TheImpactofNutrition-Specificand Nutrition-SensitiveInterventionsonHemoglobin ConcentrationsandAnemia:AMeta-reviewof SystematicReviews

Abstract

Anemia is a multifactorial condition arising from inadequate nutrition, infection, chronic disease, and genetic-related etiologies. Our aim was to assess the impact of nutrition-sensitive and nutrition-specific interventions on hemoglobin (Hb) concentrations and anemia to inform the prioritization and scale-up of interventions to address the multiple causes of anemia. We performed a meta-review synthesis of information by searchingmultipledatabasesforreviewspublishedbetween1990and2017andusedstandardmethodsforconductingameta-reviewofreviews, includingdoubleindependentscreening,extraction,andqualityassessment.Quantitativepoolingandnarrativesyntheseswereusedtosummarize information. Hb concentration and anemia outcomes were pooled in specific population groups (children aged <5 y, school-age children, and pregnant women). Methodological quality of the systematic reviews was assessed using Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria. Of the 15,444 records screened, we identified 118 systematic reviews that met inclusion criteria. Reviews focused on nutrition-specific interventions (96%). Daily and intermittent iron supplementation, micronutrient powders, malaria treatment, use of insecticidetreatednets(ITNs),anddelayedcordclampingwereassociatedwithincreasedHbconcentrationinchildrenaged<5y.Amongchildrenolderthan 5 y, daily and intermittent iron supplementation and deworming, and in pregnant women, daily iron-folic acid supplementation, use of ITNs, and delayed cord clamping, were associated with increased Hb concentration. Similar results were obtained for the reduced risk of anemia outcome. This meta-review suggests the importance of nutrition-specific interventions for anemia and highlights the lack of evidence to understand the influenceofnutrition-sensitiveandmultifacetedinterventionsonthecondition