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THE GLOBAL PREVALENCE OF ANAEMIA IN 2011

ii

WHO Library Cataloguing-in-Publication Data

The global prevalence of anaemia in 2011.

1.Anaemia epidemiology. 2.Anaemia statistics and numerical data. 3.Prevalence.

4.Child, Preschool. 5.Infant. 6.Adolescent. 7.Women. I.World Health Organization.

ISBN 978 92 4 156496 0 (NLM classication: WH 155)

World Health Organization 2015

All rights reserved. Publications of the World Health Organization are available onthe WHO website (www.who.int) or can be purchased from WHO Press, World HealthOrganization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax:+41 22 791 4857; e-mail: [email protected]).

Requests for permission to reproduce or translate WHO publications whether for sale orfor non-commercial distribution should be addressed to WHO Press through the WHOwebsite (www.who.int/about/licensing/copyright_form/en/index.html).

The designations employed and the presentation of the material in this publication do

not imply the expression of any opinion whatsoever on the part of the World HealthOrganization concerning the legal status of any country, territory, city or area or ofits authorities, or concerning the delimitation of its frontiers or boundaries. Dotted anddashed lines on maps represent approximate border lines for which there may not yetbe full agreement.The mention of specic companies or of certain manufacturers products does not implythat they are endorsed or recommended by the World Health Organization in preferenceto others of a similar nature that are not mentioned. Errors and omissions excepted, thenames of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verifythe information contained in this publication. However, the published material is beingdistributed without warranty of any kind, either expressed or implied. The responsibilityfor the interpretation and use of the material lies with the reader. In no event shall theWorld Health Organization be liable for damages arising from its use.

Design and layout: Elysium

Printed by the WHO Document Production Services, Geneva, Switzerland

Suggested citation

WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization;2015.


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CONTENTS

ACKNOWLEDGEMENTS

SCOPE AND PURPOSE 1

BACKGROUND 1

METHODS 1

Identification of data sources for blood haemoglobin concentration

and anaemia hrough a systematic review; accessing and extracting data;and systematically assessing the population representativeness of data

Adjustment of data on blood haemoglobin concentrations for altitudeand smoking

Application of a statistical model to estimate trends in the distributionof blood haemoglobin concentrations and their uncertainties

RESULTS 3

Population coverage

The proportion of the population and number of individuals withanaemia

Classification of countries by degree of public health significanceof anaemia, based on blood haemoglobin concentration

The prevalence of anaemia attributed to iron deficiency

DISCUSSION 5

CONCLUSIONS 6

REFERENCES 7

ANNEX 1. WHO MEMBER STATES GROUPED BY REGION, AS OF JANUARY 2011 15

ANNEX 2. RESULTS BY UNITED NATIONS REGION, AS OF 2011 17

ANNEX 3. NATIONAL ESTIMATES OF ANAEMIA FOR THE YEAR 2011 19

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ACKNOWLEDGEMENTS

Juan Pablo Pea-Rosas, Lisa Rogers and Gretchen A Stevens oversaw the preparation of this report. The

World Health Organization (WHO) acknowledges the technical contributions of Marianella Anzola, CamilaChaparro and Luz Maria De-Regil in the drafting and revision of this document. We would also like to

thank Florence Rusciano for her support in the preparation of the maps presented in this document.

These estimates of the prevalence of anaemia were produced by the Nutrition Impact Model Study Group

(NIMS) for Anaemia, a collaboration between WHO and Imperial College London, United Kingdom of Great

Britain and Northern Ireland (UK). The study was supported by the Bill & Melinda Gates Foundation and

the Medical Research Council of the UK. WHO would like to thank (in alphabetical order): Zulqar A Bhutta,

Francesco Branca, Luz Maria De-Regil, Majid Ezzati, Mariel M Finucaine, Seth R Flaxman, Christopher J

Paciorek, Juan Pablo Pea-Rosas and Gretchen A Stevens for the technical input in the preparation of

the estimates.

WHO also wishes to thank the many individuals, institutions, governments and nongovernmental andinternational agencies for providing data for the Micronutrients Database in the WHO Vitamin and Mineral

Nutrition Information System (VMNIS), which was developed by the Department of Nutrition for Health

and Development and is currently being maintained by the Evidence and Programme Guidance Unit.

Financial support

WHO thanks the Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, United States

Centers for Disease Control and Prevention and the Micronutrient Initiative for providing nancial support

for maintaining the VMNIS Micronutrients Database. WHO gratefully acknowledges the nancial support

of the Bill & Melinda Gates Foundation and the United States Agency for International Development

(USAID) for its work in nutrition.


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SCOPE AND PURPOSE

This document describes estimates of the prevalence of anaemia for the year 2011 in preschool-age

children (659 months) and women of reproductive age (1549 years), by pregnancy status, and byregions of the United Nations and World Health Organization (WHO), as well as by country. This report

is based on analyses previously published (1)to estimate trends (from 1995 to 2011) in the distribution

of blood haemoglobin concentrations and the prevalence of anaemia in these same population groups.

This document may serve as a resource for estimating the baseline prevalence of anaemia in women of

reproductive age, in working towards achieving the second global nutrition target 2025, a 50% reduction

of anaemia in women of reproductive age (2), as outlined in the Comprehensive implementation plan on

maternal, infant and young child nutritionand endorsed by the Sixty-fth World Health Assembly, in

resolution WHA65.6(3).

