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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.
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)
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)
[L'Oreal aids women in science in the countries of the South] L'Oreal aide la science au feminin dans les pays du Sud.
EQUILIBRES ET POPULATIONS. 2001 Mar; (66):4.The L’Oreal Award for Women in Science rewards 5 scientists annually with UNESCO support. As such, L’Oreal, a cosmetics manufacturer, is making an effort to support women’s role in research in both developed and developing countries. Professor Adeyinda Gladys Falusi, a 2001 award recipient, describes the difficult conditions in which she has studied, for 25 years, the molecular genetics of often seen hereditary blood diseases in Nigeria, such as falci-form anemia. In Africa, and especially Nigeria, a lack of resources frustrates research. When resources are available, the equipment is old and poorly maintained. Energy and transport problems also exist, including frequent power outages. It is common for lights and computers to lose power in the middle of an experiment. Regarding information sources, research centers and universities lack funding to subscribe to scientific journals. Although many of her colleagues have gone to work in countries with better research conditions, Professor Falusi prefers to remain in Nigeria with hopes of having a more significant impact upon her society. She hopes her research will directly and significantly help populations. Professor Falusi visits schools to help prevent the diseases she researches, such as anemia, affecting 3 million people in Nigeria and associated with multiple complications. She also researches malaria. Falusi and her colleagues lack the resources and support they need to properly teach the population about its health and provide access to health services. They depend upon international aid, which should be more forthcoming.
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)
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)
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)
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)
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)
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.
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)
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)
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)
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)
INDIAN PEDIATRICS. 1997 Mar; 34(3):263-5.An estimated 6.6 million of the 12.2 million deaths that occur each year among children under 5 years of age in developing countries are associated with malnutrition. The World Health Organization, in collaboration with other United Nations agencies and nongovernmental organizations, has launched campaigns focused on protein-energy malnutrition, iodine deficiency disorders, vitamin A deficiency, and iron deficiency anemia. By January 1996, 96 countries had developed national plans of action for nutrition and an additional 41 had a plan under preparation. Various types of micronutrient malnutrition (especially iron deficiency) not only are important causes of disability in themselves, but also make the body less able to withstand infections and other sources of morbidity. Iron supplementation, salt iodization, and vitamin A supplementation--in addition to the production, distribution, and preparation of healthy foods--are essential to nutritional health.
Integrated management of childhood illness: conclusions. WHO Division of Child Health and Development.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1997; 75 Suppl 1:119-28.Studies have helped improve the guidelines for the integrated management of childhood illness (IMCI) as well as the WHO/UNICEF training course for teaching those guidelines to health workers in first-level health facilities. Those guidelines can lead to the appropriate management of sick children by health workers in first-level facilities. Field studies' results on the effectiveness of the guidelines are presented and important issues to address are identified. The paper also describes the process for adapting program guidelines to specific country situations and presents the broader IMCI strategy and the status of its implementation in several countries as of May 1997. The following issues in need of further attention are discussed: the performance of lower chest wall indrawing as a sign for referral, the specificity of the clinical signs of malaria in settings of low malaria prevalence, the performance of clinical signs in detecting anemia, and the performance of the guidelines in identifying children in need of referral. Program strategy objectives are to reduce the levels of child morbidity and mortality in developing countries, and to enhance child growth and development. IMCI activities are therefore organized to improve health workers' skills, health systems, and family and community practices.
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.
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.
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).
MOTHERCARE MATTERS. 1993 Apr-May; 3(1-2):13-4.This paper presents some of the recommendations from a recent World Health Organization technical meeting examining issues involved in detecting and managing anemia at the community, health center, and hospital levels. A woman at the community level should be asked whether she feels tired or breathless after doing a normal day's work, whether she experienced more than a cup full of vaginal bleeding in the pregnancy, if she delivered a child in the preceding twelve months, whether the pregnant woman is a young primigravida, if she required a blood transfusion for her last pregnancy, and if she had problems delivering the placenta during the last pregnancy. Affirmative responses to one or more of these questions indicate that the woman may be anemic. The pallor of her conjunctiva, tongue, palms of hands, and nail beds should be examined. A woman with no high risk factor and who is not pale should receive a standard dose of iron and folate for one month, malaria chemoprophylaxis according to the local situation, and should be seen again in one month. If the woman's history shows risk factors or she looks pale, she should be given an higher dose of iron and folate for one month, malaria chemoprophylaxis according to the local situation, and antihelminth if hookworm is endemic to the area, and she should be referred to the health center for supervision. Advice should be given on diet. Iron rich foods should be eaten with some animal foods or fresh fruit or tuber staples. She should avoid tea or coffee with her meal. The standard and higher doses of iron and folate are presented, followed by recommendations for action at the health center and district hospital levels.
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.
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)
Geneva, Switzerland, World Health Organization [WHO], 1991. vi, 96 p.WHO published this manual on the prevention and control of hookworm infection and anemia primarily for community health workers. The manual addresses the epidemiology, diagnosis, and management of these conditions. Its annexes provide details of appropriate examination techniques for hookworm and hookworm anemia surveys and sample survey considerations. It emphasizes the importance of thorough population surveys. The worldwide prevalence of infection with Ancylostoma duodenale and Necator americanus is about 25%. It occurs predominantly in developing countries, where prevalence may be as high as 80% in some areas. It is a major cause of iron deficiency anemia. Its presence indicates deficiencies in sanitation and health education. Many persons, including public health officials, are not interested in national control of hookworm infection, probably because it induces low mortality and it is technically difficult to measure and quantify hookworm-related morbidity. Control of hookworm infection and hookworm-related anemia is uncomplicated and effective. It consists of health education, effective sanitation, and treatment with antihelminthics and iron supplements. The manual's seven chapters cover the following: hookworms infecting humans; clinical pathology of hookworm infection; hookworm infection as a cause of anemia; epidemiology of hookworm infection; principles of prevention and control; assessing the situation; and practical prevention and control.
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, 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)