Abstract
Relatively little progress has been made in reducing anemia prevalence among women of reproductive age (WRA anemia). Interventions, policies and programs aimed at reducing WRA anemia have the potential to improve overall not only women’s, but also children’s health and nutrition outcomes. To our knowledge, this is the first review that aimed to compile evidence on the determinants and drivers of WRA anemia reduction in low- and middle-income countries (LMICs). We synthesized the available evidence on the determinants and drivers, including government policies and programs, of WRA anemia and their mitigation strategies across a wide range of countries and geographies, thus contributing to the complex and multifactorial etiology of anemia. We carried out a systematic review of published peer-reviewed and grey literature assessing national or subnational decline in WRA anemia prevalence and the associated drivers in LMICs. Among the 21 studies meeting our inclusion criteria, proximal determinants of healthcare utilization, especially during pregnancy and with the use of contraceptives, were strong drivers of WRA anemia reduction. Changes in other maternal characteristics, such as an increase in age at first pregnancy, BMI, birth spacing, and reduction in parity, were associated with modest improvements in anemia prevalence. Access to fortified foods, especially iron-fortified flour, was also a predictor of a decrease in WRA anemia. Of the intermediate determinants, an increase in household wealth, educational attainment and access to improved sanitation contributed significantly to WRA anemia reduction. Although several common determinants emerged at the proximal and intermediate levels, the set of anemia determinants and the strength of the association between each driver and WRA anemia reduction were unique in each setting included in this review. Further research is needed to provide targeted recommendations for each country and region where WRA anemia prevalence remains high.
Highlights
Anemia—a condition where the red blood cell count is reduced and the body’s ability to meet the oxygen demands of tissues is impaired—is a public health problem affecting approximately 1.76 billion people across the globe [1]
We aimed to identify how and to what extent trends in population levels and secular anemia determinants, as well as related programs and policies, contributed to the decrease in women of reproductive age (WRA) anemia prevalence across a wide range of geographies
Increased maternal age at pregnancy was associated with a significant decline in anemia in India [22,33], and adolescent pregnancy was consistently associated with higher odds of anemia compared to pregnant women of 20–49 years, over a ten-year period [37]. These findings suggest that interventions aimed at improving overall maternal nutrition, such as balanced energy protein supplementation, and reducing the rates of adolescent pregnancies could be effective in decreasing the prevalence of anemia among women of reproductive age
Summary
Anemia—a condition where the red blood cell count is reduced and the body’s ability to meet the oxygen demands of tissues is impaired—is a public health problem affecting approximately 1.76 billion people across the globe [1]. The WHO-defined hemoglobin (Hb) cut-offs, specific to age, sex and pregnancy status, are most widely used to diagnose anemia, with the threshold being
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