Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence
Abstract
:1. Introduction
2. Approach
- C = percentage change
- P baseline: prevalence estimated based on the baseline survey, i.e., 2012
- P recent: prevalence estimated based on the most recent survey
3. Prevalence of Anemia
Prevalence of Anemia in WRA, PW, and U5C in Countries of the EMR
4. Are Countries Making Progress in Reducing the Prevalence of Anemia over Time?
5. Why Are EMR Countries Not Making Progress in Anemia Reduction? The Need to Understand the Local Context
5.1. What Is the Contribution of Iron Deficiency to Anemia in Countries of the EMR?
5.2. What Do We Know about Other Micronutrient Deficiencies in the EMR?
5.3. Interventions to Address Nutritional Causes of Anemia in the EMR
5.3.1. Fortification Programs
5.3.2. Supplementation Programs
5.3.3. Nutrition Education and Awareness
5.4. Interventions to Address Non-Nutritional Causes of Anemia in the EMR
5.4.1. Malaria Control Programs
5.4.2. Soil-Transmitted Helminth Infections
5.4.3. WASH in Countries of the EMR
5.4.4. Genetic Disorders Leading to Anemia
5.4.5. Environmental and Socioeconomic Domains
5.5. Governance: Anemia Reduction Programs and Coordination
6. Discussion and the Way Forward
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Country | Prevalence of Anemia in PW (%) a | Prevalence of Anemia in WRA (%) | Prevalence of Anemia in U5C (%) c |
---|---|---|---|
Afghanistan | 38.2 | 42 a | 46.4 |
Bahrain | 42.8 | 45.9 b | 30.1 |
Djibouti | 37.6 | 32.7 a | 42 |
Egypt | 22.6 | 28.5 a | 31.7 |
Iran | 34.1 | 30.5 a | 28.2 |
Iraq | 33.5 | 29.1 a | 24.1 |
Jordan | 37.1 | 34.7 a | 31.1 |
Kuwait | 31.2 | 37.8 b | 25.3 |
Lebanon | 35.2 | 31.2 a | 25 |
Libya | 38 | 32.5 a | 28.8 |
Morocco * | 40.4 | 34.4 * | 47.5 * |
Oman * | 29.3 * | 27.8 * | 23.8 * |
Pakistan * | 51.3 | 42.7 * | 53.7 * |
Palestine * | 30.5 * | 27 b | -- |
Qatar | 33.4 | 27.7 a | 26.3 |
Saudi Arabia | 45.5 | 43.7 b | 37.8 |
Somalia | 46.8 | 44.4 a | 55.8 |
Sudan * | 34.1 | 30.7 a | 48.1 * |
Syrian Arab Republic | 36.1 | 33.6 a | 34.9 |
Tunisia | 36.7 | 31.2 a | 28.8 |
UAE | 33.2 | 27.8 a | 27.2 |
Yemen | 63 | 69.6 a | 83.5 |
Indicator | Normal (≤4.9%) | Mild (5.0–19.9%) | Moderate (20.0–39.9%) | Severe (≥40.0%) |
---|---|---|---|---|
Underfive Children | ||||
Anemia | Jordan [42] | Oman [36] Qatar [47] UAE (Al Ain) [51] | Afghanistan [33] Iran (South West) [49] Morocco [37] Pakistan [32] | |
IDA | Jordan [42] Oman [36] | Afghanistan [33] Morocco [37] Qatar [47] UAE (Al Ain) [51] | Iran (South West) [49] Pakistan [32] | |
Women of Reproductive Age | ||||
Anemia | Jordan [42] Oman [36] Morocco [37] | Afghanistan [33] Pakistan [32] | ||
IDA | Afghanistan [33] Jordan [42] Morocco [37] Oman [36] Pakistan [32] |
Country | Iron/FA Supplementation in PW a | Supplementation in U5C | Wheat Flour Fortification b | Other Food Fortifications |
---|---|---|---|---|
Afghanistan | Yes | Iron for children under 24 months [107]. Multiple micronutrient for infants 6–23 months (powders containing iron, FA, zinc, and vitamins A, B, and D [108]). Vitamin A in children 6–59 months [107]. Zinc in preschoolers with diarrhea [107]. | Mandatory—2018 (Iron, FA, and vitamins B12 and A) [54]. | Cooking oil and ghee –Mandatory–2018 (Vitamins A and D) [107]. |
Bahrain | Yes | ND | Mandatory–2002 (Iron and FA) [54]. | ND |
Djibouti | ND | ND | Mandatory–2013 (Iron, FA, and zinc) [54,109]. | ND |
Egypt | Yes | ND | Voluntary–2009 (Iron and FA) [54,110]. | Vegetable oils–2009 [111]. |
Iran | Yes | Iron for children 6 to 24 months [112]. Multivitamin/vitamin A + D drop from day three of birth to 24 months [112]. | Mandatory–2007 (Iron, FA-proposed for vitamin D and zinc) [54]. | ND |
