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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.
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.
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.
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)
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)
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)
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.
Washington, D.C., National Academy Press, 1998. xii, 207 p.Globally, micronutrient malnutrition affects approximately 2 billion people and carries adverse sequelae of premature death, poor health, blindness, growth stunting, mental retardation, learning disabilities, and low work capacity. In late 1980s, the US Agency for International Development (USAID) funded a randomized trial of vitamin A supplementation in developing countries. In this regard, the Office of Health and Nutrition of USAID has requested the Institute of Medicine's Board on International Health to evaluate global micronutrient deficiency prevention programs conducted in developing countries. The project was conducted in two phases. The first phase featured a 2-day workshop evaluating approaches to the prevention of micronutrient malnutrition and identified the elements that led to the programs' success. This book presents the findings of the workshop, which will provide the basis of the Phase 2 study. Chapter 1 summarizes the findings and recommendations of the workshop. Chapter 2 discusses key elements in the design and implementation of micronutrient interventions. Chapters 3-5 present the three background papers on iron, vitamin A, and iodine. The appendix contains the workshop study.