Maternal anaemia prevention and control in China: A policy review.

Maternal anaemia is a major public health problem. Developing maternal anaemia prevention and control policies is an important prerequisite for carrying out evidence-based interventions. This article reviews maternal anaemia prevention and control policies in China, identifies gaps, and provides references for other countries. We examined policies concerning maternal nutrition and other related literature in China, identified through key databases and government websites, and conducted a narrative review of the relevant documentations guided by the Smith Policy-Implementing-Process framework. A total of 65 articles and documents were identified for analysis. We found that Chinese government has committed to reducing maternal anaemia at the policy level, with established objectives and a clear time frame. However, most of policies were not accompanied by operational guidelines, standardized interventions, and vigorous monitoring and evaluation mechanisms, and 85% of the policies don't have quantifiable objectives on anaemia. Maternal anaemia prevention and control services offered in clinical settings were primarily nutrition education and anaemia screening. Population-based interventions such as iron fortification have yet to be scaled up. Furthermore, medical insurance schemes in some regions do not cover anaemia prevention and treatment, and in other regions that offer coverage, the reimbursement rate is low. The number and capacity of health professionals is also limited. Policy changes should focus on the integration of evidence-based interventions into routine antenatal care services and public health service packages, standardization of dosages and provision of iron supplementation, streamline of reimbursement for outpatient expenses, and capacity building of health professionals.

Assessment of Dietary Iron Intake and Sources in Early Childhood in a Nationally Representative Cross-Sectional Survey.

BACKGROUND: Iron deficiency has particular importance in early childhood because of its impact on growth and development. Preventive food-based strategies of iron deficiency require knowledge of intakes and sources of iron. OBJECTIVE: This study aimed to assess daily iron intakes (DIIs) in 2013, to compare them with the dietary reference values, to assess their evolution since 1981, and to identify iron food sources among nonbreastfed French children younger than 3 years. DESIGN: This was a nationwide cross-sectional survey conducted in 2013 in France to assess DIIs by means of comparing them with the dietary reference values. Parents' reported diet diaries were collected for 3 nonconsecutive days. PARTICIPANTS/SETTING: Of the 1,184 children enrolled in the study, 1,035 nonbreastfed healthy children aged 0.5 to 35 months stratified into 11 age groups were included after informed consent was obtained from parents and according to a weighted quota sampling method. MAIN OUTCOME MEASURES: DII from the different food sources and trends in their evolution from 1981 to 2013 was assessed. STATISTICAL ANALYSES PERFORMED: Results are expressed as median with interquartile range and range and mean ± SD. Student t test was used with the 2-sided α level of significance set at 5%. RESULTS: Mean ± SD DII was 6.7 ± 2.3 mg/d before 6 months, 8.2 ± 2.7 mg/d from 6 months to 1 year, and 7.0 ± 3.2 mg/d from 1 to 3 years. The prevalence of infants older than 7 months with a DII less than the dietary reference values was 52.5%, and that of young children was 30%. After slightly increasing until 2005, DIIs decreased thereafter. Formulas contributed to most of the DIIs up to 2 years of age. Cereals were the second largest contributor to DIIs, and meat accounted for a small part of iron intake. CONCLUSIONS: A substantial number of children between 6 months and 3 years of age were at risk of insufficient iron intake. This risk increased from 2005 to 2013. The role of formula in ensuring iron intake is highlighted. More research on health outcomes of low iron intakes is needed.

[Cost-benefit analysis on the intervention of application iron-fortified soy sauce for anemia in Deqing 15-54 years women, Zhejiang].

