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Maternal and Child Nutrition. 2017 Dec 22; 1-9.The World Health Organization (WHO) recommends iron-folic acid (IFA) supplementation during pregnancy to improve maternal and infant health outcomes. Multiple micronutrient (MMN) supplementation in pregnancy has been implemented in select countries and emerging evidence suggests that MMN supplementation in pregnancy may provide additional benefits compared to IFA alone. In 2015, WHO, the United Nations Children's Fund (UNICEF), and the Micronutrient Initiative held a “Technical Consultation on MMN supplements in pregnancy: implementation considerations for successful incorporation into existing programmemes,” which included a call for indicators needed for monitoring, evaluation, and surveillance of MMN supplementation programs. Currently, global surveillance and monitoring data show that overall IFA supplementation programs suffer from low coverage and intake adherence, despite inclusion in national policies. Common barriers that limit the effectiveness of IFA-which also apply to MMN programs-include weak supply chains, low access to antenatal care services, low-quality behavior change interventions to support and motivate women, and weak or non-existent monitoring systems used for programme improvement. The causes of these barriers in a given country need careful review to resolve them. As countries heighten their focus on supplementation during pregnancy, or if they decide to initiate or transition into MMN supplementation, a priority is to identify key monitoring indicators to address these issues and support effective programs. National and global monitoring and surveillance data on IFA supplementation during pregnancy are primarily derived from cross-sectional surveys and, on a more routine basis, through health and logistics management information systems. Indicators for IFA supplementation exist; however, the new indicators for MMN supplementation need to be incorporated. We reviewed practice-based evidence, guided by the WHO/Centers for Disease Control and Prevention logic model for vitamin and mineral interventions in public health programs, and used existing manuals, published literature, country reports, and the opinion of experts, to identify monitoring, evaluation, and surveillance indicators for MMN supplementation programs. We also considered cross-cutting indicators that could be used across programme settings, as well as those specific to common delivery models, such as antenatal care services. We then described mechanisms for collecting these data, including integration within existing government monitoring systems, as well as other existing or proposed systems. Monitoring data needs at all stages of the programme lifecycle were considered, as well as the feasibility and cost of data collection. We also propose revisions to global-, national-, and subnational-surveillance indicators based on these reviews.
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.
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)
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)
Journal of Tropical Pediatrics. 2006 Apr; 52(2):75-77.As a result of accumulating evidence about the benefits of exclusive breastfeeding, the World Health Organization issued a statement recommending exclusive breastfeeding for 6 months. This document advised that further studies are needed for assessment of the risk of micronutrient deficiencies, especially in susceptible infants. These infants include those living in areas where iron, zinc and vitamin A deficiencies are prevalent. Upon this word of caution and with recommendations that iron supplementation be started at 4–6 months of age in breastfed infants, such supplementation has been started in some developing countries such as Turkey and Brazil. However current evidence regarding the actual need for this supplementation is inadequate. (excerpt)
EARTH TIMES. 1996 Oct 16-31; 9(18):8.Vitamin A, iodine, and iron are widespread, cheap, available, and needed in small quantities by the human body in order to remain healthy. Many people, however, especially women and children, do not consume adequate quantities of these micronutrients. Indeed, vitamin deficiency affects more than 200 million children worldwide, and a lack of vitamin A supplementation could be the cause of 1-3 million child deaths per year. The problem remains particularly serious in 76 countries. Vitamin A affects vision and the immune system such that deficiency can cause blindness, delay recovery from diarrhea, and cause an episode of measles to be more severe. Vitamin A deficiency is more likely to be found in arid regions, among the poor, and in areas without a historical pattern of eating vitamin A-rich foods. Supplementation readily corrects the problem. The author notes that the United Nations Children Fund (UNICEF) has helped make countries aware of the problem of micronutrient deficiencies.
Hunger and malnutrition: the determinant of development: the case for Africa and its food and nutrition workers.
East African Medical Journal. 1992 Aug; 69(8):424-7.Hunger and malnutrition in Africa have been on the increase since the 1960s. During the 1970s, it is estimated that 30 million people were directly affected by famine and malnutrition. About 5 million children died in 1984 alone. In Mozambique during the 1983-84 famine, about 100,000 people perished. In Ethiopia, Sudan, Somalia, Liberia, and Angola armed conflicts compound the problem. Ethiopia alone had 9 million famine victims in 1983. The most common form of malnutrition in Africa is protein energy deficiency affecting over 100 million people, especially 30-50 million children under 5 years of age. Almost another 200 million are at risk. Iron deficiency, commonly called anemia, also affects 150 million people, mostly women and children. Iodine deficiency leads to disorders like mental retardation, cretinism, deafness, abortion, low resistance to disease, and goiter and this affects 60 million with about 150 million more at risk. Vitamin A deficiency causes blindness and low resistance to disease and affects about 10 million. Protein energy deficiency is treated by using donated foods in hospitals, rehabilitation centers, day care centers, and feeding centers. There are no community programs for anemia, or vitamin A or iodine deficiencies. Vaccines for preventing and drugs for treating diseases that cause malnutrition are imported. Therefore, African food and nutrition professionals met in 1988 and created the Africa Council for Food and Nutrition Sciences (AFRONUS) to eliminate famine and malnutrition in Africa. Activities have started in: 1) developing contacts between the workers in food and nutrition; 2) assessing the situation of food and nutrition in Africa; 3) developing an action plan; 4) implementing the plan; and 5) monitoring progress. Food and Nutrition Policy Guidelines have also been prepared by AFRONUS for food and nutrition workers. Africa has enough natural resources to solve the problem of hunger and malnutrition, but these resources have to be harnessed.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(3):302-16.Tables present data on the prevalence of anemia in the world. Anemia may be defined as a state in which the quantity or the quality of circulating red cells is reduced below the normal level. The most common way to diagnose anemia is by measuring the hemoglobin concentration in the blood which is controlled by a homeostatic mechanism. It varies slightly among normal subjects. In 1959, the World Health Organization (WHO) proposed levels of hemoglobin concentrations for different groups of individuals that could be considered as the lower limits of normality. Subjects with values below these levels were considered to be anemic. The causes of anemia, which are multiple, include a deficiency of hemopoietic factos, genetic disorders causing hemolytic anemias, infections including malaria, and increased losses of blood caused inter alia by infections such as ankylostomiasis or schistosomiasis. A survey of the prevalence of anemia in women in developing countries was published by WHO in 1982. It estimated the prevalence of nutritional anemia in developing countries (other than China) at 60% in pregnant women and 47% in non-pregnant women. The prevalence of anemia in all women of reproductive age was estimated at 49%. It appears that studies on the prevalence of anemia were conducted regularly during the 1960-84 period, with the exception of studies on elderly people most of which were conducted before 1970. Most studies included from 100 to 300 subjects. Studies on adolescents usually covered fewer than 100 subjects. The tables provide no data on the severity of anemia, i.e., the percentage of subjects with a hemoglobin concentration below a specific level. On the basis of the present review, the total prevalence of anemia in the world is most likely about 30%. Expressed in absolute numbers this means some 1300 million people of the estimated world population of 4440 million in 1980. For the developing regions of the world, the prevalence of anemia is probably about 36% or 1200 million people, and for the more developed regions about 8% or just under 100 million people. Young children and pregnant women are the most affected groups with an estimated global prevalence of 43% and 51%, respectively. The regions with the highest overall prevalence of anemia are South Asia and Africa. With the exception of pregnant women, the prospects for the prevention of iron deficiency anemia in a population are poor at the present time. Iron fortification and the daily administration of an iron supplement present great problems in developing countries, and they will not be resolved easily.