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Guideline: use of multiple micronutrient powders for point-of-use fortification of foods consumed by pregnant women.
Geneva, Switzerland, WHO, 2016. 32 p.The guideline is intended for a wide audience, including governments, nongovernmental organizations, healthcare workers, scientists and donors involved in the design and implementation of micronutrient programmes and antenatal care services and their integration into national and subnational public health strategies and programmes. This WHO guideline states that routine use of multiple micronutrient powders during pregnancy is not recommended as an alternative to standard iron and folic supplementation during pregnancy for improving maternal and infant health outcomes.
The state of food security and nutrition in the world 2017: building resilience for peace and food security.
Rome, Italy, FAO, 2017. 133 p.This report has been jointly published by the Food and Agriculture Organization of the United Nations (FAO), the International Fund for Agricultural Development (IFAD), the United Nations Children’s Fund (UNICEF), the World Food Programme (WFP) and the World Health Organization (WHO). The 2017 edition marks the beginning of a new era in monitoring efforts to achieve a world without hunger and malnutrition within the framework of the Sustainable Development Goals (SDGs). The report will henceforth monitor progress towards the targets on both ending hunger (SDG Target 2.1) and ending all forms of malnutrition (SDG Target 2.2). It will also include analyses of how food security and nutrition are related to progress on other SDG targets.
An Investment Framework for Nutrition: Reaching the Global Targets for Stunting, Anemia, Breastfeeding, and Wasting.
Washington, D.C., International Bank for Reconstruction and Development / The World Bank, 2017 Apr. 258 p.The report estimates the costs, impacts and financing scenarios to achieve the World Health Assembly global nutrition targets for stunting, anemia in women, exclusive breastfeeding and the scaling up of the treatment of severe wasting among young children. To reach these four targets, the world needs $70 billion over 10 years to invest in high-impact nutrition-specific interventions. This investment would have enormous benefits: 65 million cases of stunting and 265 million cases of anemia in women would be prevented in 2025 as compared with the 2015 baseline. In addition, at least 91 million more children would be treated for severe wasting and 105 million additional babies would be exclusively breastfed during the first six months of life over 10 years. Altogether, achieving these targets would avert at least 3.7 million child deaths. Every dollar invested in this package of interventions would yield between $4 and $35 in economic returns, making investing in early nutrition one of the best value-for-money development actions. Although some of the targets -- especially those for reducing stunting in children and anemia in women -- are ambitious and will require concerted efforts in financing, scale-up, and sustained commitment, recent experience from several countries suggests that meeting these targets is feasible. These investments in the critical 1000 day window of early childhood are inalienable and portable and will pay lifelong dividends -- not only for children directly affected but also for us all in the form of more robust societies -- that will drive future economies.
Prevalence of Malnutrition and Associated Factors among Hospitalized Patients with Acquired Immunodeficiency Syndrome in Jimma University Specialized Hospital, Ethiopia.
Ethiopian Journal of Health Sciences. 2016 May; 26(3):217-26.BACKGROUND: HIV/AIDS predisposes to malnutrition. Malnutrition exacerbates HIV/AIDS progression resulting in increased morbidity and mortality. The magnitude of malnutrition in HIV/AIDS patients has not been well studied in Ethiopian setup. Our objective was to assess the prevalence of malnutrition and associated factors among HIV/AIDS patients admitted to Jimma University Specialized Hospital (JUSH). METHOD: A cross-sectional study was conducted to assess the nutritional status of 109 HIV/AIDS patients admitted from November 2013 to July 2014. Cohort design was also used for outcome assessment. Serum levels of hemoglobin, albumin and CD4 counts were determined. Data were organized, coded, cleaned, entered into a computer and analyzed using SPSS version 16.0. Descriptive analysis was done initially. Those variables in the bivariate analysis with P-value < 0.25 were then considered as candidates to be included in the multivariable logistic regression model. A P-vale of < 0.05 was considered as statistically significant. RESULTS: The mean age of the patients was 32.7+/-8.12 with male to female ratio of 1:1.9. Patients were in either clinical stage, 3(46.8%), or stage, 4(53.2%). Forty nine (45%) of the respondents had a CD4 count of < 200 cells/microL. The overall prevalence of malnutrition was 46.8% (BMI<18.5kg/m2) and 44.1% (MUAC= 20cm). Eighty four (77.1%) of the patients had a serum albumin level of =3.5g/dl while 76 (69.6%) of the patients had anemia (Hg<12g/dl). CONCLUSION: The prevalence of malnutrition was found to be high. WHO Stage 4 disease and CD4 count <200cells/microl were independent predictors of malnutrition.
