Understanding Anemia

122 Pages·2017·2.23 MB·English

UNDERSTANDING ANEMIA
GUIDANCE FOR CONDUCTING A LANDSCAPE ANALYSIS
SECOND EDITION
ABOUT SPRING
The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project is a five-
year USAID-funded cooperative agreement to strengthen global and country efforts to scale up high-impact
nutrition practices and policies and improve maternal and child nutrition outcomes. The project is managed
by JSI Research & Training Institute, Inc., with partners Helen Keller International, The Manoff Group, Save the
Children, and the International Food Policy Research Institute.
ACKNOWLEDGMENTS
The Understanding Anemia: Landscape Analysis Guidance was developed by SPRING staff Ms. Alexis D’Agostino,
Ms. Teemar Fisseha, and Dr. Sorrel Namaste. Dr. Gary Brittenham provided invaluable conceptual guidance,
technical review, and feedback throughout the development of this resource. Special thanks go to additional
SPRING staff members who developed and reviewed the content: Ms. Carrie Hubbel Melgarejo, Ms. Theresa
McMenomy, Dr. Denish Moorthy, Ms. Hillary Murphy, and Mr. Victor Pinga. We also thank the SPRING
Knowledge Management team for their development of the final resource, especially Mr. Jimmy Bishara, Mr.
Daniel Cothran, Ms. Heather Davis, and Ms. Paula Lancaster. We extend our appreciation to the USAID staff in
Washington for their continued support of this work and helpful feedback throughout the process.
This resource would not have been possible without the contributions of the following expert reviewers (listed
in alphabetical order): Dr. Lindsay Allen, Ms. Jeniece Alvey, Dr. Erik Boy, Dr. Bernard Brabin, Dr. Alex Brito,
Ms. Jennifer Busch-Hallen, Dr. Christine Northrop-Clewes, Dr. Omar Dary, Dr. Luz Maria De-Regil, Ms. Sonia
Dominguez, Dr. Reina Engle-Stone, Ms. Karen Fogg, Dr. Patrizia Fracassi, Dr. Rosalind Gibson, Dr. Mary
Hodges, Dr. Maria Elena Jefferds, Dr. Elizabeth Jordan, Dr. Justine Kavle, Dr. Rolf Klemm, Dr. Laura McGough,
Dr. Francis Ngure, Dr. Jennifer Nielsen, Dr. Helena Pachon, Dr. Michel Pacqué, Ms. Naomi Printz, Dr. Rochelle
Rainey, Dr. Lisa Rogers, Dr. Fabian Rohner, Ms. Elaine Roman, Dr. S. René Salgado, Ms. Jesse Shapiro, Ms.
Katherine Wolfe, Dr. Bradley A. Woodruff, and Dr. Yaobi Zhang.
RECOMMENDED CITATION
SPRING. 2017. Understanding Anemia: Guidance for Conducting a Landscape Analysis. Second Edition. Arlington,
VA: Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project
First edition published: 2016
Revised January 2017
SPRING
JSI Research & Training Institute, Inc.
1616 Fort Myer Drive, 16th Floor
Arlington, VA 22209 USA
Tel: [phone]
Fax: [phone]
Email: [email protected]
Web: www.spring-nutrition.org
Photo courtesy of USAID and Feed the Future
This report is made possible by the generous support of the American people through the United States Agency for International
Development (USAID) under the terms of the Cooperative Agreement No. AID-OAA-A-11-00031 (SPRING), managed by JSI Research
& Training Institute, Inc. (JSI). The contents are the responsibility of JSI, and do not necessarily reflect the views of USAID or the
United States Government.