OBJECTIVE: To make a cost-benefit analysis on anemia intervention with iron-fortified soy sauce in 15-54 years old women. METHODS: The study was conducted in Deqing county, Zhejiang province in 2012-2013. A total 585 women as sampling size were estimated with statistical model and randomly selected by probability proportionate to size sampling. Hemoglobin were measured before intervention and after 15 months. The cost of the intervention project were collected with manpower, communication and other invest. The benefit was estimated with profiling model. RESULTS: After the intervention, the anemia prevalence of sampled women decreased from 31.1% to 21.9%(P<0.01). The major cost of the project was 156 400 RMB, and total benefits result ing from projects were 1 448 485 RMB. The cost-benefit ratio of the project is 1∶9.49. If investing one yuan can produce economic benefits of nearly 9.49 yuan, therefore, the intervention projectis worth to be scaling up. Sensitivity analysis showed the result of this study was stable. CONCLUSION: The intervention can significantly reduce the prevalence of anemia in women, and reduce the economic burden of the diseases. .

Use of iron supplement to prevent anemia in children aged six to 59 months attended at the Family Health Strategy (ESF) units in a city in Minas Gerais, Brazil / Uso de suplemento de ferro para prevenção da anemia em crianças de seis a 59 meses atendidas pela Estratégia Saúde da Família de um município de Minas Gerais, Brasil

Abstract Objectives: to evaluate the use of iron supplementation and associated factors in children aged six to 59 months attended at the Family Health Strategy units in a city in Minas Gerais (MG). Methods: a cross-sectional, analytical-exploratory study, carried out with 252 children aged six to 59 months, attended at ten units, between 2014 and 2016. A structured questionnaire was used to collect data on socioeconomic conditions, maternal health, child's health and the knowledge of those responsible regarding anemia and iron supplementation, in addition to analysis of the child's medical records /booklet to collect test results. Descriptive statistics, bivariate association analysis and logistic regression for multivariate analysis were performed. Results: only 22.6% of the children aged between six and 24 months were receiving iron supplement at the time of the interview. Considering children aged six to 59 months, 13.1% were supplemented and breastfeeding time (p=0.006) and the participation in childcare (p=0.042), were positively associated with the use of supplementation. Conclusion: most children aged six to 24 months were not receiving supplementation as recommended by the Ministry of Health, demonstrating the need to implement prevention programs, such as the National Iron Supplementation Program and training of professionals on the importance of health education in preventing childhood anemia.

Resumo Objetivos: avaliar o uso do suplemento de ferro e fatores associados em crianças de seis a 59 meses atendidas em unidades Estratégia Saúde da Família em município de Minas Gerais (MG). Métodos: estudo transversal, analítico-exploratório, realizado com 252 crianças na faixa etária seis a 59 meses, atendidas em dez unidades, entre 2014 e 2016. Utilizou-se questionário estruturado para coleta de dados sobre condições socioeconômicas, saúde materna, saúde da criança e conhecimentos dos responsáveis acerca da anemia e suplementação com ferro, além de análise do prontuário / caderneta da criança para coleta de resultados de exames. Realizou-se análise estatística descritiva, análise de associação bivariada e regressão logística para análise multivariada. Resultados: apenas 22,6% das crianças com idade entre seis e 24 meses estavam recebendo o suplemento de ferro no momento da entrevista. Considerando as crianças de seis a 59 meses, 13,1% eram suplementadas e o tempo de amamentação (p=0,006) e a participação na puericultura (p=0,042) apresentaram associação com o uso de suplemento. Conclusão: a maioria das crianças de seis a 24 meses não recebia a suplementação, demonstrando a necessidade de implementação dos programas de prevenção, como o Programa Nacional de Suplementação de Ferro e capacitação dos profissionais sobre a importância da educação em saúde para prevenção da anemia infantil.

Impact of Fortified Infant Cereals on the Burden of Iron Deficiency Anemia in 6- to 23-Month-Old Indonesian Infants and Young Children: A Health Economic Simulation Model.

Iron deficiency and iron deficiency anemia (IDA) are highly prevalent among Indonesian infants and young children (IYC). Severe IDA hampers mental development in young children and is linked to lower quality of life and lower productivity as adults. The consumption of fortified infant cereals (FIC) increases iron intake during the weaning period, thus reducing the social burden of IDA. In this manuscript, we aimed to assess the impact of FIC on the burden of IDA on IYC in Indonesia. We analyzed data for IYC aged 6-23 months from the fifth wave (2014-2015) of the Indonesia Family Life Survey (IFLS) and the Indonesia Demographic and Health Survey 2017 (IDHS-17). We adapted a health economic simulation model to estimate the impact of FIC that accounted for lifetime health and cost consequences in terms of reduced future income and DALYs. The mean Hb level was 10.5 ± 1.4 g/dL. Consumers of FIC had a reduced burden of disease (43,000 DALYs; USD 171 million) compared with non-consumers. The consumption of fortified infant cereals plays an important role in reducing the burden of IDA, and it might complement the available strategy of nutritional interventions to address this problem in Indonesian IYC.

