Addressing the What, the Who and the Why behind recent reductions in anemia in Uganda: A multisectoral effort to find out

Public health officials and researchers in Uganda were pleasantly surprised to find that between 2001 and 2011, anemia rates had decreased markedly for women and children. However, sustaining this momentum requires an understanding of the reasons why anemia rates are decreasing. As is often the case in public health, finding the answers proved to be quite complicated, however, a clearer way forward has been revealed, and with renewed commitment and collaboration between key stakeholders, Uganda will continue to see decreases in anemia prevalence.

Anemia affects 1.6 billion people, or 25% of the world’s population, making it the most common nutritional deficiency[1]. With such a large proportion of the world burdened with anemia, this translates into an astounding 0.6% loss in Gross Domestic Product[2]. Iron deficiency Anemia (IDA) alone contributes to over 100,000 maternal deaths and 600,000 perinatal deaths each year[3]. In Uganda, anemia affects an even greater percentage of the population, most of whom are women and children. In 2006, 73% of children under five and 42% of women of reproductive age (WRA) were anemic, making anemia a severe public health problem by World Health Organization (WHO) standards.

When the 2011 Uganda Demographic Health Survey (DHS) report was released six years later, the national statistics on anemia showed a sharp downward trend. Anemia prevalence rates had dropped to 49% for children under the age of five and to 23% for WRA–a 24% and 19% decrease, respectively. These numbers far surpassed the Government of Uganda’s (GoU) targets for 2016[4] and signified a major transformation in Ugandans’ health-status, but, a secondary analysis is needed to determine which health seeking behaviors and health services led to the decrease in anemia.

Since 2012, USAID’s Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project has focused efforts on improving country ownership and building capacity around anemia prevention and control programs. In October 2013, over 100 representatives from the GoU and international and national nutrition experts came together for the Uganda National Anemia Stakeholders’ Meeting to discuss the results of this analysis. The analysis concluded that a combination of factors most likely led to the overall decrease in anemia prevalence. Bed net use among women of reproductive age has increased from 26% in 2001 to 55% in 2011. Antenatal Care (ANC) coverage is high in Uganda with over 96% of women attending at least one ANC visit during pregnancy. The success of three programs in particular—deworming, vitamin A supplementation, and bed net use, appear to have contributed to the decrease in anemia prevalence in children under five. The analysis also identified health behaviors that had not improved, such as iron-folic acid supplementation for women and providing two or more doses of malaria prophylaxis during the ANC visits, shedding light on programs that warranted targeting going forward.[5]

As a result of this meeting, and the findings from the analysis, key stakeholders recognized that if they wanted to continue the momentum from the progress already made in reducing anemia, they needed a multisectoral, collaborative approach. They revitalized the National Working Group on Anemia, which is now chaired by the Commissioner of Community Health Services, and is composed of representatives from the Office of the Prime Minister, the Ministry of Health, the Ministry of Agriculture, Animal Industries and Fisheries, the Ministry of Gender, Labor and Social Development, the Ministry of Education and Sports, UN agencies as well as international and local nongovernmental organizations. They met on January 24, 2014 to prioritize key actions within the National Anemia Action Plan and secure commitments from stakeholders. SPRING will be publishing the findings from the secondary analysis and the workshop report in the coming months. Watch out here: http://www.spring-nutrition.org/technical-areas/anemia-prevention-and-control for those resources.

 


[1] De Benoist B, McLean E, Egli I, Cogswell M. (Eds.) Worldwide prevalence of anaemia 1993-2005. WHO Global database on anaemia.  Geneva: 2008, WHO & CDC.  http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf

[2] Horton S, Ross J (2003). The economics of iron deficiency. Food Policy, 28:51-75.

[3] Stoltzfus RJ, et al. Iron deficiency anaemia. In: Ezzati M, editor. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organisation; 2004. 163-209.

[4] Government of Uganda. 2011. Uganda Nutrition Action Plan. http://www.health.go.ug/docs/UNAP_11_16.pdf

[5] Uganda Demographic and Health Surveys [Datasets]. Calverton, Maryland: ICF International [Distributor], 2001, 2006, and 2011.

4 responses to “Addressing the What, the Who and the Why behind recent reductions in anemia in Uganda: A multisectoral effort to find out”

  1. very interesting paper
    I would like to know how many time beneficiaries get deworming tablet and vitamin A supplementation in a year
    In my country Burkina Faso, deworming and VAS are done twice a year but anemia rate is still high and women and under 5 years benefit from LLIN and malaria prophylaxis too
    Can you share your methodology to improve women and their children health in the world
    best regards

  2. Thank you for your interest in SPRING, Nana. In most countries of sub-Saharan Africa, children under 5 get deworming medicine and Vitamin A supplements two times a year like you do in Burkina Faso. In addition, WHO recommends that pregnant women take deworming prophylaxis after 16 weeks of gestation.

    The SPRING project works on reducing stunting and anemia among children under 2 and women of reproductive age. We work closely with select countries to build country ownership of, and sustained commitment to, multiple anemia-related interventions through a two-step process. First, we guide national-level policy-makers and program managers in better understanding the multiple causes of anemia in their populations. This step is based upon discussions of familiar conceptual frameworks describing the immediate, underlying and basic causes of undernutrition as well as the lifecycles approach that will have been tailored to describe the causes of anemia in each country. With agreement among national stakeholders on what causes anemia, we initiate the second step of the process by facilitating further discussions to develop context-specific, evidence-based and cost-effective interventions across multiple sectors to addresses the preventable causes of anemia. Both steps of this process are designed and implemented in ways that enhance the capacity of national stakeholders to combine global evidence with local knowledge on the causes of anemia and the likely impacts, costs and feasibility of potential interventions.

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