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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Food and Nutrition Bulletin, June 2016

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.

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The Journal of Nutrition, June 2016

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.

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The Journal of Nutrition, June 2016

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.

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Lab on a Chip, October 2016

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. 

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BMC Infectious Diseases, October 2016

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.

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American Journal of Public Health, July 2016

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.

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The American Journal of Tropical Medicine and Hygiene, August 2016

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.

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Maternal and Child Nutrition, October 2016

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.

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The American Journal of Tropical Medicine and Hygiene, June 2016

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.

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The Journal of Nutrition, July 2016

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.

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

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HF-TAG, 2016

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.

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WHO, 2016

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.

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CITE at MIT, 2016

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.

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Chronicle, August 2016

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.

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HarvestPlus, September 2016

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.

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Micronutrient Initiative, August 2016

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.

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HarvestPlus, August 2016

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.

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HKI, September 2016

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.

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WHO, 2016

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.

Events
Links to presentations, proceedings, and other meeting materials

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October 24 – 28, 2016

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.

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October 13, 2016

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.

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 500 members from over 55 countries. The COP webinar series presents relevant and timely topics to members based on their feedback and the latest happenings in the field.

On October 18, 2016, the COP hosted its fourth webinar, The Contribution of Neglected Tropical Diseases to Anemia, attended by 90 people. The topic seems to have brought a new audience, as at least half of the attendees were not previous members. The Q&A shared after the session is available on the AREA website for members.

In addition to hosting webinars, the COP disseminates anemia-related vacancy and conference announcements, recent publications, and reports. For example, since the last resource review, the following were shared: 

  • The WHO’s new Antenatal Care Guidelines, an exciting comprehensive view on supporting a positive pregnancy experience (including replacement of some existing WHO Guidelines)
  • An invitation to participate in the second phase of WHO’s online consultation on revising guidelines on hemoglobin concentrations for the diagnosis of anemia
  • An opportunity to give input on the priorities for a future USAID-funded multisectoral nutrition program and the UN Decade of Action on Nutrition
  • Requests to convene with other members or attend sessions at the International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition (1-2 December, Rome) and the Micronutrient Forum (23-28 October, Cancun)
  • A Storify (compilation of tweets) and a list of anemia takeaways from the Micronutrient Forum Global Conference (available on the AREA website)
  • Updates to a debate about anemia in the 2016 Global Nutrition Report
  • An invitation to a webinar on biofortification and a share-out of materials from a webinar on adolescent nutrition
  • Post-doctorate, consultancy, and job opportunities with UNICEF India, the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project, and the Food Fortification Initiative, as well as a Millennium Challenge Account consultation on IFA procurement, a study in Panama on the acceptability and adherence of MNPs and iron syrup, and a project on barriers to livestock-rearing strategies to reduce anemia in Ghana

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

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.

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.

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.

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.

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.

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).