Research shows that antenatal iron-folic acid (IFA) supplementation improves maternal anemia and poor pregnancy outcomes, and may also have an effect on child survival. This study investigated the relative contribution of antenatal IFA supplementation on the risk of child mortality in Nepal over a 15- year period. The authors found the risk of neonatal mortality was reduced by 42 percent in children whose mothers reported taking any IFA supplements during their pregnancy.
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.
Can Fortification Be Implemented in Rural African Communities Where Micronutrient Deficiencies are Greatest? Lessons from Projects in Malawi, Tanzania, and Senegal
Industrial fortification of staple cereals, fats, and oils has been successful in decreasing the burden of micronutrient malnutrition. The authors of this document review the history, progress, and sustainability of community-level fortification within an integrated nutrition and health program in Malawi, Tanzania, and Senegal. The authors conclude that, in the absence of strong community capacity, it may be better to promote medium-scale fortification initiatives that link to home-based fortification efforts.
Does Smoke From Biomass Fuel Contribute to Anemia in Pregnant Women in Nagpur, India? A Cross-sectional Study
Using data from the National Institutes of Health-funded Maternal and Newborn Health Registry Study in Nagpur, India, this study evaluated whether exposure to smoke from biomass fuel as opposed to clean fuel was an independent risk factor for anemia in pregnancy. Exposure to biomass fuel was found to be associated with higher risks of mild and moderate-to-severe anemia in pregnancy.
This cross-sectional study was conducted in Ethiopia to determine correlation between maternal and neonatal hematologic profiles and iron status. The authors found that newborns of iron deficient anemic mothers had significantly lower levels of ferritin and hemoglobin concentrations and concluded that maternal iron-deficiency anemia may have an effect on newborn iron stores.
Factors Associated with Ultrasound-aided Detection of Suboptimal Fetal Growth in a Malaria-endemic Area in Papua New Guinea
Fetal growth restriction (FGR) may lead to increased infant mortality rates and ill-health in adulthood. This study showed an association between maternal undernutrition, short stature, and anemia with indicators of FGR in a malaria-endemic region of Papua New Guinea. Further, intermittent preventive treatment in pregnancy was associated with increased weight z-scores, and anemia with reduced change in weight z-scores. The authors concluded that antenatal nutritional interventions and malaria prevention may improve fetal growth.
In Ivorian School-age Children, Infection with Hookworm Does Not Reduce Dietary Iron Absorption or Systemic Iron Utilization, Whereas Afebrile Plasmodium Falciparum Infection Reduces Iron Absorption By Half
Parasitic infections are common in sub-Saharan Africa; they lead to chronic inflammation and may result in anemia by preventing iron recycling and reducing iron absorption. The authors found that hookworm infection does not produce inflammation or increase hepcidin; neither does it reduce iron absorption and utilization. On the other hand, afebrile malaria increased inflammation and hepcidin, while reducing iron absorption; it did not reduce iron utilization.
Iron+Folic Acid Distribution and Consumption Through Antenatal Care: Identifying Barriers Across Countries
The supplementation of iron-folic acid (IFA) tablets as part of antenatal care (ANC) is an important intervention for prevention and control of anemia. The results of this 22-survey analysis showed that although ANC attendance is high (83%), adherence to the ideal supplementation regimen was low (8%). This analysis provides a useful schematic for decision-makers to identify programmatic “falter points” to consuming 180 IFA tablets: ANC attendance, IFA receipt or purchase, IFA consumption, and the number of tablets consumed.
This review examined studies on the use of multiple micronutrient powders (MNPs) in pregnancy, compared with supplements or no additional micronutrients. Overall, MNPs were similar to multiple micronutrient supplements in their effect on anemia and hemoglobin in mothers at or near term. The authors concluded that future trials should assess MNP adherence and evaluate the effects on birth outcomes and morbidity.
This study assessed prenatal hemoglobin levels on early child psychomotor development. It found an inverted U-shaped relationship between prenatal hemoglobin at first and second antenatal care visit and infant gross motor function. This indicates that low and high hemoglobin concentrations during pregnancy may be detrimental to the early motor functions of one-year-old children; there appears to be a hemoglobin concentration range that may be optimal.