Iron Fortification through Universal Distribution of Double-Fortified Salt Can Increase Wages and Be Cost-Effective: An Ex-Ante Modeling Study in India.

BACKGROUND: The alleviation of iron deficiency through iron supplementation has not effectively reduced anemia in India, mainly due to low compliance. Food fortification with iron is considered a viable alternative, and the provision of double-fortified salt (DFS; with iron and iodine) has been mandated in public health programs. Limited evidence exists on its benefit-cost ratio. OBJECTIVE: In this study we sought to estimate the economic benefit in terms of increased wages in relation to introduction of DFS in reduction of anemia and the cost of doing so. METHODS: The economic benefit of introducing DFS in India was derived using a series of mathematical, statistical, and econometric models using data from national surveys capturing earnings and dietary iron intake of the population. Anemia status was predicted from data on dietary intake, sanitation, and for women, menstrual losses. The impact of iron deficiency anemia (IDA) on wages was estimated using a Heckman Selection model and 2-stage least squares procedure. Benefit of DFS was estimated through increased wages attributed to anemia reduction compared with its cost. RESULTS: Men and women with IDA had lower wages (by 25.9%, 95% CI: 11.3, 38.1; and by 3.9%, 95% CI: 0.0, 7.7, respectively) than those without IDA. Additional iron intake through DFS was predicted to reduce prevalence of IDA (from 10.6% to 0.7% in men and 23.8% to 20.9% in women). The economic benefit-cost ratio of introducing DFS at a national level was estimated to be 4.2:1. CONCLUSIONS: Iron fortification delivered through DFS under a universal program can improve wages and be sufficiently cost-effective for its implementation at scale in India.

Impacto de la educación alimentaria nutricional en la prevención de la anemia ferropénica en niños menores de 5 años / Impact of nutritional food education on the prevention of iron deficiency anemia in children under 5 years old

