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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.
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)
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)
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)
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)
Lancet. 1999 Apr 10; 353(9160):1251.In Andhra Pradesh, India, women's groups have formed a Group Against Targeted Sterilization (GATS) to protest the creation of sterilization camps created by government officials in Hyderabad and Secunderabad, where 20,000 people, mostly women, were sterilized to meet a quota deadline. GATS charges that the women were offered incentives to undergo sterilization and that those who resisted were threatened with disconnection of their household utilities. GATS does not oppose family planning or female sterilization but opposes the dehumanizing use of incentives and threats. The impoverished women who are targeted for mass sterilization undergo the procedures in unhygienic settings. Many are anemic, which is a contraindication to any surgical procedure, and they receive no postoperative care. The targeted sterilizations were performed under the banner of the Indian Population Project (IPP), which is funded by the World Bank. GATS fears that the entire IPP will be diverted from the intention of its donor (the World Bank is committed to a target-free approach) and will become subservient to population control efforts.
SYNOPSIS. 1998 Jan; (2):1-8.The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.
Implementing the ICPD Plan of Action in Central Asian Republics and Kazakhstan (CARAK). Kyrgyzstan. Breast-feeding is best.
ENTRE NOUS. 1995 May; (28-29):11.The socioeconomic problems which began in Kyrgyzstan in 1990 have impacted on the health of the people living there. A major decline in income, living standards, and social security is reflected in the low fertility rate, high maternal and infant mortality, and shorter life expectancy. Tuberculosis, viral hepatitis, anemia, hypertrophy, and rachitis have become very common in young children. In order to remedy this situation, breast feeding has gained the importance of a national program. Other unresolved issues include the high neonatal mortality rate, and the increasing maternal mortality rate (from 76.4 per 100,000 live births in 1991 to 84.2 per 100,000 currently). There has been a functioning family planning service and a system of social patronage since 1989. In the latter system, a social worker takes charge of families at risk. One worker on average attends 30 families. The International Planned Parenthood Federation has financed 689 social patronage workers over the past year. International organizations have supported the supply of contraceptives through humanitarian aid. Because of this, the number of women accepting family planning is rising and the fertility rate is decreasing (from 28.2 per 1000 in 1991 to 26.9 in 1993).