2016; Geneva, Switzerland, WHO, 2016. 38 p.This guideline provides a global, evidence-informed recommendation on iron supplementation in postpartum women, as a public health intervention for the purpose of improving maternal and infant health outcomes. The guideline aims to help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions to achieve the Sustainable Development Goals (SDGs), in particular, Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture.
World Health Organization. Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition. Geneva, Switzerland, 2014.
Advances In Nutrition. 2015 Jan; 6(1):134-5.Add to my documents.
Controlling maternal anemia and malaria. Ensuring pregnant women receive effective interventions to prevent malaria and anemia: What program managers and policymakers should know.
[Washington, D.C.], Maternal and Child Survival Program, 2015 Apr.  p. (USAID Cooperative Agreement No. AID-OAA-A-14-00028)This brief describes WHO recommendations for IPTp (intermittent preventive treatment of malaria in pregnancy) to prevent MIP (malaria in pregnancy) and iron-folic acid (IFA) supplementation to prevent iron deficiency anemia in sub-Saharan Africa (SSA) countries, with an emphasis on giving the correct dose of folic acid to maximize the effectiveness of interventions to prevent malaria. The brief is for program managers of health programs and policymakers to guide them in designing programs and developing policies. (Excerpts)
Geneva, Switzerland, WHO, 2015.  p.This document provides estimates of the prevalence of anaemia for the year 2011 in preschool-age children (6-59 months) and women of reproductive age (15-49 years), by pregnancy status, and by regions of the United Nations and World Health Organization (WHO), as well as by country. This document may serve as a resource for estimating the baseline prevalence of anaemia in women of reproductive age, in working towards achieving the second global nutrition target 2025, a 50% reduction of anaemia in women of reproductive age, as outlined in the Comprehensive implementation plan on maternal, infant and young child nutrition and endorsed by the Sixty-fifth World Health Assembly, in resolution WHA65.6.
Dissemination of WHO guidelines and recommendations on micronutrients: policy, practice and service delivery issues. Report of a regional meeting, Bangkok, 14-16 October 2014.
New Delhi, India, WHO, Regional Office for South-East Asia, 2015.  p. (SEA-NUT-195)The public health implications of micronutrient deficiencies are very important since these deficiencies adversely affect fetal and child growth, cognitive development of infants, children and adolescents, women of reproductive age and the elderly, and lower their resistance to infection. Of all the micronutrient deficiencies, anaemia is the most common in the South-East Asia Region and an estimated 55% of preschool children, 45% of pregnant women and 40% of women of child-bearing age are anaemic. Low intake of iron and other important nutrients in the diet, parasitic infections and low bioavailability of iron from plant-based diets are considered to be the causative factors. In recent years, WHO has produced or updated several evidence-based guidelines and recommendations on a large number of nutrients of public health importance. These evidence-based guidelines for nutrition action will assist the Member States to focus on key areas of intervention and develop a harmonized monitoring framework to assess the impact of such interventions on the prevalence of micronutrient deficiencies. A regional meeting on dissemination of WHO guidelines and recommendations on micronutrients: policy, practice and service delivery issues, was organized by the World Health Organization’s Regional Office for South-East Asia in collaboration with the Department of Nutrition for Health & Development, WHO Headquarters, the Institute of Nutrition – Mahidol University, Thailand and the Micronutrient Initiative, in Bangkok, Thailand from 14-16 October 2014. The overall objective of the meeting was to discuss the effective dissemination and incorporation of WHO guidelines and recommendations on micronutrients in national control and prevention programmes highlighting the following topics: i) dissemination of current WHO guidelines and recommendations on micronutrients; ii) overview of recent strategies and approaches for addressing anaemia in different population groups; and iii) review of national protocols for the control and prevention of micronutrients deficiencies, with particular focus on anaemia.
