|Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anaemia (International Life Sciences Institute, 1998, 46 p.)|
Ideally, all countries where iron deficiency anemia exists would have a comprehensive anemia control program that includes an appropriate mix of interventions designed to best address local conditions. However, countries with the most widespread and severe anemia are often those with the most limited resources. It is important to prioritize program efforts so that scarce resources can be most effectively used.
The appropriate selection of interventions depends on many factors. It first depends on the epidemiology of iron deficiency anemia in the area. Who has iron deficiency anemia, and why? Because of their high physiological demands for iron, young children and pregnant women will be at greatest risk of iron deficiency anemia in almost every context. If no epidemiological information is available, it is safe to assume that these are the groups in which to begin. However, useful information often exists even when formal surveys have not been conducted. The contributing etiologies of anemia (e.g., whether there are hookworms or malaria) and the extent of iron deficiency anemia in other population groups (e.g., school-children) varies by region. If surveys cannot be conducted, impressions of health care workers, midwives, and doctors should be gathered. If anemia seems to be a clinical problem in men as well as women and children, then it is likely that malaria, hookworm, or other diseases are playing an important role in addition to dietary iron deficiency.
Second, the available infrastructures determine the cost and feasibility of different approaches. Prenatal care, growth monitoring, and immunization clinics maybe effective ways to reach mothers and children, with interventions in some places, but where coverage of health services is very low, village women's groups, traditional birth attendants, schools, religious groups, or other community organizations may also need to be involved. The feasibility of iron fortification of foods will depend on the existence of widely consumed, centrally processed foods. The feasibility of dietary improvement depends on the diversity of foods available.
A third critical factor is the opinions and priorities of the community being served. Community involvement is key to the acceptance and sustainability of interventions. The community as a whole must develop a sense of active partnership with the health system based on their conviction that the programs will benefit its members. Involving community members in the development of a program generates a sense of community ownership of the program that may be essential to its success.