The Impact of Anthelmintic Treatment Intervention on Malaria Infection and Anaemia in School and Preschool Children in Magu District, Tanzania: An Open Label Randomised Intervention Trial
Interventions to control helminth infections may have an impact on both malaria and anemia. This study assessed the impact of two anthelmintic treatment approaches (single and repeated doses of praziquantel and albendazole) on malaria infection and anemia in school and pre-school age children in Tanzania. The authors found that repeated anthelmintic treatment did not have an impact on malaria infection compared to single dose treatment; however, both treatment approaches improved children’s hemoglobin levels.
Reports, Tools, and Other Related Materials
Based on new study results from the Micronutrient Initiative, the Bangladesh Government re-committed to strengthening its iron-folic acid (IFA) supplementation program to protect pregnant women from anemia and their newborns from complications.
Although Nigeria has had a mandated food fortification policy since 2002, a study last year concluded that only 30 percent of products in markets contained required levels of micronutrients. This prompted the Global Alliance for Improved Nutrition to partner with Maverick Equinox on social marketing for the promotion of fortification-related messages through radio, SMS, banners, billboards, and live market events.
Iron-biofortified varieties of commonly consumed staple crops have the potential to contribute to the daily iron requirements in diets and thus reduce iron deficiency among children and women in developing countries. This working paper from HarvestPlus, examines the consumer acceptance and willingness-to-pay for two iron bean varieties in Rwanda: red iron bean and white iron bean. The findings from this study could inform the design of efficient delivery and marketing strategies for iron bean varieties in Rwanda.
Controlling Maternal Anemia and Malaria: Ensuring Pregnant Women Receive Effective Interventions to Prevent Malaria and Anemia: What Program Managers and Policymakers Should Know
Developed by USAID’s Maternal and Child Survival Program and the President’s Malaria Initiative, this program brief describes World Health Organization recommendations to prevent malaria and iron-deficiency anemia during pregnancy, with an emphasis on giving the correct dose of folic acid to avoid counteracting the efficacy of antifolate antimalarial drugs. The brief is intended to guide program design and policy development.
The “Hb Meter,” a new mobile app field tested by Africare’s Mwanzo Bora Nutrition Program, is the first non-invasive test for anemia that detects hemoglobin levels using a mobile phone’s camera flash. Africare/Tanzania is currently testing the Hb Meter against standard hemoglobin measurement tools. If it works, Hb Meter will likely encourage more people to test for anemia and it may reduce the cost and risk of infection associated with the standard test.
Fortifying staple foods—maize, flour, and edible oils—is a cost effective intervention to tackle malnutrition and reduce life threatening conditions and diseases. The latest infographic by the Global Alliance for Improved Nutrition presents five conditions (spina bifida, anemia, goiter, night blindness, rickets) that can be eliminated by including basic micronutrients in staple food groups.
Knorr, the biggest brand of the multinational consumer goods company Unilever, unveiled its commitment to help Nigeria reduce the prevalence of iron deficiency anemia, a major public health issue. It will work to make cooking iron-rich foods more desirable, easy to understand, and affordable.
Biofortification is a viable strategy to improve the nutritional status of populations dependent on staple food crops for sustenance. This new interactive online tool - the Biofortification Priority Index (BPI) -focuses on three micronutrients (iron, vitamin A, and zinc) and allows the user to enter search criteria and sort and view results on a color-coded map according to crop, region, and priority for investment. The BPI will be useful to stakeholders in making investment decisions on biofortification that will have the highest payoff in reducing micronutrient deficiencies.
Scientists at CGIAR have found 30 new types of beans that are tolerant to heat, and could ensure sustained production in Africa and Latin America. Some of these beans are rich in iron, which will allow farmers to simultaneously increase iron in the diet and expand production in the face of climate change.
This news item highlights the importance of targeting adolescent girls, as we strive to reduce global rates of anemia and reach the World Health Assembly target to reduce anemia by 50 percent in women of reproductive age by 2025. It also urges the global community to move from a narrow focus on outcomes for pregnant adolescents to strategies that help all adolescent girls thrive in school, work, and life.