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.2)Recognizing that accelerated global action is needed to address the pervasive and corrosive problem of the double burden of malnutrition, in 2012 the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified a set of six global nutrition targets that by 2025 aim to: achieve a 40% reduction in the number of children under-5 who are stunted; achieve a 50% reduction of anaemia in women of reproductive age; achieve a 30% reduction in low birth weight; ensure that there is no increase in childhood overweight; increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%; reduce and maintain childhood wasting to less than 5%. As part of its efforts, the World Health Organization (WHO) has developed a series of six policy briefs, linked to each of the global targets, to guide national and local policy-makers on what actions should be taken at scale, in order to achieve the targets. Recognizing that the six targets are interlinked, many evidence-based, effective interventions can help make progress toward multiple targets. The purpose of these briefs is to consolidate the evidence around which interventions and areas of investment need to be scaled up, and to guide decision-makers on what actions need to be taken in order to achieve real progress toward improving maternal, infant and young child nutrition. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.4)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025 . This policy brief covers the second target: a 50% reduction of anaemia in women of reproductive age. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in reducing the rates of anaemia among women of reproductive age. (Excerpts)
Global policy and programme guidance on maternal nutrition: what exists, the mechanisms for providing it, and how to improve them?
Paediatric and Perinatal Epidemiology. 2012 Jul; 26 Suppl 1:315-25.Undernutrition in one form or another affects the majority of women of reproductive age in most developing countries. However, there are few or no effective programmes trying to solve maternal undernutrition problems. The purpose of the paper is to examine global policy and programme guidance mechanisms for nutrition, what their content is with regard to maternal nutrition in particular, as well as how these might be improved. Almost all countries have committed themselves politically to ensuring the right of pregnant and lactating women to good nutrition through the Convention on the Elimination of all Forms of Discrimination Against Women. Despite this, the World Health Organization (WHO) has not endorsed any policy commitments with regard to maternal nutrition. The only policy guidance coming from the various technical departments of WHO relates to the control of maternal anaemia. There is no policy or programme guidance concerning issues of maternal thinness, weight gain during pregnancy and/or low birthweight prevention. Few if any countries have maternal nutrition programmes beyond those for maternal anaemia, and most of those are not effective. The lack of importance given to maternal nutrition is related in part to a weakness of evidence, related to the difficulty of getting ethical clearance, as well as a generalised tendency to downplay the importance of those interventions found to be efficacious. No priority has been given to implementing existing policy and programme guidance for the control of maternal anaemia largely because of a lack of any dedicated funding, linked to a lack of Millennium Development Goals indicator status. This is partly due to the poor evidence base, as well as to the common belief that maternal anaemia programmes were not effective, even if efficacious. The process of providing evidence-based policy and programme guidance to member states is currently being revamped and strengthened by the Department of Nutrition for Health and Development of WHO through the Nutrition Guidance Expert Advisory Group processes. How and if programme guidance, as well as policy commitment for improved maternal nutrition, will be strengthened through the Nutrition Guidance Expert Advisory Group process is as yet unclear. The global movement to increase investment in programmes aimed at maternal and child undernutrition called Scaling Up Nutrition offers an opportunity to build developing country experience with efforts to improve nutrition during pregnancy and lactation. All member states are being encouraged by the World Health Assembly to scale-up efforts to improve maternal infant and young child nutrition. Hopefully Ministries of Health in countries most affected by maternal and child undernutrition will take leadership in the development of such plans, and ensure that the control of anaemia during pregnancy is given a great priority among these actions, as well as building programme experience with improved nutrition during pregnancy and lactation. For this to happen it is essential that donor support is assured, even if only to spearhead a few flagship countries. (c) 2012 Blackwell Publishing Ltd.
Geneva, Switzerland, WHO, 2010.  p.The World Health Organization Guidelines for the treatment of malaria provides evidence-based and up-to-date recommendations for countries on malaria diagnosis and treatment which help countries formulate their policies and strategies. In scope, the Guidelines cover the diagnosis and treatment of uncomplicated and severe malaria caused by all types of malaria, including in special groups (young children, pregnant women, HIV / AIDS), in travellers (from non-malaria endemic regions) and in epidemics and complex emergency situations. The first edition of the Guidelines for the treatment of malaria were published in 2006. The second edition introduces a new 5th ACT to the four already recommended for the treatment of uncomplicated malaria. Furthermore, the Guidelines recommend a parasitological confirmation of diagnosis in all patients suspected of having malaria before treating. The move towards universal diagnostic testing of malaria is a critical step forward in the fight against malaria as it will allow for the targeted use of ACTs for those who actually have malaria. This will help to reduce the emergence and spread of drug resistance. It will also help identify patients who do not have malaria, so that alternative diagnoses can be made and appropriate treatment provided. The new Guidelines will therefore help improve the management of not only malaria, but other childhood febrile illnesses.