UNDERSTANDING ANEMIA
GUIDANCE FOR CONDUCTING A LANDSCAPE ANALYSIS
SECOND EDITION
UNDERSTANDING ANEMIA
ii GUIDANCE FOR CONDUCTING A LANDSCAPE ANALYSIS
UNDERSTANDING ANEMIA
Contents
Acronym List ------------------------------------------------------------------------------ v
Overview of the Landscape Analysis Guidance -----------------------------------------------------1
Using the Landscape Analysis Tool ------------------------------------------------------------- 5
Gathering Information on Anemia ------------------------------------------------------------- 6
Step 1: Characterize Anemia Prevalence ----------------------------------------------------------12
Step 2: Establish Causes of Anemia -------------------------------------------------------------18
Infection ----------------------------------------------------------------------------- 20
Malaria ----------------------------------------------------------------------------21
Soil-Transmitted Helminths ----------------------------------------------------------- 24
Schistosomiasis -------------------------------------------------------------------- 26
Micronutrient Deficiencies --------------------------------------------------------------- 29
Iron Deficiency --------------------------------------------------------------------- 30
Vitamin A Deficiency ------------------------------------------------------------------34
Folate Deficiency ------------------------------------------------------------------- 38
Vitamin B12 Deficiency --------------------------------------------------------------- 40
Zinc Deficiency ----------------------------------------------------------------------42
Inflammation ---------------------------------------------------------------------------44
Genetic Red Blood Cell Disorders -----------------------------------------------------------46
Step 3: Review Anemia Policies ----------------------------------------------------------------49
Step 4: Assess Status of Anemia Interventions --------------------------------------------------- 52
Case Management of Malaria ------------------------------------------------------------- 56
Deworming for Schistosomiasis ----------------------------------------------------------- 58
Deworming for Soil-Transmitted Helminths ---------------------------------------------------61
Indoor Residual Spraying ----------------------------------------------------------------- 64
Intermittent Preventive Treatment during Pregnancy -------------------------------------------- 66
Long-Lasting Insecticide-Treated Bed Nets --------------------------------------------------- 68
Dietary Diversification ------------------------------------------------------------------- 70
Dietary Modification ---------------------------------------------------------------------73
GUIDANCE FOR CONDUCTING A LANDSCAPE ANALYSIS iii
UNDERSTANDING ANEMIA
High-dose Vitamin A Supplementation for Children ---------------------------------------------75
Industrial Food Fortification- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -77
Iron-Folic Acid Supplementation in Women of Reproductive Age ---------------------------------- 80
Maternal, Infant, and Young Child Nutrition -------------------------------------------------- 83
Routine Micronutrient Interventions for Children ---------------------------------------------- 86
Clean Play Spaces ---------------------------------------------------------------------- 89
Handwashing --------------------------------------------------------------------------91
Use of Basic and Safely Managed Sanitation Facilities- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 93
Use of Safely Managed Drinking Water Services ----------------------------------------------- 95
Water Treatment ------------------------------------------------------------------------97
Delayed Cord Clamping ------------------------------------------------------------------ 99
Family Planning ------------------------------------------------------------------------101
Biofortification -------------------------------------------------------------------------103
Increased Production of Nutrient-Rich Foods -------------------------------------------------105
Promotion of Food Safety ----------------------------------------------------------------107
Counseling and Management of Genetic Blood Disorders ---------------------------------------109
Next Steps and Resources ------------------------------------------------------------------- 111
iv GUIDANCE FOR CONDUCTING A LANDSCAPE ANALYSIS
UNDERSTANDING ANEMIA
Acronym List
AGP alpha-1-acid-glycoprotein
CFSVA Comprehensive Food Security and Vulnerability Analysis
CRP C-reactive protein
DDT organochloride
DHIS2 District Health Information System2
DNA deoxyribonucleic
ELISA enzyme-linked immunosorbent assay
G6PD glucose-6-phosphate deficiency
GAIN Global Alliance for Improved Nutrition
HbS sickle hemoglobin
HIV human immunodeficiency virus
HPLC high-performance liquid chromatography
IFA iron-folic acid
IPTp intermittent preventive treatment during pregnancy
IRS indoor residual spraying
ITN insecticide-treated bed nets
IYCF infant and young child feeding
IZiNCG International Zinc Nutrition Consultative Group
LLIN long-lasting insecticide-treated bed net
SP sulfadoxine-pyrimethamine
STH soil-transmitted helminth
GUIDANCE FOR CONDUCTING A LANDSCAPE ANALYSIS v
UNDERSTANDING ANEMIA
sTfR serum transferrin receptors
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
WHO World Health Organization
vi GUIDANCE FOR CONDUCTING A LANDSCAPE ANALYSIS
UNDERSTANDING ANEMIA
Overview of the Landscape Analysis many different ways and they are closely related
Guidance to a context assessment or situation analysis. For
this guidance, we define a landscape analysis as
Anemia is a major public health problem. It is
a detailed assessment that uses primary and/
characterized by low levels of hemoglobin, a protein
or secondary data to describe a problem and
that carries oxygen throughout the body. The effects
the policies and interventions already in place to
of anemia include reduced cognitive and physical
address this problem, in a given setting.
development in children, fatigue, and reduced
physical stamina and productivity for people of While the final format and output of a completed
all ages (Low et al. 2013; Lozoff 2007; Murray- anemia landscape analysis will vary, your landscape
Kolb 2013; Pasricha et al. 2014). During pregnancy, analysis should include, at a minimum—
anemia increases the risk of preterm delivery, low
• introduction to the anemia situation in your
birthweight, and maternal and neonatal mortality
country
(Rahman et al. 2016).