Feed the Future worked with health professionals in Honduras to better understand the causes of anemia and identify appropriate preventative measures by conducting household visits to observe feeding and hygiene behaviors. They found that parasitic infection is likely a major cause of anemia. The Government of Honduras is undertaking several actions to address the high levels of anemia in the country.
The Lucky Iron Fish Project has introduced a simple and effective tool to increase dietary iron intake without using iron pills: a small metal fish—a symbol of luck in Cambodian culture—that, if used properly during cooking, can provide 75 percent of an adult's daily recommended intake of iron, and even more for a child.
The government of India has launched the world's largest national school-based deworming effort to date, targeting 140 million children twice a year in 11 states with presumed high levels of soil transmitted helminths and once a year to 100 million children in other states.
As part of a series of online question-and-answer sessions that pose questions to leading experts in the areas of nutrition and food security, The Guardian hosted a live chat to answer the question, “how can we stop neglecting girls' nutrition?” Held with a panel of leading nutrition experts and programmers, this session focused on adolescent girls as an important target group for nutrition interventions and an effective way to break the intergenerational cycle of malnutrition.
The Global Alliance for Improved Nutrition (GAIN), in partnership with Devex, has launched the Future Fortified online series. The series investigates how food fortification can prevent many of the health and nutrition challenges that burden developing countries. This series will update regular content including reports, blogs, infographics, videos, quizzes, and more from GAIN, its partners, and others within the development community.
The ICNFS 2015: 17th International Conference on Nutrition and Food Sciences will bring together leading academic scientists, researchers, and research scholars to share experiences and research results, and discuss the most recent innovations, practical challenges, and solutions adopted in the field of nutrition and food sciences. SPRING will present on a method for making rapid, initial assessments of the consumption and distribution of iron-folic acid supplements through antenatal care among pregnant women in developing countries.
Multiple Micronutrient Supplements in Pregnancy: Implementation Considerations for Successful Integration into Existing Programmes
The World Health Organization, in collaboration with the United Nations Children’s Fund, and the Micronutrient Initiative, will convene a meeting titled Multiple micronutrient supplements in pregnancy: implementation considerations for successful incorporation into existing programmes in August 2015. The meeting will examine the programmatic evidence that can inform the scale up of multiple micronutrient supplementation during pregnancy in antenatal care programs and other delivery platforms.
The 68th World Health Assembly (WHA) was held in Geneva, Switzerland, bringing together World Health Organization Member States to focus on key milestones for nutrition toward achieving the WHA 2025 Global Targets. These include the approval of two resolutions on nutrition and agreed indicators to measure nutrition among mothers, infants, and young children.
Point-of-use fortification is increasingly being introduced and scaled up. The United Nations Children’s Fund, the U.S. Centers for Disease Control and Prevention, the United Nations World Food Programme, and the Home Fortification Technical Advisory Group have organized a series of webinars tailored for program implementers who are either planning or implementing “point-of-use” fortification programs. For more information on the third, fourth, and fifth webinars in the series, please use the following links:
Addressing Micronutrient Powders (MNP) Supply Issues, Micronutrient Powder Formulation, Dosing Regimen and Delivery Channels, MNP and the International Code of Marketing of Breastmilk Substitutes
Online Community Corner
The Multisectoral Anemia Task Force Secretariat comprises the CORE Group, FANTA, MCHIP, and SPRING, as well as the U.S. President’s Malaria Initiative and USAID’s Water, Sanitation and Hygiene program, Neglected Tropical Diseases program, and Food for Peace office. It developed three frameworks presenting the causal and program pathways for maternal and child anemia. The frameworks were showcased by Dr. Rolf Klemm (Johns Hopkins University) at the first partner’s meeting on October 18, 2013 to guide the discussion on integrated approaches to anemia prevention and control. The three frameworks can be downloaded here.
Websites to Watch
HarvestPlus is a leader in the global effort to end hidden hunger caused by the lack of essential vitamins and minerals. Coordinated by the International Center for Tropical Agriculture (CIAT) and the International Food Policy Research Institute (IFPRI), HarvestPlus is part of the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), which helps realize the potential of agricultural development to deliver gender-equitable health and nutritional benefits to the poor.