed, shared, and used. This toolkit recommends an integrated package of services to control the three major causes of anemia and provides background information related to these causes and guidance about implementing programs to address them. The toolkit also discusses maternal and child health programs that contribute to anemia.

Micronutrient Initiative
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The Micronutrient Initiative is the leading organization working exclusively to eliminate vitamin and mineral deficiencies in the world´s most vulnerable populations.

President's Malaria Initiative (PMI)
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PMI is a key component of the U.S. Government's Global Health Initiative and strives to reduce the intolerable burden of malaria and help relieve poverty on the African continent.

REFINE homepage
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REFINE is a knowledge-sharing mechanism that aims to improve food aid interventions. This repository houses ongoing and published studies on food aid products, programs, and processes.

Scaling Up Nutrition
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Scaling Up Nutrition (SUN) is a movement bringing together governments, civil society, the United Nations, donors, businesses, and researchers around the principle that all people have a right to food and good nutrition. The SUN approach is strongly multisectoral and features country-level resources on nutrition-specific and -sensitive programs.

The Home Fortification Technical Advisory Group (HF-TAG)
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HF-TAG is a multisectoral community of stakeholders involved in home fortification with a vision of a world without malnourished children.

The Manoff Group (TMG)
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TMG is a partner on SPRING and has developed (in consultation with a Steering Committee of World Bank, WHO, and UNICEF) and advocacy strategy and materials to help convince people to tackle the problem of iron deficiency.

U.S. Global Health Programs
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This website features the U.S. Government’s major investments in global health, including hallmarks like The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), The President’s Malaria Initiative (PMI), and Feed the Future (FTF).

UNICEF homepage
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UNICEF is a leading humanitarian and development agency working globally for the rights of every child. UNICEF believes all children have a right to survive, thrive, and fulfill their potential – to the benefit of a better world.

UNSCN
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The United Nations System Standing Committee on Nutrition (UNSCN) is the food and nutrition policy harmonization forum of the United Nations.  The mandate of the UNSCN is to promote cooperation among UN agencies and partner organizations in support of community, national, regional, and international efforts to end malnutrition in all of its forms in this generation. It aims to do so by refining the direction, increasing the scale, and strengthening the coherence and impact of efforts against global malnutrition. 

USAID Bureau for Global Health
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Since at least the 1970’s, USAID has been involved in global efforts to address iron deficiency and anemia.

WASHplus homepage
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The WASHplus project supports healthy households and communities by creating and delivering interventions that lead to significant improvements in access, practices, and health outcomes related to water supply, sanitation, and hygiene (WASH) and household air pollution (HAP).