A decision tree may be useful for determining which biomarkers to include when planning assessments of particular populations and population subgroups (e.g., women of reproductive age, pregnant women, children, or adolescents) [Figure 1].

The algorithm proposed below requires classifying a region of interest (national or subnational) as having a high or medium/low infection burden (first level). This designation can be made based either on bioindicators of infection or on other available indicators (e.g., the proportion of households without improved water or sanitation, the prevalence of schistosomiasis or soil-transmitted helminths). In communities with a high infection burden, the following level is to determine if the communities are malaria-endemic regions or not, and malaria may be the highest priority for assessment when determining causes of anemia in these regions.

Following the first two levels of the algorithm, based on infection burden and malaria presence in the population, the following analysis is based on the prevalence of moderate or severe anemia (based on the most recent available data). Under each category, there are several indicators listed to be used in case there are limitations in resources and access to diagnostic laboratories.

Figure 1. Proposed algorithm for prioritizing biomarkers to measure when assessing anemia etiology at the population level a

Figure 1. Proposed algorithm for prioritizing biomarkers to measure when assessing anemia etiology at the population level

a Population groups to consider when applying this process include pregnant women, non-pregnant women of childbearing age, children, and adolescents. Reproductive indicators will vary by population group (e.g., use of hormonal contraception or heavy menses for women; low birthweight or maternal anemia for children). Gray boxes with biomarkers are numbered from high to low priority for assessment. b Moderate and severe anemia defined per WHO guidelines (https://www.who.int/vmnis/indicators/haemoglobin.pdf, accessed Aug 11, 2020). c Infections (other than malaria) that directly cause anemia (not indirectly via inflammation) include helminthiasis and schistosomiasis. d Inherited hemoglobin disorders (IHD) protective to P. falciparum malaria need special consideration in anemia etiology assessment. e Micronutrient deficiencies other than iron that lead to anemia include vitamin A, folate, and vitamin B12.

We found 5 resource(s)

Factors Associated with Anaemia in a Nationally Representative Sample of Nonpregnant Women of Reproductive Age in Nepal
National Micronutrient Status Survey published by Maternal & Child Nutrition in
This study evaluated haemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders from the cross‐sectional 2016 Nepal National Micronutrient Status Survey with the aim to evaluate factors associated with anaemia among a nationally representative sample of nonpregnant women of reproductive age.
Predictors of Anemia in Women of Reproductive Age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project
Journal Article published by The American Journal of Clinical Nutrition in
This study used data from 10 cross-sectional, nationally representative data to assess the associations between anemia and multiple proximal (e.g., iron and vitamin A deficiencies, inflammation, malaria, and body mass index) and distal risk factors (e.g., education status, household sanitation and hygiene, and urban or rural residence) in…
Predictors of Anemia in Preschool Children: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project
Journal Article published by The American Journal of Clinical Nutrition in
This study used cross-sectional data from 16 surveys to evaluate predictors of anemia in preschool children (6-59 months of age) by country and infection-burden category. Findings indicate that iron deficiency, malaria, breastfeeding, stunting, underweight, inflammation, low socioeconomic status, and poor sanitation were each associated with…
The Proportion of Anemia Associated with Iron Deficiency in Low, Medium, and High Human Development Index Countries: A Systematic Analysis of National Surveys
Systematic Review published by Nutrients in
This article presents findings from a meta-analysis assessing the proportion of anemia that is attributable to iron deficiency. Data from 23 countries was pooled for pre-school children and non-pregnant women of reproductive age and the proportion of anemia attributable to iron deficiency was estimated by region, inflammation exposure, anemia…
The Global Prevalence of Anaemia in 2011
Technical Report published by World Health Organization in
This WHO report describes estimates of the prevalence of anemia for the year 2011 in preschool-age children (6–59 months) and women of reproductive age (15–49 years), by pregnancy status and by regions of the United Nations and WHO, as well as by country.