Anemia Reduction

Rationale
Reducing anemia will decrease maternal and perinatal mortality, improve cognitive development and schooling in children, and increase physical capacity and work productivity in adults. About 42 percent of pregnant women and 47 percent of preschool children worldwide are anemic. The most common cause of anemia is iron deficiency, which is associated with 115,000 maternal deaths and 591,000 perinatal deaths each year (Stolzfus et al., 2004).

Challenge
Despite its significance to public health and overall development, anemia is a low priority on the agendas of ministries of health and donors. The magnitude of damage done by anemia has only recently been re-analyzed. Now evidence has also been gathered to show that countries have been able to reduce the anemia problem on a large scale, e.g. in Thailand, Nicaragua, and India. One of the challenges is addressing the multiple causes of anemia including insufficient iron in the diet and infectious diseases such as malaria, hookworm, and HIV/AIDS. Another challenge is ensuring that iron supplements are routinely available through antenatal care and other mechanisms, and distributed with effective counseling for pregnant women.

Most countries do not have policy guidelines or intervention strategies for addressing childhood anemia. Findings from a trial in coastal Tanzania (Pemba island) indicate that daily iron folic acid supplementation in young children should be used only in children with iron deficiency or anemia. Iron folic acid supplementation in children who are iron replete may result in adverse health consequences in high malaria transmission zones with few health services.
  
A2Z Response
The goal of A2Z is to reduce anemia through improved iron intake and control of worms and malaria in high prevalence settings through routine health services. The project is involved in anemia reduction programs in Cambodia, India, the Philippines, and Uganda; and through the partnership with World Vision International in several other countries.

A2Z and collaborating partners:

  • Advocate for anemia reduction in pregnancy as a highly cost-effective strategy for reducing maternal mortality
  • Conduct situational analysis to determine the best package of interventions for reducing anemia, in Uganda and India
  • Advocate for and secure resources from governments (e.g. India, Uganda, Cambodia) and non-governmental organizations (such as. World Vision International) for designing and implementing packages of interventions for maternal and child anemia reduction at scale, for example:
    • For Maternal Anemia the package consists of 100+ tablets of iron folic acid, one dose of deworming medication, and linking with intermittent preventive treatment of malaria and the promotion of bednets
    • For Child Anemia the package consists of iron or micronutrient supplements, and/or fortified complementary foods, and/or food supplements starting at six months; deworming every six months starting at one year; and intermittent preventive treatment of malaria and use of treated bednets where malaria is prevalent
  • Support costing and advocacy for assured financial resources for scaling up anemia reduction programs in India and Uganda 
  • Assess and address supply constraints and strengthen capacity to accurately forecast supply needs for improved distribution and storage mechanisms and for the appropriate use and recording of supplies in Uganda, India, and Cambodia
  • Facilitate documentation of the impact of intervention packages on anemia levels in Cambodia, India, and Uganda
  • Demonstrate and support better use of population and coverage data to detect low-performing areas and help target resources to fill in gaps in Uganda and India
  • Capture lessons learned, document cost-effectiveness, and identify effective processes, tools, and frameworks for adaptation and dissemination globally

Visit the Resources section of the website for more information on anemia reduction.

 


Reference: Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anaemia. In: Ezzati M, Lopez AD, Rodgers A, Murray ELJ, eds. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization, 2004: 163-209.