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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.
Low sensitivity of total lymphocyte count as a surrogate marker to identify antepartum and postpartum Indian women who require antiretroviral therapy.
Journal of Acquired Immune Deficiency Syndromes. 2007 Nov; 46(3):338-342.Some studies support the use of total lymphocyte count (TLC) as a surrogate marker for CD4 cell count to guide antiretroviral therapy (ART) initiation. However, most of these studies have focused on nonpregnant adults. In light of expanding ART access through prevention of mother-to-child transmission (PMTCT)-plus programs in resource-limited settings, we assessed the sensitivity, specificity, and positive predictive value (PPV) of TLC for predicting low CD4 counts in antepartum and postpartum women in Pune, India. CD4, TLC, and hemoglobin were measured at third trimester, delivery, and 6, 9, and 12 months postpartum (PP) in a cohort of 779 HIV-infected women. Optimal TLC cutoff for predicting CD4 < 200 cells/mm3 was determined via logistic regression where sensitivity, specificity, PPV, and an area under the receiver operating characteristic (ROC) curve were calculated. Among the 779 women enrolled, 16% had WHO clinical stage 2 or higher and 7.9% had CD4 < 200 cells/mm3. Using 2689 TLC-CD4 pairs,the sensitivity, specificity, and PPV of TLC < 1200 cells/mm3 for predicting CD4 < 200 cells/mm3 was 59%, 94%, and 47%, respectively. The sensitivity of TLC < 1200 cells/mm3 cutoff ranged between 57% and 62% for time points evaluated. Addition of hemoglobin < 12 g/dL or < 11 g/dL increased the sensitivity of TLC to 74% to 92% for predicting CD4 < 200 cells/mm3 but decreased the specificity to 33% to 69% compared to TLC alone. A combination of TLC, hemoglobin, and WHO clinical staging had the highest sensitivity but lowest specificity compared to other possible combinations or use of TLC alone. The sensitivity and specificity of TLC < 1200 cells/mm3 to predict a CD4 < 350 cells/mm3 was 31% and 99%, respectively. Our data suggest that antepartum and PP women with TLC < 1200 cells/mm3 are likely to have CD4 < 200 cells/mm3. However, the sensitivity of this TLC cutoff was low. Between 45% and 64% of antepartum and PP women requiring initiation of ART may not be identified by using TLC alone as a surrogate markerfor CD4 < 200 cells/mm3. The WHO-recommended TLC cutoff of < 1200 cells/mm3 is not optimal for identifying antepartum and PP Indian women who require ART. (author's)
Geneva, Switzerland, WHO, 1992. 100 p.The discussion of the prevalence of anemia in women focused on definitions of nutritional anemia, cause of nutritional anemia, and the sources of data and estimation methods. Tables are provided by country and region for hemoglobin levels (mean and percentage below the mean for lactating women, for pregnant women, for nonpregnant women, and all women) and for serum iron, serum folate, and serum vitamin B12 (mean and percentage below the norm). WHO's Maternal Health and Safe Motherhood Program is the repository for data. Nutritional anemia is caused by malnutrition such that the hemoglobin content of the blood is lower than normal as a result of deficiency in 1 or more essential nutrients. Iron is usually stored in the bone where it can be used to increase the rate of formation of hemoglobin to satisfy increased needs, such as during pregnancy. Causes of anemia are low nutrient intake, poor absorption or utilization, or increased nutrient losses or demands. Iron is absorbed more readily in the presence of animal foods or vitamin C and inhibited by meals of tea or high levels of bran. Other causes are malaria, sickle cell disease, bacterial infections, blood loss from obstetric causes, or intestinal parasites, such as hookworms. Underlying factors are poverty and hardships from poor nutrition, water shortages, food taboos, inadequacies in food production and storage and the absence of effect systems of social security. Anemia can be a direct cause of death or contribute to hemorrhage, which can lead to death, e.g., an anemic mother during childbirth cannot afford to lose less than 150 ml of blood, compared with a healthy mother's 1 liter blood loss. Anemic mothers have a lower resistance to infection, and surgery poses a risk. WHO anemia levels are determined as < 120 g/L of hemoglobin for nonpregnant adult women and < 110 g.L for pregnant adult women, < .50mg/L serum iron, < 3 ng/ml serum folate concentration, and < 100 pg/ml serum vitamin B12. 2,170 million persons were found to be anemic according to WHO definitions. The most affected groups were pregnant women, preschool age children, low birth weight infants, other women, the elderly, school age children, and adult men. In developing countries, prevalence rates are 40-60% among pregnant women. In developed countries, 18% if pregnant women and 12% of nonpregnant women are anemic. Over 33% of women in the world were anemic; the problem is particularly acute in Asia.
