Impact of Nutrition Education and Counseling on Anemia Prevalence and Iron Status in Women of Reproductive Age: a Systematic Review Open Access
Olude, Oluwafunke Abigail (2011)
Abstract
Background: Anemia affects 42% of pregnant and 30% of
nonpregnant women of reproductive age (WRA). It
is associated with hemorrhage, poor neonatal
outcomes, reduced work productivity and increased risk of
infections. Causes of anemia include
infections, hemoglobinopathies and nutritional deficiencies.
A
commonly employed strategy to tackle anemia is nutrition education
and counseling (NEC).
NEC strategies focus on increasing heme and nonheme iron intake,
decreasing the intake of iron
absorption inhibitors, encouraging iron-folic acid
supplementation.
Objective: The objective of this review is to systematically
evaluate the impact of NEC on indicators of
anemia and iron status in pregnant and nonpregnant WRA in
low/middle income
(LMIC) and high income countries (HIC) and to identify current gaps
in research.
Methods: A systematic review of the impact of NEC delivered to
pregnant and
nonpregnant females 11-49 years on anemia and iron status was
conducted using modified
GRADE (Grading of Recommendations Assessment, Development and
Evaluation) and CHERG
(Child Health Epidemiology Reference Group) approaches. Data from
studies meeting inclusion/exclusion criteria were abstracted into a
standardized form.
Meta-analysis was conducted for outcomes with ≥ 3 studies by
pregnancy status; sub group
analysis was conducted according to country context and category of
NEC inter-
vention.
Results: Three categories of NEC delivery emerged, namely 1) NEC
provided alone
(7 studies); 2) NEC as part of a comprehensive package of health
messages (3 studies); and 3)
NEC with nutrition support (9 studies). Overall, NEC reduced the
risk of anemia in pregnant
((RR=0.63 (0.48, 0.82)) and nonpregnant WRA (RR= 0.45 (0.24,
0.86)). NEC was most effec-
tive in LMIC and when provided with nutrition support. However, it
did not improve mean Hb, mean hematocrit, iron deficiency, mean
serum iron and ferritin.
Discussion: NEC decreased risk of anemia in WRA regardless of
pregnancy status,
in LMIC and when provided with nutrition support. The overall
quality of evi-
dence was judged to be moderate for anemia and mean Hb and low or
very low for mean hematocrit, iron
deficiency, mean serum iron and mean serum ferritin. Better
designed studies grounded in ap-
propriate theories are needed to adequately estimate the
effectiveness of NEC to
improve anemia status and iron stores and identify best
practices.
Table of Contents
Abbreviations
..................................................................................................................................
xi
Introduction
......................................................................................................................................
1
Chapter 1: Literature Review
...........................................................................................................
3
1.1 Scope of the problem
.............................................................................................................
3
1.2 Health consequences of anemia
.............................................................................................
6
1.4 Causes of anemia
...................................................................................................................
7
1.5 Diagnostic indicators of iron deficiency, iron deficiency
anemia and anemia. ................... 13
1.6 Prevention and control of iron deficiency anemia and anemia
............................................ 13
Chapter 2: Methods
........................................................................................................................
20
2.1 Literature Search Strategy
....................................................................................................
20
2.2 Inclusion / exclusion criteria
................................................................................................
20
2.3 Data collection and analysis
.................................................................................................
21
Meta- analysis
........................................................................................................................
21
Grading the evidence
.............................................................................................................
23
Chapter 3: Results
..........................................................................................................................
25
3.1 Anemia prevalence and anemia related outcomes
...............................................................
26
3.1a Anemia prevalence
.........................................................................................................
26
3.1b Mean Hemoglobin
.........................................................................................................
28
3.1c Mean Hematocrit
............................................................................................................
29
3.2 Iron status related outcomes
.................................................................................................
30
3.2a Iron Deficiency
...............................................................................................................
30
3.2b Mean Serum Iron
...........................................................................................................
30
3.2c Serum Ferritin
................................................................................................................
31
Chapter 4: Discussion
.....................................................................................................................
34
Appendix 1
.....................................................................................................................................
50
Appendix 2
.....................................................................................................................................
53
Appendix 3
.....................................................................................................................................
54
Appendix 4
.....................................................................................................................................
73
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