Iron supplementation of young children in regions where malaria transmission is intense and infectious disease highly prevalent. WHO statement.
Geneva, Switzerland, WHO, .  p.Iron deficiency with its attendant anaemia is the most prevalent micronutrient disorder on a worldwide basis. In 2001, the UN General Assembly at the Special Session on Children recommended that the prevalence of iron deficiency and anaemia be reduced by one third in children by the year 2010. If achieved, this would contribute greatly to the realization of the Millenium Development Goals. In most countries, national policies have been implemented to provide iron supplements to pregnant women, and to a lesser extent to young children, as the primary strategy for preventing iron deficiency and anaemia. Although the benefits of iron supplementation have generally been considered to outweigh the putative risks, there is some evidence to suggest that supplementation at levels recommended for otherwise healthy children carries the risk of increased severity of infectious disease in the presence of malaria and/or undernutrition. (excerpt)
Archives of Gynecology and Obstetrics. 2007 Dec; 276(6):583-589.The objective was to evaluate quality of life (QOL) and identify its associated factors in a cohort of women with gynecologic cancer. A cross-sectional study was conducted, including 103 women with cervical or endometrial cancer, aged between 18 and 75 years who were receiving their entire treatment at the institution where the investigation was carried out. QOL was measured by the World Health Organization's QOL instrument-abbreviated version (WHOQOL-BREF). Clinical and sociodemographic characteristics, in addition to prevalence of cancer-related symptoms prior to radiotherapy were investigated. Bivariate analysis was performed, applying the Mann-Whitney test. Multivariate analysis was used to identify factors associated with QOL. The mean age of the participants was 56.8 plus or minus 11.6 years. The study included 67 (65%) women with cervical cancer and 36 (35%) women with endometrial cancer. Most participants were at an advanced stage (63.1%). The most common complaints were pain (49.5%) and vaginal bleeding (36.9%). The prevalence of anemia was 22.3%. On multivariate analysis, it was observed that anemia (P = 0.006) and nausea and/or vomiting (P = 0.010) determined impairment in physical domain. Pain negatively influenced physical domain (P = 0.001), overall QOL (P = 0.024), and general health (P = 0.013), while the history of surgery positively affected general health (P = 0.001). Cancer-related symptoms were factors that most interfered with QOL in women with gynecologic cancer. Therefore, more attention should be focused on identifying these symptoms, adopting measures to minimize their repercussions on QOL. (author's)
Diagnostic accuracy comparison between clinical signs and hemoglobin color scale as screening methods in the diagnosis of anemia in children.
Revista Brasileira de Saude Materno Infantil. 2006 Apr-Jun; 6(2):183-189.The objectives were to compare the validity and reproducibility of clinical signs with the World Health Organization hemoglobin color scale. Two hundred six children in the age range of 6-23 months, at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP, were assessed. Two examiners evaluated the clinical signs and the hemoglobin color scale of each child at the different times. The hemoglobin value was used as a standard for validation. In more than 90% of cases the agreement between the values of the color scale and the laboratorial hemoglobin was <2 g/dL. Between the clinical signs the highest sensitivity level for diagnosing Hb<11 g/dL was presented by the hemoglobin color scale (75.7%). For moderate/severe anemia Hb<9g/dL the highest sensitivity was shown by combined palmar or conjunctival pallor (74.3%) and by the color scale (52.5%), according to the first and second observer, respectively. The highest specificity level for Hb<11 g/dL was presented by palmar pallor in comparison with the mother's palm and conjunctival pallor (100%). For Hb<9 g/dL the highest specificity was presented by the hemoglobin color scale (91.9%). This study suggests that moderate/ severe anemia can be diagnosed either by clinical signs or by the color scale, while, in cases of mild anemia, the better diagnosis tool appears to be the color scale. (author's)
New and Noteworthy in Nutrition. 2002 Sep 13; (38):6-7.The high prevalence of low hemoglobin (Hb) concentration among breastfed Indonesian infants aged 3.5 months is related to maternal anemia, according to a study by Saskia de Pee and colleagues from Helen Keller International, UNICEF and the National Institute for Health Research and Development in Jakarta. They analyzed cross-sectional data from the HKI/GOI Nutrition and Health Surveillance System in rural Java from September 1999 to February 2001. The prevalence of Hb below 110g/l was a very high 71%. Comparing infants of nonanemic mothers with a normal birth weight, normal birth weight infants of anemic mothers were 1.8 times as likely to have a low Hb; infants of nonanemic mothers but with low birth weight: 1.15 times as likely, with the highest risk for low Hb predictably being those with low birth weight and anemic mothers (3.68 times). Other risk factors included maternal stunting, a young mother, and lower maternal education. (excerpt)