INTRODUCCIÓN: La anemia es una condición en la cual el número de eritrocitos es insuficiente, condicionando así la capacidad para transportar oxígeno a cada parte del cuerpo. Esta afecta principalmente a niños menores de 5 años, gestantes y mujeres en edad fértil. Al 2011, a nivel mundial se documentó una prevalencia promedio del 43% en niños menores de 5 años. Las prevalencias varían significativamente al comparar una región de alto ingreso con una región de bajo ingreso como Asia del Sur y África central occidental. Existen diversos tipos de anemia, siendo la anemia por deficiencia de hierro la más frecuente. A nivel mundial, se ha evidenciado que 50% de la prevalencia de anemia es atribuible a la deficiencia de hierro. En niños, los factores condicionantes para presentar esta condición incluyen el bajo peso al nacer, la prematuridad, la exposición al plomo, el bajo consumo de alimentos ricos en hierro y/o fortificados con hierro. El diagnóstico de anemia se realiza a partir de la medición de la hemoglobina. En niños menores de 59 meses, se diagnóstica dicha condición cuando el valor se encuentra por debajo de 11g/dl. Se sabe que la concentración de hemoglobina por sí sola no puede detectar muchos casos de deficiencia de hierro, pues la vida útil de los glóbulos rojos refleja el contenido de hierro de la médula ósea de hasta 120 días atrás. Razón por la cual es necesario realizar pruebas adicionales que permitan evaluar la depleción de los depósitos de hierro; a través de la medición de la ferritina sérica, transferrina, hierro sérico. El hierro es un nutriente esencial para el funcionamiento del cuerpo humano, ya que participa de diversos procesos como el transporte de oxígeno, síntesis de ADN, entre otros. Por lo que, su carencia puede afectar el desarrollo cognitivo, motor, emocional y neurofisiológico de los niños a corto y largo plazo. Un estudio realizado en Perú demostró que el costo per cápita por la pérdida cognitiva asociada a la anemia es de s/. 44,38, lo que equivale al 0,33% del PBI per cápita (8). En ese sentido, varios países han desplegado numerosos esfuerzos para disminuir la prevalencia de esta condición. OBJETIVOS: Objetivo general: Determinar el impacto de la educación alimentaria nutricional en la prevención de la anemia en niños menores de 5 años. Objetivos específicos: Realizar una búsqueda sistemática de la evidencia en diversas bases electrónicas considerando los criterios de elegibilidad. Sintetizar los hallazgos a partir de los estudios seleccionados. METODOLOGÍA: La presente revisión ha seguido la guía para reportar revisiones sistemáticas de "Preferred Reporting Items for Systematic reviews and Meta-Analysis" (PRISMA) y ha sido elaborada en el marco de la elaboración de una Guía de Práctica Clínica nacional para el manejo de anemia por deficiencia de hierro. RESULTADOS: 278 registros fueron identificados para realizar la lectura de títulos y resúmenes, de estos 14 fueron seleccionados para la revisión a texto completo. 11 registros fueron excluidos, cuatros se encontraban duplicados, dos de ellos eran resúmenes de congresos, cuatro no cumplían los criterios de elegibilidad; ya sea porque no consideraron a la población o desenlaces de interés. Finalmente, tres estudios fueron seleccionados. CONCLUSIONES: Se identificaron tres artículos científicos, un ensayo comunitario en población de niños eutróficos y dos estudios controlados aleatorizados en población de niños con desnutrición considerando indicadores antropométricos y puntos de corte distintos. Con relación al impacto de la educación nutricional sobre la ferritina sérica, Ahmad et al (2020) reportaron una reducción de la ferritina sérica al terminar la intervención; mientras que Kapur et al (2003), reportaron un aumento. Cabe mencionar que en el estudio de Ahmad se consideró una población de niños con desnutrición. Con relación al impacto de la educación nutricional sobre la prevalencia de anemia, Inayati et al (2012), reportaron una reducción significativa. Con relación al impacto de la educación nutricional sobre los conocimientos, actitudes e ingesta diaria de hierro, Kapur et al (2003) reportaron un incremento significativo para estos desenlaces.

Assessment of community awareness of the possible relationship between black tea consumption and iron deficiency anemia.

BACKGROUND & AIMS: Iron deficiency anemia is a public health problem affecting both developing and developed countries, with devastating consequences on health as well as social and economic development. However, there are scarce data regarding community awareness in Saudi Arabia; therefore, this study was conducted to assess the awareness of the community about the relationship between black tea consumption and iron deficiency anemia. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted, with 231 participants from Al-Ahsa region agreeing to participate voluntarily. The study instrument gathered sociodemographic data on the participants and asked them awareness-related questions. RESULTS: None of the study participants was completely aware of iron-rich foods, although the majority of the participants had a decent awareness level. Statistically significant differences were found between age, educational level, and type, the number of cups of black tea consumed per day, and awareness of the relationship between black tea consumption and iron deficiency anemia. CONCLUSIONS AND RECOMMENDATIONS: Based on the finding that the majority of the participants had moderate awareness, education and awareness-raising strategies should be planned and offered to improve nutritional habits and to encourage refraining from the consumption of food and drinks that hinder iron bioavailability.

Hepcidin and other indicators of iron status, by alpha-1 acid glycoprotein levels, in a cohort of Mexican infants.

