How can organisations get the tools they need to reduce anemia in women of reproductive age? Swedish company HemoCue has initiated a Global Call to Action to highlight the importance of screening and treatment of anemia in support of reaching the World Health Assembly’s target of a 50 percent reduction in the condition by 2025. As important as it is to fight anemia in this target group, it is equally important to do so for pregnant women, for children and where anemia can be caused by a preexisting condition like malaria. No one should be left behind
Why is anemia so important?
It is important as it has immediate effect, and unless it is acted upon, it has long-term effects. Iron deficiency anemia is the most widespread nutritional disorder in the world, affecting over 1.6 billion people, with the highest rates being in South Asia and Central and West Africa. It disproportionately affects children and women of reproductive age with far-reaching health consequences such as cognitive dysfunction and an inability to reach their full potential. It may be because nutritious food or iron supplements are not available, but it can also be that malaria during pregnancy has not been detected and acted upon. Untreated anemia due to malaria may lead to the inability to fulfill a healthy pregnancy and deliver a healthy baby. For this reason the 1,000 days between a woman’s pregnancy and her child’s second birthday offers a unique window of opportunity to shape a healthier and better future. The right nutrition during this 1,000-day window can have a profound impact on a child’s ability to grow, learn and rise out of poverty. Acting on anemia and reducing its prevalence can help drive progress against the other global nutrition targets; and to shape a society’s long-term health, stability and prosperity. Screening adolescent girls, pregnant women and newborn babies up to the age of 2 can make a real difference. “We need to act now,” says Lena Wahlhed, Director Alliance Development at HemoCue.”For each year we fail to act, we lose children, women, mothers – and they lose the ability to realise their life’s potential.”
What action is needed?
Improving nutrition and avoiding anemia is one of the best investments we can make to achieve lasting progress in global health and development. In order to know who is at most risk, screening for anemia is key. “We need the right indicators. We need to know not only if people are increasing their calorie intake, but whether their nutrition is improving,” says Ana Lucía Márquez Escobedo from the Hunger Project Mexico. In recognizing this, in 2012 the World Health Assembly (WHA) endorsed six global targets for improving maternal, infant and child nutrition with the goal of achieving them by 2025. One of the WHA targets is a 50 percent reduction in anemia among women of reproductive age. Maternal anemia is associated with a higher risk of mortality and morbidity in expectant mothers, and low birth weight, prematurity and risk for impaired physical and cognitive development for the baby. Given that it is also associated with other global nutrition targets — including stunting and wasting — WHA member states agreed that combatting anemia is vital for not only people’s health but also for their nations’ productivity and development.
Nutrition and the SDGs — and anemia?
The 17 Sustainable Development Goals and their associated 169 targets provide governments with a very clear picture of what they need to do, and what would serve as further value-added actions. According to target 2.2 in Global Goal 2 on Zero Hunger, the stated aim is to eradicate “all forms of malnutrition” and it mentions specific population subgroups including children under 5, adolescent girls, pregnant and lactating women, as well as older people. “We of course welcome that stunting, wasting and overweight are included, but these indicators will provide only a partial view of progress on the goal,” says José Manuel Roche, head of research at Save the Children UK, who has represented the organisation at multiple IAEG-SDG meetings. “Measuring anemia among adolescent girls, women of reproductive age and especially among lactating women, is very important.” Despite an initial proposal to measure six indicators for target 2.2 including stunting, wasting, overweight, breast- feeding, anemia and mid-upper arm circumference (MUAC), the measurement has been limited to the three lagging indicators, leaving out the leading indicators: anemia, breast-feeding and MUAC.
How to diagnose anemia
Christian Hellqvist Herder, consultant to Business Sweden, says: “I’d really like to see that recommendations [to measure anemia] are given because anemia is so important when it comes to nutrition.” Hellqvist Hverder says that developing a comprehensive global anemia-screening programme would be invaluable and advocated the measurement of hemoglobin — to detect anemia — using a solution where the results are delivered immediately and accurately. HemoCue develops and manufactures such measuring devices, which are already being used in more than 130 countries. The HemoCue Hb solution appears to be reaching those who need it most — whether that is in Asia, Africa or in Latin America.
Improve outcomes for the future
The early detection of anemia could have the potential to mitigate the long-term consequences of the disorder, says Dr. Jeffrey Griffiths, professor of public health and community medicine at Tufts University School of Medicine in Boston. “It used to be thought that so long as anemia was treated then, any earlier period of anemia could be wiped away,” he says. “However, studies from Central America show that children who had anemia treated were at a substantial disadvantage compared to children who had not had anemia. Early detection might mitigate these long-term consequences.”
According to Griffiths, that’s why the early detection of anemia using HemoCue’s hemoglobin measurement device — which he describes as “a global gold standard” and “accurate and easy to use” — is so vital. The benefits of HemoCue solutions for anemia are also recognized by Save the Children, which believes it is the most effective instrument to assess anemia in the field. Save the Children UK’s Manuel Roche says that while the Zero Hunger goal was aspirational, the way it was going to be measured should also “reflect the ambition expressed in the Agenda 2030 declaration.”
Lena Wahlhed adds: “In order to improve the outcomes for our future, we need to act now. The longer we wait; the longer it will take.”
The SDGs — leave no one behind
And looking ahead, given that every second pregnant woman and about 40 percent of pre-school children in developing countries are estimated to have anemia, the Hunger Project Mexico’s Márquez comments that now is the time to move from the discourse of the SDGs towards concrete, practical action and implementation. “The SDGs are about not leaving anyone behind. We need to make sure the agenda is owned by rural poor communities,” says Márquez. Where resources are limited, addressing anemia does not need to be a separate programme: it is of profound importance and can be included in malaria, malnutrition and HIV/AIDS programmes — but also as a general health indicator and in capacity-building initiatives. Although women and children are most vulnerable, it is too important to leave anyone behind. The time to act is now.