Global guidelines for the prevention of iron deficiency anemia in the public health context published since 2000
| Intervention . | Target population . | Dose . | Agency, year . | Systematic review . |
|---|---|---|---|---|
| Intermittent (weekly) iron supplementation | All menstruating adolescent girls and women where prevalence of anemia in this group is 20% or higher. | Iron: 60 mg of elemental iron Folic acid: 2800 μg (2.8 mg) | WHO, 201168 | Fernandez-Gaxiola and De-Regil 201130 |
| Intermittent (weekly) iron supplementation | Preschool and school-age children where prevalence of anemia in this group is 20% or higher. | Preschool: 25 mg elemental iron School age: 45 mg elemental iron | WHO, 201169 | De-Regil et al 201132 |
| Home fortification with multiple micronutrient powders | Children 6 to 23 mo old where the prevalence of anemia in this group is 20% or higher. | Iron: 12.5 mg elemental iron, preferably as ferrous fumarate Vitamin A: 300 μg retinol Zinc: 5 mg elemental zinc, preferably as zinc gluconate | WHO, 201148 | De-Regil et al 201170 |
| Home fortification with multiple micronutrient powders (not recommended) | Pregnant women | N/A | WHO, 201171 | Suchdev et al 201172 |
| Daily iron supplementation | All low-birth-weight infants Children 6 to 23 mo old where diet does not provide foods fortified with iron or where anemia prevalence is higher than 40% Children 2 to 5 y old, school-age children, women of childbearing age, pregnant women, and lactating women where anemia prevalence is higher than 40% | Low birth weight: elemental iron: 2 mg/kg/d from birth to 23 mo 6 to 23 mo: elemental iron: 2 mg/kg from 6 to 23 mo old 2 to 5 y: elemental iron: 2 mg/kg (maximum dose, 30 mg) for 3 mo School-age children: iron: 30 mg/d + folic acid: 250 μg/d for 3 mo Women of childbearing age: iron: 60 mg/d + folic acid: 400 μg/d for 3 mo Pregnant women: iron: 60 mg/d + folic acid: 400 μg/d for duration of pregnancy Lactating women: iron: 60 mg/d + folic acid: 400 μg/d for 3 mo post partum | WHO/UNU/UNICEF, 20012 | N/A |
| Optimization of food-based approaches to controlling anemia (ie, improvement of dietary diversity, changing meal patterns to ensure optimal iron absorption [minimize inhibitors and increase enhancers of iron absorption]) | Community-wide | N/A | WHO/UNU/UNICEF, 20012 | N/A |
| Wheat and maize flour fortification | Consider when industrially produced wheat or maize flour is consumed by a large proportion of the population of the country | Fortification with iron, folic acid, zinc, B12, and vitamin A recommended; formulation and dose based on average per capita wheat flour availability | WHO, FAO, UNICEF, GAIN, MI, FFI, 200973 | N/A |
| Nutrient content of complementary foods in infants: meat, poultry, fish, or eggs should be eaten daily or as often as possible. Vegetarian diets cannot meet nutrient needs at this age unless nutrient supplements or fortified products are used. | Use fortified complementary foods as needed. | Not specified | PAHO74 | N/A |
| Periodic deworming for soil-transmitted helminths | Where prevalence among school age children is higher than 50%: twice-yearly deworming for preschool and school-age children, women of reproductive age, and selected others at high risk. Where prevalence among school age children is 20% to 50%: once-yearly deworming for preschool and school-age children, women of reproductive age, and selected others at high risk. | Albendazole (200 mg for children younger than 2 y; otherwise 400 mg) or mebendazole (500 mg) | WHO, 200675 | N/A |
| Periodic deworming for schistosomiasis | High-risk community: When there is higher than 50% infection by microscopy or higher than 30% visible hematuria, there should be annual treatment of all school-age children and selected others; medium-risk community: When there is 10% to 50% infection by microscopy or less than 30% visible hematuria, school-age children and selected others should be treated every 2 y; low-risk community: Where there is less than 10% infection by microscopy, school-age children should be treated twice during the school year. | Praziquantel (dose dependent on height) | WHO, 200675 | N/A |
| Monitoring and Evaluation | ||||
| The measurement of the iron status of populations is best achieved using serum ferritin and soluble transferrin receptor; measurement of hemoglobin should also be undertaken, and measurement of an indicator of inflammation (eg, C-reactive protein, α-1 glycoprotein) should be undertaken where infection/inflammation is common. Serum ferritin is the best indicator of a response to an intervention to control iron deficiency and should be measured with the hemoglobin concentration in program evaluations. If funding is available, it could also be useful to measure the concentration of an acute-phase protein (ie, C-reactive protein, α-1 glycoprotein). | WHO/CDC, 200758 | WHO/CDC58 | ||
| Logic model for program theory for implementation of micronutrient supplementation in various settings | WHO/CDC, 201176 | N/A | ||
| Other Approaches | ||||
| Delayed clamping of the umbilical cord at 30 to 120 s after delivery | WHO, 200941 | McDonald 200877 | ||
| Intervention . | Target population . | Dose . | Agency, year . | Systematic review . |
|---|---|---|---|---|