The purpose of this study was to describe the changes in iron status indicators at 6 and 12 months of age, controlling by inflammation by measuring alpha-1 acid glycoprotein (AGP). This longitudinal study included 48 healthy-term singleton infants with birth weight ≥ 2500 g, born in hospitals of the Mexican Institute for Social Security. Complete blood count, ferritin, soluble transferrin receptor (sTfR), hepcidin, and AGP were measured in blood at 6 and 12 months of age. sTfR/ferritin ratio and total body iron (TBI) stores were calculated. Hemoglobin and sTfR/ferritin ratio increased with age, while ferritin and TBI decreased. In infants without inflammation, hepcidin, sTfR, and MVC did not show significant changes from 6 to 12 months of age, while ferritin and TBI decreased. In infants with inflammation, hepcidin, TBI, and ferritin levels increased, while hemoglobin and sTfR/ferritin ratio decreased. MVC and sTfR did not change significantly in the presence or absence of inflammation. Hepcidin concentration correlated positively and significantly with ferritin and TBI stores and showed significant negative correlation with sTfR/ferritin ratio. Our study showed that, in absence of inflammation and ID, during the first year of life, physiological changes occur in hemoglobin and ferritin levels as well as in indicators derived from ferritin and sTfR; in contrast, hepcidin and sTfR did not show significant change. However, hepcidin concentration was lower in infants with ID and was higher when inflammation was present, supporting that infants have a functional hepcidin response to changes in iron stores.

Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children.

Importance: Iron deficiency (ID) has the greatest prevalence in early childhood and has been associated with poor developmental outcomes. Previous research examining associations of income and food insecurity (FI) with ID is inconsistent. Objective: To examine the association of family income and family risk of FI with iron status in healthy young children attending primary care. Design, Setting, and Participants: This cross-sectional study included 1245 children aged 12 to 29 months who attended scheduled primary care supervision visits from 2008 to 2018 in Toronto, Canada, and the surrounding area. Exposures: Family income and risk of FI were collected from parent-reported questionnaires. Children whose parents provided an affirmative response to the 1-item FI screen on the Nutrition Screening Tool for Every Toddler or at least 1 item on the 2-item Hunger Vital Sign FI screening tool were categorized as having family risk of FI. Main Outcomes and Measures: Iron deficiency (serum ferritin level <12 ng/mL) and ID anemia (IDA; serum ferritin level <12 ng/mL and hemoglobin level <11.0 g/dL). All models were adjusted for age, sex, birth weight, body mass index z score, C-reactive protein level, maternal education, breastfeeding duration, bottle use, cow's milk intake, and formula feeding in the first year. Results: Of 1245 children (595 [47.8%] girls; median [interquartile range] age, 18.1 [13.3-24.0] months), 131 (10.5%) were from households with a family income of less than CAD $40 000 ($29 534), 77 (6.2%) were from families at risk of FI, 185 (14.9%) had ID, and 58 (5.3%) had IDA. The odds of children with a family income of less than CAD $40 000 having ID and IDA were 3 times higher than those of children in the highest family income group (ID: odds ratio [OR], 3.08; 95% CI, 1.66-5.72; P < .001; IDA: OR, 3.28; 95% CI, 1.22-8.87; P = .02). Being in a family at risk of FI, compared with all other children, was not associated with ID or IDA (ID: OR, 0.43; 95% CI, 0.18-1.02; P = .06; IDA: OR, 0.16; 95% CI, 0.02-1.23; P = .08). Conclusions and Relevance: In this study, low family income was associated with increased risk of ID and IDA in young children. Risk of FI was not a risk factor for ID or IDA. These findings suggest that targeting income security may be more effective than targeting access to food to reduce health inequities in the prevention of iron deficiency.

Sociodemographic predictors of early postnatal growth: evidence from a Chilean infancy cohort.

