The January Nutrition Society Paper of the Month is from Public Health Nutrition and is entitled ‘Implications of inconsistent anaemia policies for children and adolescents in Africa’

Almost 50 % of children and adolescents in sub-Saharan Africa are anaemic, which has profound effects on their intellectual and physical development and their chance of survival. Evidence-based policies are essential in order to reduce anaemia, but as it results from interdependent factors there are difficulties in the development of cohesive policies for diagnosis, prevention and treatment. Nutritional requirements are also derived from food intake studies in healthy Western children and may not always be appropriate in a developing country situation.

This study evaluated the quality of these policies and the extent to which they were based on evidence relevant to the African context. Recommendations are made for improving the policy-making process.

What have we done?

A comprehensive and unrestricted database and website search for guidelines (as defined by WHO). We identified policies which targeted anaemia diagnosis, treatment and prevention in children and non-pregnant adolescents (18 years old) in Africa. Policy quality was assessed using   ‘The Appraisal of Guidelines for Research and Evaluation instrument (AGREE II)’ without any adaptation. A search for high-quality evidence in the Cochrane Library was performed to assess the evidence base for policies.

What did we find?

A total of 1247 documents were identified and screened and 46 were selected for analysis. There was policy consensus on usefulness of iron supplements, the need to treat co-morbidities and the use of blood transfusions for severe anaemia. Information about diagnosis was scarce, and messages regarding the control of anaemia were mixed. Few of the policies were tailored for the African context, and they were located on several websites hosted by different health programmes.

There were examples of ambiguities within individual policies and inconsistencies between policies on key issues. For example, the definitions for categories of anaemia severity were inconsistent, specific age groups were often not identified, and when target age groups were specified these varied between policies.

Does evidence support the anaemia policies?

Few policy documents described their evidence base, and it was not possible to draw conclusions on how policy changes were related to evidence, or the recommendations made. Anomalies within and between policies, and lack of generalisability, limited the option to pool data.

Is there any way forward?

Context-specific research is required to fill evidence gaps, to identify need for local adaptations, and for advice on clinical interventions. Global policy may need to be modified by WHO at the regional level to allow for these factors. Appropriate guideline development and peer review groups should be constituted and rigorous methods for policy updates and development should be established. A comprehensive review of existing research evidence concerning anaemia in African children is urgently needed so that knowledge gaps can be identified and prioritised and research commissioned to fill the gaps. Context-specific issues concerning, safety and benefits of iron supplementation in infection endemic areas, or in HIV infection, sickle cell disease, or young infants are important.

There are many issues and wider discussion is required on this important contributor to child survival.

This paper is freely available for one month via the following link:

Nutrition Society Paper of the Month

Each month a paper is selected by one of the Editors of the five Nutrition Society Publications (British Journal of Nutrition, Public Health Nutrition, Nutrition Research Reviews, Proceedings of the Nutrition Society and Journal of Nutritional Science). This paper is freely available for one month.


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