Food and Nutrition Bulletin. 2003; 24 Suppl 4:S99-S103.Iron deficiency is considered to be one of most prevalent forms of malnutrition, yet there has been a lack of consensus about the nature and magnitude of the health consequences of iron deficiency in populations. This paper presents new estimates of the public health importance of iron-deficiency anemia (IDA), which were made as part of the Global Burden of Disease (GBD) 2000 project. Iron deficiency is considered to contribute to death and disability as a risk factor for maternal and perinatal mortality, and also through its direct contributions to cognitive impairment, decreased work productivity, and death from severe anemia. Based on meta-analysis of observational studies, mortality risk estimates for maternal and perinatal mortality are calculated as the decreased risk in mortality for each 1 g/dl increase in mean pregnancy hemoglobin concentration. On average, globally, 50% of the anemia is assumed to be attributable to iron deficiency. Globally, iron deficiency ranks number 9 among 26 risk factors included in the GBD 2000, and accounts for 841,000 deaths and 35,057,000 disability-adjusted life years lost. Africa and parts of Asia bear 71% of the global mortality burden and 65% of the disability-adjusted life years lost, whereas North America bears 1.4% of the global burden. There is an urgent need to develop effective and sustainable interventions to control iron-deficiency anemia. This will likely not be achieved without substantial involvement of the private sector. (author's)
Contraception. 2006 Feb; 73(2):195-204.The use of progestogen-only contraceptives among women with sickle cell anemia has generated concerns about possible hematological and other clinical complications. Based on the literature, we assessed whether use of progestogen-only contraceptives is associated with adverse health effects among women with sickle cell anemia. We searched the MEDLINE database for articles published in peer-reviewed journals between 1966 and September 2004 that were relevant to sickle cell anemia and use of progestogen-only contraceptives. Of the 70 articles identified through the search, 8 met the criteria for this review. These studies did not identify any adverse events or clinically or statistically significant adverse changes in hematological or biochemical parameters associated with the use of progestogen-only contraceptive methods. Six studies suggested that users experienced a decrease in clinical symptoms and less frequent and severe painful crises compared with nonusers. Although data are limited, these studies suggest that progestogen-only contraceptives are safe for women with sickle cell anemia. (author's)
Should adolescents be specifically targeted for nutrition in developing countries? To address which problems, and how?
Geneva, Switzerland, World Health Organization [WHO], . 38 p.Concern for nutrition in adolescence has been rather limited, except in relation to pregnancy. This paper reviews adolescent-specific nutritional problems, and discusses priority issues for the health sector, particularly in developing countries. Chronic malnutrition in earlier years is responsible for widespread stunting and adverse consequences at adolescence in many areas, but it is best prevented in childhood. Iron deficiency and anaemia are the main problem of adolescents world-wide; other micronutrient deficiencies may also affect adolescent girls. Improving their nutrition before they enter pregnancy (and delaying it), could help to reduce maternal and infant mortality, and contribute to break the vicious cycle of intergenerational malnutrition, poverty, and even chronic disease. Food-based and health approaches will oftentimes need to be complemented by micronutrient supplementation using various channels. Promoting healthy eating and lifestyles among adolescents, particularly through the urban school system, is critical to halt the rapid progression of obesity and other nutrition related chronic disease risks. There are pressing research needs, notably to develop adolescent-specific anthropometric reference data, to better document adolescents' nutritional and micronutrient status, and to assess the cost-effectiveness of multinutrient dietary improvement (or supplements) in adolescent girls. Our view is that specific policies are needed at country level for adolescent nutrition, but not specific programmes. (author's)