• description of the methods used to conduct the
Anemia disproportionately affects young children,
landscape analysis, including how you gather
pregnant women, and women of reproductive
information to include in the landscape analysis
age. Globally, 43 percent of children under 5 years
of age, 38 percent of pregnant women, and 29
• discussion of the risk factors for, or causes of,
percent of women of reproductive age are anemic
anemia that are present in your country
(Kassebaum et al. 2014; Kassebaum and GBD 2013
Anemia Collaborators 2016). More information • overview of the policy situation in your country,
on the populations most affected by anemia as it relates to anemia
is provided in the Step 1: Characterize Anemia
• discussion of the coverage and implementation
Prevalence section of this guidance. Anemia is
of anemia prevention and reduction activities.
caused by multiple factors, with the main types of
factors being infection, micronutrient deficiency, For country examples of anemia landscape analyses,
inflammation, and genetic blood variations. More please visit the Next Steps and Resources section.
information about the causes of anemia is provided
in the Step 2: Establish Causes of Anemia section WHY CONDUCT AN ANEMIA LANDSCAPE ANALYSIS?
of this guidance. Recognizing the contributions Tackling the problem of anemia—a major
from different sectors can better promote effective endeavor—requires policymakers and implementers
integration of anemia-related policies and programs. across a country to be committed and to show
More information on the policies and interventions leadership. The United States Agency for
to reduce anemia can be found in the sections International Development’s (USAID) Integrated
Step 3: Review Anemia Policies and Step 4: Assess Anemia Prevention and Control Toolkit on the
Status of Anemia Interventions of this guidance. Knowledge for Health website (www.k4health.
org/toolkits/anemia-prevention) identifies three
WHAT IS A LANDSCAPE ANALYSIS? key steps for developing a strategy for anemia
Landscape analyses have been conducted in prevention and control:
GUIDANCE FOR CONDUCTING A LANDSCAPE ANALYSIS 1
UNDERSTANDING ANEMIA
1. Know the problem. this guidance document and/or the accompanying
Excel-based tool to review an existing anemia
2. Raise awareness and develop partnerships.
landscape analysis.
3. Identify interventions and implementation plans.
This guidance leads you through the process of
Conducting an anemia landscape analysis will conducting a landscape analysis to understand the
help stakeholders “Know the problem.” With this anemia situation in your country. Box 1 explains
information, you can easily move on to the next two the information included in the guidance
steps of strategy development. It is important to document. Throughout the guidance, we offer
note that the three-step process can be circular. For suggestions about how to use the information and
example, participation in the process of “knowing incorporate it into your landscape analysis.
the problem” may help raise awareness and develop
WHO SHOULD BE INVOLVED IN DEVELOPING A
partnerships with stakeholders not previously
LANDSCAPE ANALYSIS?
involved in anemia work.
A variety of factors cause anemia and multiple
sectors are involved in controlling and treating
WHO SHOULD USE THIS ANEMIA GUIDANCE AND
it, so this exercise will benefit from input from
TOOL?
various sectors and stakeholder groups. Including
The guidance is primarily directed at technical
multiple voices in this process, from the beginning,
experts planning to carry out a landscape analysis;
creates an awareness of the problem of anemia
the guidance will also be of interest to anyone looking
and ownership of the process of combating anemia.
for a better understanding of anemia in their country:
Conducting a landscape analysis should include
government staff in anemia-related ministries,
staff from government, along with representatives
nutrition program implementers, and planning staff
of civil society, donors, academia, United Nations
in anemia-related sectors. The process of developing
agencies, and the private sector who work in areas
an anemia landscape analysis should include
that include—
participation by multiple stakeholders working
together to ensure all relevant and existing data are
• health
included and to build buy-in.
• water and sanitation
HOW DO YOU USE THE ANEMIA LANDSCAPE
• education
GUIDANCE DOCUMENT?
The Guidance for Conducting a Landscape Analysis • agriculture
and accompanying Excel-based Anemia Landscape
• gender and social welfare
Analysis Tool provide the reader with a guide and
tool to develop an anemia landscape analysis • industry
that includes context-specific evidence, and it
• finance
identifies areas that should be prioritized to guide
anemia efforts in your country. You can also use • statistics.
2 GUIDANCE FOR CONDUCTING A LANDSCAPE ANALYSIS