A Review of Anemia Prevalence, and Prevention and Control Strategies, in the Eastern Europe and Central Asia Region

Abstract

Anemia is a global public health and nutrition problem. However, data on its prevalence and potential causal factors in the 22 countries of the UNICEF Europe and Central Asia region are not systematically collected, analyzed, and reported, leading to challenges in formulating appropriate preventative strategies. We examined available anemia prevalence data among different population groups through reviewing survey reports from 2010 to 2022; conducted a literature review to explore underlying determinants of anemia including iron deficiency; and collated and reviewed program and policy documentation across the region. Anemia prevalence data for the period 1999-2009 were also researched to examine trends in anemia prevalence in the region over the past 23 y. Nationally representative data for anemia for ≥1 population group since 2010 were found for half the 22 countries, whereas less than a quarter of countries had recent data for iron deficiency. There was a lack of evidence for other factors potentially contributing to anemia in the region. Where information was available, our findings highlight that anemia remained a problem of public health significance among girls and women 15-49 y old and preschool children in all countries with data; anemia was highly associated with iron deficiency; large discrepancies in anemia prevalence existed between geographical regions and subpopulation groups within countries; and only a few countries were implementing the recommended WHO strategies to prevent and control anemia. The paucity of recent, representative, data on anemia in many countries and on the etiology of anemia in most countries remain obstacles to ensuring that effective anemia prevention strategies are placed high on national agendas in the region.

Keywords: adolescent health and nutrition; maternal health and nutrition; nutrition sensitive; nutrition specific; women of reproductive age; young child health and nutrition.

FIGURE 1

Prevalence of anemia among PSC (A) and WRA (B), latest available data and change over time since 1999, for ECA countries with national survey data. Cut-offs shown for WHO categorization of public health (PH) significance of anemia based on prevalence estimated from blood hemoglobin. ∗Hemoglobin adjusted for altitude. ∗∗Hemoglobin adjusted for altitude and smoking. ∗∗∗Hemoglobin adjusted for smoking (no star indicates that no information on hemoglobin adjustment was available in the report). All prevalence figures and adjustments, WHO 2011 [9]. ^ǂHemoglobin measured in venous blood. All other data shown are based on measurements from capillary blood.

FIGURE 2

Range in the prevalence of anemia among PSC (A) and WRA (B) for the geographical region of each country with lowest prevalence compared with the region with highest prevalence, for ECA countries with data from a national survey since 2010. Cut-offs shown for WHO categorization of public health (PH) significance of anemia based on prevalence estimated from blood hemoglobin. ∗Hemoglobin adjusted for altitude. ∗∗Hemoglobin adjusted for altitude and smoking. No star indicates that no information on hemoglobin adjustments was available to the report authors. All prevalence figures and adjustments, WHO 2011 [9].