Acta Obstetricia et Gynecologica Scandinavica. 2003 Nov; 82(11):1063-1064.In these days of evidence-based medicine, whatever is done to provide evidence in favor or against a procedure, protocol, program, test or intervention is always welcomed. It is in this light that the new World Health Organization (WHO) antenatal care model, now being propagated for general implementation, will be assessed. The focus of the WHO antenatal model was the developing countries because it was rightly assumed that the routinely recommended antenatal care program is often poorly implemented and clinical visits can be irregular, with long waiting times and poor feedback to the women. A multicenter, randomized, control trial was therefore conducted to compare the old, standard "western" model of antenatal care with the new WHO model, which limits the number of visits to the clinic and restricts tests and clinical procedures. But this all-important study did not consider it appropriate to include at least one African country, with all the peculiarities of sub- Saharan Africa. Even then, out of the four chosen countries, Saudi Arabia, for instance, cannot be said to be a classic example of a developing country. The design of the study was therefore suspect from the outset! A closer look at the trial itself revealed more defects and debatable issues. For instance, the primary maternal outcome monitored was a maternal morbidity index, partly defined by eclampsia occurring within 24 h of delivery and severe postpartum anemia (hemoglobin <90 g/L). The issue of excluding eclamptics whose fits occur after 24 h of delivery might not be as controversial as labeling patients with hemoglobin of <90 g/L with severe anemia. Certainly there are many elegant studies that do not support that definition of severity, at least for African mothers. (excerpt)
SCN News. 2002 Dec; (25):4-30.This paper addresses the most common nutrition and health problems in turn, assessing the extent of the problem; the impact of the condition on overall development, and what programmatic responses can be taken to remedy the problem through the school sys- tern. The paper also acknowledges that an estimated 113m children of school-age are not in school, the majority of these children living in Sub-Saharan Africa and South-East Asia. Poor health and nutrition that differentially affects this population is also discussed. (excerpt)
Tashkent, Uzbekistan, Analytical and Information Center, 2003 May. ix, 30 p.This preliminary report documents the changes that have occurred in the medical-demographic situation of Uzbekistan since the 1996 Demographic and Health Survey. Additional information is provided concerning issues of both male and female adult health: life style practices, knowledge and attitudes towards tuberculosis, HIV/AIDS, STDs, risk factors for cardiovascular diseases, and information about respiratory, digestive, and dental diseases. (excerpt)
World Health Organization hemoglobin cut-off points for the detection of anemia are valid for an Indonesian population.
Journal of Nutrition. 1999; 129:1669-1674.The study was designed to determine whether population-specific hemoglobin cut-off values for detection of iron deficiency are needed for Indonesia by comparing the hemoglobin distribution of healthy young Indonesians with that of an American population. This was a cross-sectional study in 203 males and 170 females recruited through a convenience sampling procedure. Hemoglobin, iron biochemistry tests and key infection indicators that can influence iron metabolism were analyzed. The hemoglobin distributions, based on individuals without evidence of clear iron deficiency and infectious process, were compared with the National Health and Nutrition Survey (NHANES) II population of the United States. Twenty percent of the Indonesian females had iron deficiency, but no male subjects were iron deficient. The mean hemoglobin of Indonesian males was similar to the American reference population at 152 g/L with comparable hemoglobin distribution. The mean hemoglobin of the Indonesian females was 2 g/L lower than that of the American reference population, which may be the result of incomplete exclusion of subjects with milder form of iron deficiency. When the WHO cutoff (Hb < 120 g/L) was applied to female subjects, the sensitivity of 34.2% and specificity of 89.4% were more comparable to the test performance for white American women, in contrast to those of the lower cut-off. On the basis of the finding of hemoglobin distribution of men and the test performance of anemia (Hb < 120 g/L) for detecting iron deficiency for women, it is concluded that there is no need to develop different cut-off points for anemia as a tool for iron-deficiency screening in this population. (author's)
In: Prevention of micronutrient deficiencies: tools for policymakers and public health workers, edited by Christopher P. Howson, Eileen T. Kennedy, and Abraham Horwitz. Washington, D.C., National Academy Press, 1998. 45-102.Since iron is an essential nutrient, deficiency of such would result in a wide range of functional consequences including anemia. Development of iron deficiency is indicated by low plasma ferritin, low transferrin saturation and elevated free erythrocyte protoporphyrin, serum transferrin receptors, and low hemoglobin. Iron balance is favored by the ingestion of sufficient iron in food. Improvement of the supply, intake and bioavailability of food iron and food fortification are identified as sustainable approaches to the elimination of iron deficiency. Estimates of relative effectiveness and cost per Disability Adjusted Life Year (DALY) of different supplementation strategies as well as comparison with iron fortification computed by various models are presented by the WHO, UN International Children's Emergency Fund and UNU. Studies of developing countries such as Thailand, India, South Africa, Guatemala, and Venezuela have been conducted addressing the effectiveness of iron fortification.