OBJECTIVES: Infant anthropometric growth varies across socioeconomic factors, including maternal education and income, and may serve as an indicator of environmental influences in early life with long-term health consequences. Previous research has identified sociodemographic gradients in growth with a focus on the first year and beyond, but estimates are sparse for growth before 6 months. Thus, our objective was to examine the relationship between sociodemographic factors and infant growth patterns between birth and 5 months of age. DESIGN: Prospective cohort study. SETTINGS: Low-income to middle-income neighbourhoods in Santiago, Chile (1991-1996). PARTICIPANTS: 1412 participants from a randomised iron-deficiency anaemia preventive trial in healthy infants. MAIN OUTCOME MEASURES: Longitudinal anthropometrics including monthly weight (kg), length (cm) and weight-for-length (WFL) values. For each measure, we estimated three individual-level growth parameters (size, timing and velocity) from SuperImposition by Translation and Rotation models. Size and timing changes represent vertical and horizontal growth curve shifts, respectively, and velocity change represents growth rate shifts. We estimated the linear association between growth parameters and gestational age, maternal age, education and socioeconomic position (SEP). RESULTS: Lower SEP was associated with a slower linear (length) velocity growth parameter (-0.22, 95% CI -0.31 to -0.13)-outcome units are per cent change in velocity from the average growth curve. Lower SEP was associated with later WFL growth timing as demonstrated through the tempo growth parameter for females (0.25, 95% CI 0.05 to 0.42)-outcome units are shifts in days from the average growth curve. We found no evidence of associations between SEP and the weight size, timing or velocity growth rate parameters. CONCLUSION: Previous research on growth in older infants and children shows associations between lower SEP with slower length velocity. We found evidence supporting this association in the first 5 months of life, which may inform age-specific prevention efforts aimed at infant length growth.

Recommendation and use of ferrous sulphate in 12- and 24-month-old children: evaluation in the 2015 Pelotas Birth Cohort. / Recomendação e uso de sulfato ferroso em crianças de 12 e 24 meses de idade: avaliação da coorte de nascimentos de Pelotas, RS, de 2015.

AIM: To verify the prevalence of recommendation of iron supplementation among children aged 12 and 24 months. METHODOLOGY: All children born in the maternities of Pelotas/RS in 2015 were eligible for the Cohort. The outcomes were the recommendation of ferrous sulphate by health professionals and its use. RESULTS: The cohort followed up 4,275 children. Approximately 64.0% of them were recommended to receive iron supplementation until 12 months of age. Among these, 68.8% used iron. From 12 to 24 months, 39.4% of the children received a prescription of iron supplementation, and among them, 26.2% actually used it. At 12 months, after adjusted analysis, higher maternal education, higher family income, lower parity, and low birth weight remained associated with the outcome. At 24 months, after adjusted analysis, we observed a higher recommendation of iron supplementation among mother with lower parity and for children with low birth weight. CONCLUSION: There was a low frequency of recommendation and low rate of use of iron among children. These findings are highly relevant given the high prevalence of anemia observed in children this year. The low recommendation of iron use among children up to 24 months of age, and the low use among those who are recommended to use it reflect the need for coordinated actions among health professionals and the expansion of knowledge among mothers to enable a wider reach of this important public policy.

Reducing the burden of iron deficiency anemia in Cote D'Ivoire through fortification.

BACKGROUND: Iron deficiency anemia (IDA) is highly prevalent in the Cote d'Ivoire and has severe health and economic consequences. In this paper, we apply a health economic model to quantify the burden of IDA, and the contribution of nationwide mandatory iron fortification of wheat flour and voluntary iron fortification of condiments to the reduction of this burden. METHODS: The analysis for the population from 6 months to 64 years builds on published reviews and publicly available datasets and is stratified by age-groups and socioeconomic strata using comparative risk assessment model. RESULTS: Without the impact of these fortification strategies, the annual burden of IDA is estimated at 242,100 disability adjusted life years (DALYs) and 978.1 million USD. Wheat flour and condiment fortification contributed to a reduction of the IDA burden by approximately 5% each. CONCLUSION: In places with high prevalence of malaria and other infectious diseases, such as the Côte D'Ivoire, food fortification as a nutritional intervention should be accompanied with infectious disease prevention and control. The findings of this study provide additional input for policy makers about the magnitude of the impact and can support the conception of future fortification strategies.