| Intermittent (weekly) iron supplementation | All menstruating adolescent girls and women where prevalence of anemia in this group is 20% or higher. | Iron: 60 mg of elemental iron Folic acid: 2800 μg (2.8 mg) | WHO, 201168 | Fernandez-Gaxiola and De-Regil 201130 |
| Intermittent (weekly) iron supplementation | Preschool and school-age children where prevalence of anemia in this group is 20% or higher. | Preschool: 25 mg elemental iron School age: 45 mg elemental iron | WHO, 201169 | De-Regil et al 201132 |
| Home fortification with multiple micronutrient powders | Children 6 to 23 mo old where the prevalence of anemia in this group is 20% or higher. | Iron: 12.5 mg elemental iron, preferably as ferrous fumarate Vitamin A: 300 μg retinol Zinc: 5 mg elemental zinc, preferably as zinc gluconate | WHO, 201148 | De-Regil et al 201170 |
| Home fortification with multiple micronutrient powders (not recommended) | Pregnant women | N/A | WHO, 201171 | Suchdev et al 201172 |
| Daily iron supplementation | All low-birth-weight infants Children 6 to 23 mo old where diet does not provide foods fortified with iron or where anemia prevalence is higher than 40% Children 2 to 5 y old, school-age children, women of childbearing age, pregnant women, and lactating women where anemia prevalence is higher than 40% | Low birth weight: elemental iron: 2 mg/kg/d from birth to 23 mo 6 to 23 mo: elemental iron: 2 mg/kg from 6 to 23 mo old 2 to 5 y: elemental iron: 2 mg/kg (maximum dose, 30 mg) for 3 mo School-age children: iron: 30 mg/d + folic acid: 250 μg/d for 3 mo Women of childbearing age: iron: 60 mg/d + folic acid: 400 μg/d for 3 mo Pregnant women: iron: 60 mg/d + folic acid: 400 μg/d for duration of pregnancy Lactating women: iron: 60 mg/d + folic acid: 400 μg/d for 3 mo post partum | WHO/UNU/UNICEF, 20012 | N/A |
| Optimization of food-based approaches to controlling anemia (ie, improvement of dietary diversity, changing meal patterns to ensure optimal iron absorption [minimize inhibitors and increase enhancers of iron absorption]) | Community-wide | N/A | WHO/UNU/UNICEF, 20012 | N/A |
| Wheat and maize flour fortification | Consider when industrially produced wheat or maize flour is consumed by a large proportion of the population of the country | Fortification with iron, folic acid, zinc, B12, and vitamin A recommended; formulation and dose based on average per capita wheat flour availability | WHO, FAO, UNICEF, GAIN, MI, FFI, 200973 | N/A |
| Nutrient content of complementary foods in infants: meat, poultry, fish, or eggs should be eaten daily or as often as possible. Vegetarian diets cannot meet nutrient needs at this age unless nutrient supplements or fortified products are used. | Use fortified complementary foods as needed. | Not specified | PAHO74 | N/A |
| Periodic deworming for soil-transmitted helminths | Where prevalence among school age children is higher than 50%: twice-yearly deworming for preschool and school-age children, women of reproductive age, and selected others at high risk. Where prevalence among school age children is 20% to 50%: once-yearly deworming for preschool and school-age children, women of reproductive age, and selected others at high risk. | Albendazole (200 mg for children younger than 2 y; otherwise 400 mg) or mebendazole (500 mg) | WHO, 200675 | N/A |
| Periodic deworming for schistosomiasis | High-risk community: When there is higher than 50% infection by microscopy or higher than 30% visible hematuria, there should be annual treatment of all school-age children and selected others; medium-risk community: When there is 10% to 50% infection by microscopy or less than 30% visible hematuria, school-age children and selected others should be treated every 2 y; low-risk community: Where there is less than 10% infection by microscopy, school-age children should be treated twice during the school year. | Praziquantel (dose dependent on height) | WHO, 200675 | N/A |
| Monitoring and Evaluation | ||||
| The measurement of the iron status of populations is best achieved using serum ferritin and soluble transferrin receptor; measurement of hemoglobin should also be undertaken, and measurement of an indicator of inflammation (eg, C-reactive protein, α-1 glycoprotein) should be undertaken where infection/inflammation is common. Serum ferritin is the best indicator of a response to an intervention to control iron deficiency and should be measured with the hemoglobin concentration in program evaluations. If funding is available, it could also be useful to measure the concentration of an acute-phase protein (ie, C-reactive protein, α-1 glycoprotein). | WHO/CDC, 200758 | WHO/CDC58 | ||
| Logic model for program theory for implementation of micronutrient supplementation in various settings | WHO/CDC, 201176 | N/A | ||
| Other Approaches | ||||
| Delayed clamping of the umbilical cord at 30 to 120 s after delivery | WHO, 200941 | McDonald 200877 | ||
CDC, Centers for Disease Control and Prevention; FAO, Food and Agriculture Organization of the United Nations; FFI, Flour Fortification Initiative; GAIN, Global Alliance for Improved Nutrition; MI, Micronutrient Initiative; UNICEF, United Nations Children’s Fund; WHO, World Health Organization; PAHO: Pan American Health Organization.