Impact of Nutrition Education and Counseling on Anemia Prevalence and Iron Status in Women of Reproductive Age: a Systematic Review Público

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health
Palabra Clave	iron pregnant nutrition education and counseling women of reproductive age anemia review
Committee Chair / Thesis Advisor	Girard, Amy Webb, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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