Recomendação e uso de sulfato ferroso em crianças de 12 e 24 meses de idade: avaliação da coorte de nascimentos de Pelotas, RS, de 2015 / Recommendation and use of ferrous sulphate in 12- and 24-month-old children: evaluation in the 2015 Pelotas Birth Cohort

RESUMO: Objetivo: Verificar a prevalência e os fatores associados à recomendação de uso de ferro a crianças aos 12 e aos 24 meses de idade. Metodologia: Todas as crianças nascidas nas maternidades de Pelotas em 2015 foram elegíveis para a coorte. Os desfechos foram a recomendação de uso de sulfato ferroso por profissional de saúde e a respectiva utilização. Resultados: A coorte acompanhou 4.275 crianças. Aproximadamente 65% receberam recomendação de suplementação de ferro até 12 meses. Destas, 68,8% fizeram a utilização recomendada. Dos 12 aos 24 meses, 39,4% das crianças receberam recomendação de suplementação de ferro e 26,2% fizeram o uso recomendado. Aos 12 meses, após ajuste, permaneceram associadas com recomendação de uso de ferro: maior escolaridade, maior renda, menor paridade e baixo peso ao nascer. Aos 24 meses, após ajuste, observou-se maior recomendação às mães com menor paridade e às crianças com baixo peso ao nascer. Conclusão: Houve baixa recomendação e baixa utilização de ferro. Esses achados são preocupantes diante da alta prevalência de anemia em crianças na faixa etária estudada. A baixa recomendação de profilaxia de ferro a crianças até 24 meses de idade, assim como a baixa utilização entre aquelas que receberam a orientação de uso refletem a necessidade de ações coordenadas entre profissionais de saúde e de ampliação do conhecimento entre as mães para possibilitar maior alcance dessa importante política pública.

ABSTRACT: Aim: To verify the prevalence of recommendation of iron supplementation among children aged 12 and 24 months. Methodology: All children born in the maternities of Pelotas/RS in 2015 were eligible for the Cohort. The outcomes were the recommendation of ferrous sulphate by health professionals and its use. Results: The cohort followed up 4,275 children. Approximately 64.0% of them were recommended to receive iron supplementation until 12 months of age. Among these, 68.8% used iron. From 12 to 24 months, 39.4% of the children received a prescription of iron supplementation, and among them, 26.2% actually used it. At 12 months, after adjusted analysis, higher maternal education, higher family income, lower parity, and low birth weight remained associated with the outcome. At 24 months, after adjusted analysis, we observed a higher recommendation of iron supplementation among mother with lower parity and for children with low birth weight. Conclusion: There was a low frequency of recommendation and low rate of use of iron among children. These findings are highly relevant given the high prevalence of anemia observed in children this year. The low recommendation of iron use among children up to 24 months of age, and the low use among those who are recommended to use it reflect the need for coordinated actions among health professionals and the expansion of knowledge among mothers to enable a wider reach of this important public policy.

Regional Overview on Maternal and Child Nutrition and Examples of Nutrition Governance and Policy Responses: Europe, Central Asia and Eastern Mediterranean Regions.

The Eastern Mediterranean Regions and Europe and Central Asia Regions are facing an epidemiological and nutrition transition, especially among vulnerable groups including mothers, children and adolescents. This has led to a double burden of malnutrition (DBM). Poor infant and young child feeding (IYCF), poor dietary diversity, excessive consumption of energy dense unhealthy foods, a growing obesogenic environment for children, including aggressive marketing of unhealthy foods for children, and reduced physical activity are among the main causes. In addition, several countries in the region lack the nutrition governance capacity to respond effectively to the DBM. This article reviews the context and provides a set of conclusions in which countries are called to reduce the marketing of unhealthy foods for children, enforce the fortification of staple foods with micronutrients to reduce micronutrient deficiencies and improve IYCF, including breastfeeding in the region. Also, the call is strong for cross-border multi-sectoral efforts to address the DBM in these regions.

Effect of community based health education on knowledge and attitude towards iron and folic acid supplementation among pregnant women in Kiambu County, Kenya: A quasi experimental study.