Iraq | Yes | ND | Mandatory–2008; Government provision of premix stalled since 2014 (Iron and FA) [54]. | ND |
Jordan | Yes | Vitamin A capsule for children at the age of 18 months (200,000 IU) [94]. | Mandatory–2002 (Iron, FA, zinc, and vitamins A, D, B1, B2, B3, B6, and B12) [42,54]. | ND |
Kuwait | Yes | ND | Mandatory (Iron, FA, and vitamins B1, B2, and B3) [54]. | ND |
Lebanon | Yes | ND | No fortification | ND |
Libya | Yes | ND | No fortification | ND |
Morocco | Yes | 2014–Vitamin A for children under the age of 2 [84]. | Mandatory–2006 (Iron and FA) [54,113]. | Vegetable oils–2006 [114]. |
Oman | Yes | 1998–Vitamin A for children under the age of 2 [93]. | Mandatory–1996 (Iron and FA) [54]. | Vegetable oils–Mandatory–2010 (Vitamins A and D) [36]. |
Pakistan | Yes | ND | Mandatory in some provinces–2017 (Iron, FA, zinc, and vitamin B12) [54]. | Oils and ghee–2016 (Vitamins A and D) [115]. |
Palestine | Yes | Iron drops for infants up to 24 months [65]. Vitamin A and D for infants from birth and until 12 months [65]. | Mandatory–2006 (Iron, FA, zinc, and vitamins A, D, B1, B2, B3, B6, and B12) [54,65]. | ND |
Qatar | Yes | ND | Voluntary (Iron, FA, and vitamins B1, B2, and B3) [54]. | ND |
Saudi Arabia | Yes | ND | Mandatory (Iron, FA, and vitamins B1, B2, and B3 [54]. | ND |
Somalia | Yes Supplements also include vitamins A, B1, B2, B6, B12, C, D, and E, niacin, copper, selenium, iodine, and zinc. | Iron syrups for anemia treatment in young children [96]. Vitamin A for U5C [96]. Zinc for U5C for the treatment of diarrhea [96]. | ND | ND |
Sudan | Yes | Vitamin A for 6–59 months during the 2019 measle campaign [116]. Multiple Micronutrient Powder (called Vitamino) (15 micronutrients including Iron and FA) for 6–59 months [116]. | Voluntary by one mill–2005 (Iron and FA) [54]. | ND |
Syrian Arab Republic | Yes | ND | Voluntary (Iron and FA) [54]. | ND |
Tunisia | Yes | ND | ND | ND |
UAE | Yes | ND | Voluntary (Iron, FA, and vitamins B1, B2, and B3) [54]. | ND |
Yemen | ND | ND | Mandatory–2001 (Iron and FA) [54]. | Oils and ghee–2001 (Vitamins A and D) [117]. |
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Al-Jawaldeh, A.; Taktouk, M.; Doggui, R.; Abdollahi, Z.; Achakzai, B.; Aguenaou, H.; Al-Halaika, M.; Almamary, S.; Barham, R.; Coulibaly-Zerbo, F.; et al. Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence. Int. J. Environ. Res. Public Health 2021, 18, 2449. https://doi.org/10.3390/ijerph18052449
Al-Jawaldeh A, Taktouk M, Doggui R, Abdollahi Z, Achakzai B, Aguenaou H, Al-Halaika M, Almamary S, Barham R, Coulibaly-Zerbo F, et al. Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence. International Journal of Environmental Research and Public Health. 2021; 18(5):2449. https://doi.org/10.3390/ijerph18052449
Chicago/Turabian StyleAl-Jawaldeh, Ayoub, Mandy Taktouk, Radhouene Doggui, Zahra Abdollahi, Baseer Achakzai, Hassan Aguenaou, Moussa Al-Halaika, Salima Almamary, Rawhieh Barham, Ferima Coulibaly-Zerbo, and et al. 2021. "Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence" International Journal of Environmental Research and Public Health 18, no. 5: 2449. https://doi.org/10.3390/ijerph18052449
APA StyleAl-Jawaldeh, A., Taktouk, M., Doggui, R., Abdollahi, Z., Achakzai, B., Aguenaou, H., Al-Halaika, M., Almamary, S., Barham, R., Coulibaly-Zerbo, F., Ammari, L. E., Elati, J., Nishtar, N. A., Omidvar, N., Shams, M. Q., Qureshi, A. B., & Nasreddine, L. (2021). Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence. International Journal of Environmental Research and Public Health, 18(5), 2449. https://doi.org/10.3390/ijerph18052449