Tropical Medicine and International Health. 2000 Mar; 5(3):214-21.The WHO recommends that all pregnant women be screened for anemia. In rural Africa this is often done by clinical examination which is known to have variable reliability. The recently developed WHO Haemoglobin Colour Scale may be the answer to this problem as it is simple and reliable. This study examines the training procedure recommended by WHO for the Haemoglobin Colour Scale when resources are very limited. The authors trained 7 laboratory technicians from the Medical Research Council Laboratories Hospitals, Fajara, The Gambia, and 13 Community Health Nurses (CHNs) from North Bank Division East, a rural area in The Gambia, to use the Haemoglobin Colour Scale. The CHNs used the Scale to estimate hemoglobins on all new bookings to antenatal clinics for a period of 1 month and recorded how they were managed. At the end of the study period they completed a qualitative questionnaire about the Scale. Both groups of trainees were successfully trained although the WHO protocol for training was impossible to follow due to resource limitations. 8 of the 13 trained CHNs used the Scale in practice and recorded 307 estimations with a mean hemoglobin of 9.1 g/dl. The results were normally distributed. 6 of the 9 patients with Hb readings of <4 g/dl were managed correctly. In response to the questionnaire the CHNs thought the Scale was cheap, easy and quick to use and as good as the hemoglobinometer they had used previously. The main criticism was that it was not robust enough. The development of a low-technology, cheap, simple, and reliable method for measuring hemoglobin is a welcome development. However, a simpler training procedure and a standard way of measuring observer performance are necessary. (author's)
SOUTH AFRICAN MEDICAL JOURNAL. 1992 May 2; 81(9):444-5.The advantages and side effects of the injectable contraceptive, Depo-Provera, are highlighted. It has been available to women in South Africa and in about 90 developing and developed countries for 20 years. It is an effective and convenient contraceptive with no serious side effects. Its failure rate is 0.2-0.6/100 woman years. Nevertheless there is still concern that it may cause breast cancer because original tests of Depo-Provera using beagles indicated that it may increase breast cancer risk. WHO and the UK Committee on Safety of Medicines have since dropped the requirement of testing of beagles since they cannot predict the effects of steroids on women. A 12-year WHO multinational, hospital-based case-control study on neoplasia and hormonal contraceptives reassures Depo-Provera's safety. For example, the risk of breast cancer did not increase with duration or in women who had used it for >5 years. The risk was higher, however, among women who had used it for <4 years, particularly <35-year old women. The same holds true for oral contraceptive (OC) users. It has been suggested that this slight increase is because Depo-Provera and OCs may accelerate growth of some existing, previously undetected breast tumors. The WHO study verifies that the benefits of Depo-Provera surpass the side effects which include disturbed bleeding patterns, weight gain, and headaches. For example, it decreases the risk of ovarian and endometrial cancer. It is even more beneficial in developing countries where women often suffer from anemia because it increases hemoglobin levels. Further since women in developing countries cannot always comply and take their OCs, Depo-Provera can grant them the protection they need against pregnancy thus saving many lives. Depo-Provera should be available in developed as well as in developing countries.
Nutritional anemia: its understanding and control with special reference to the work of the World Health Organization.
American Journal of Clinical Nutrition. 1979 Feb; 32(2):368-417.Since 1949, the World Health Organization, recognizing the public health importance of nutritional anemia, has sponsored efforts directed towards its understanding and control. During this period, often as a result of the work of the Organization, advances have been made in many areas. Basic understanding of iron, folate, and vitamin B12 nutrition, and the various factors which may influence the availability and requirements of these factors, has greatly increased. Surveys in a number of countries have highlighted the widespread prevalence of nutritional anemia, particularly in developing countries. The major factor responsible is a deficiency of iron, with folate deficiency also playing a role in some population groups, especially in pregnant women. There is increasing evidence that anemia adversely affects the health of individuals and may have profound socioeconomic consequences. Control of nutritonal anemia is possible by providing the deficient nutrient(s) either as therapeutic supplements or by fortification of commonly used foodstuffs. Some control programs are reviewed and suggestions for further action are outlined. The Organization still has an important role to play in this field, encouraging the development of control programs and providing advice and technical assistance to member countries. (author's)