INTRODUCTION: Iron and Folic Acid Supplementation (IFAS) services are currently provided free of charge to pregnant women in Kenya during antenatal care (ANC) but compliance remains low. Poor awareness is an important factor contributing to low utilization of IFAS. Inadequate counselling is one of the key factors associated with poor awareness on IFAS. Community based health education is a promising diversification strategy for IFAS health education to curb this problem. OBJECTIVES: To determine effect of community based IFAS health education, utilizing CHVs, on IFAS knowledge, levels of counselling on various IFAS topics and attitude towards IFAS among pregnant women in Kiambu County. METHODOLOGY: A Pretest-Posttest Quasi-Experimental study design, consisting of intervention and control group, was applied among 340 pregnant women 18-49 years, in five health facilities, selected using two stage sampling in Lari Sub-County, Kiambu County, Kenya. Community health volunteers provided IFAS health education with weekly supplements and follow-ups to pregnant women in intervention group, while control group received the same from health care providers. Baseline and endline data were collected during ANC and compared. Quantitative data was analyzed using STATA version 14. Analysis of effect of intervention was done using Difference-In-Difference approach. RESULTS: There was an effect difference in maternal IFAS knowledge of 13%, with intervention group levels increasing most by 35 percentage points. The odds of being knowledgeable were 3 times more at endline than baseline. There was significant (p<0.001) change in proportion with positive attitude towards IFAS: the odds of having positive attitude at endline was 9 times that of baseline (OR = 9.2:95%CI 3.1, 27.2). CONCLUSION: Implementation of community based health education improved maternal knowledge, positive attitude and proportion of pregnant women counselled on IFAS, better improvement being recorded in intervention group. Hence, there is need to integrate community based approach with antenatal IFAS distribution to improve supplementation.

Ferric carboxymaltose for patients with heart failure and iron deficiency in Italy: cost-effectiveness and budget impact.

Aim: To evaluate the cost-effectiveness of intravenous ferric carboxymaltose (FCM) versus placebo for the management of iron deficiency in patients with chronic heart failure in the Italian healthcare system and to estimate its impact on the national healthcare budget. Materials & methods: A Markov model was developed to project costs and health outcomes over 1 year, based on data from literature. Healthcare resources consumption was derived from an e-survey administered to clinicians. Costs were obtained from official tariffs. Results: Treatment with FCM represents a dominant strategy compared with placebo, leading to national budget annual savings of 20-97 million Euros, according to different increasing utilization rates. Conclusion: FCM is a cost-saving option for the treatment of chronic heart failure patients with iron deficiency in Italy.

Food-basket intervention to reduce micronutrient deficiencies among Maasai-pregnant women in Tanzania: a quasi-experimental study.

BACKGROUND: Micronutrients comprised of vitamin and mineral nutrients that are needed during pregnancy for foetal growth, development and maturation, as well as for reducing/preventing maternal complications. However, micronutrient-rich foods (vegetables and fruits) are lacking in the Ngorongoro Conservation Area as a result of restrictions on cultivation in conservation areas and the unavailability of vegetables and fruits in local markets. The present study introduced a food basket intervention and assessed the effectiveness of the food baskets with respect to addressing anaemia, vitamin A and iron deficiencies among pregnant Maasai women within the Ngorongoro Conservation Area. METHODS: The quasi-experimental study included Misigiyo ward as a control group (provided education only) and Olbalbal ward as an intervention group (provided food baskets and education). The study assessed haemoglobin, serum ferritin and retinol at baseline and during follow-up. Haemoglobin, serum ferritin and retinol were quantitatively (duplicate) measured with HemoCue™ (HemoCue AB, Ängelholm, Sweden), Maglumi 800 (Snibe Diagnostic, Shenzhen, China) and vitamin A enzyme-linked immunosorbent assay, respectively. Dependent and independent t-tests were used to compare the micronutrient blood levels between and within the groups. RESULTS: The present study found a statistically significant increase in serum retinol (P < 0.001) in the intervention group compared to the control group; moreover, baseline serum retinol was positively associated with the follow-up serum retinol, whereas baseline haemoglobin and serum ferritin were negatively associated. CONCLUSIONS: The food basket intervention holds promise with repect to reducing micronutrient deficiency, especially in communities where micronutrient-rich foods are scarce.