BACKGROUND

Anaemia, dened as a low blood haemoglobin concentration, has been shown to be a public health problem

that affects low-, middle- and high-income countries and has signicant adverse health consequences,

as well as adverse impacts on social and economic development (1, 46). Although the most reliable

indicator of anaemia at the population level is blood haemoglobin concentration, measurements of this

concentration alone do not determine thecause of anaemia. Anaemia may result from a number of causes,

with the most signicant contributor being iron deciency.1Approximately 50% of cases of anaemia are

considered to be due to iron deciency, but the proportion probably varies among population groupsand in different areas, according to the local conditions(1, 7, 8). Other causes of anaemia include other

micronutrient deciencies (e.g. folate, riboavin, vitamins A and B12

), acute and chronic infections (e.g.

malaria, cancer, tuberculosis and HIV), and inherited or acquired disorders that affect haemoglobin

synthesis, red blood cell production or red blood cell survival (e.g. haemoglobinopathies)(9, 10).

Anaemia resulting from iron deciency adversely affects cognitive and motor development, causes

fatigue and low productivity (8, 9, 11) and, when it occurs in pregnancy, may be associated with low birth

weight and increased risk of maternal and perinatal mortality(12, 13). In developing regions, maternal

and neonatal mortality were responsible for 3.0 million deaths in 2013 and are important contributors to

overall global mortality(14, 15).It has been further estimated that 90 000 deaths in both sexes and all

age groups are due to iron deciency anaemia alone(16). Any strategy implemented to prevent or treat

anaemia should be tailored to local conditions, taking into account the specic etiology and prevalence

of anaemia in a given setting and population group.

METHODS

The study design, data sources and statistical modelling methods on which this report is based have

been presented in detail elsewhere(1). The methods were designed to assess trends in the distribution

of blood haemoglobin concentrations between 1995 and 2011, using a statistical model (described

1Iron deciency anaemia and anaemia are often used synonymously and the prevalence of anaemia has often been used as a proxy for

iron deciency anaemia. However, it is important to realize that not all anaemia is caused by iron deciency.


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below in Application of a statistical model to estimate trends in the distribution of blood haemoglobin

concentrations and their uncertainties); however, only the estimates from 2011 are presented here.

Briey, the analysis included three steps, described under the subheadings that follow.

Identication of data sources for blood haemoglobin concentration and anaemia througha systematic review; accessing and extracting data; and systematically assessing the

population representativeness of data

A PubMed search was carried out for relevant search terms related to anaemia, haemoglobin and iron

status, searching for studies published after 1 January 1990. In addition to indexed articles, many

reports of national and international agencies were identied and accessed through requests to each

corresponding organization.

Data that were representative of the population level, or representative of at least three regions within

the country, were included. Data mainly came from the Micronutrients Database of the WHO Vitamin and

Mineral Information System (VMNIS), which summarizes data on the micronutrient status of populations,

collected from the scientic literature and through collaborators, including WHO regional and country

ofces, United Nations organizations, ministries of health, research and academic institutions, andnongovernmental organizations. In some cases, anonymized individual-level data were obtained from

multi-country surveys, including demographic and health surveys, multiple indicator cluster surveys,

reproductive health surveys and malaria indicator surveys. Data sources were included if:

blood haemoglobin concentration was measured;

the study reported anaemia or mean blood haemoglobin concentration for preschool-age children

or women of reproductive age;

a probabilistic sampling method was used;

the sample size was at least 100;

data were collected after 1990;

data were from the 190 countries designated for the original analysis.

Details on the selection of data sources are available as web appendices for the original publication

(1,17);however, this document only presents data for 185 Member States of WHO (see Annexes 1and3).

Adjustment of data on blood haemoglobin concentrations for altitude and smoking

Total and severe anaemia were dened according to WHO thresholds for blood haemoglobin concentration

for individuals living at sea level(18).High altitude and smoking both increase haemoglobin concentration

(18), so, where applicable, data that had been adjusted for altitude and smoking status were used

whenever possible.Biologically implausible haemoglobin values (200 g/L) were excluded.

Application of a statistical model to estimate trends in the distribution of bloodhaemoglobin concentrations and their uncertainties

A Bayesian hierarchical mixture model (1) was used to estimate trends in the distribution of blood

haemoglobin concentrations for children and for women of reproductive age by pregnancy status. Briey,

the model calculates estimates for each country and year, informed by data from that country and year

themselves, if available, and by data from other years in the same country and in other countries with

data for similar time periods, especially countries in the same region. The model borrows data to a

greater extent when data are non-existent or weakly informative, and to a lesser degree for data-rich

countries and regions. The resulting estimates are also informed by covariates that help predict blood

haemoglobin concentrations (e.g. maternal education, prevalence of sickle-cell disorders, mean weight-

for-age z-score for children). The uncertainty ranges (credibility intervals)1reect the major sources of

1As a Bayesian statistical model was used, 95% credibility intervals were calculated. These are analogous to confdence intervals, which

are used in frequentist statistics.


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uncertainty, including sampling error, non-sampling error due to issues in sample design/measurement,

and uncertainty from making estimates for countries and years without data. All analyses were done

separately for children and women of reproductive age. Estimates were made for: preschool-age children

(659 months),1women of reproductive age (1549 years), and pregnant women (1549 years) and non-

pregnant women (1549 years) separately. Data from male and female children were pooled.

The time frame for the estimates presented in the original analyses (1)was 19952011. The complete

population distributions of blood haemoglobin concentrations for every country and year wereestimated, which allowed calculation of the relevant summary statistics. For example, from the population

distributions, the mean population blood haemoglobin concentration and the total number of individuals

affected by, and the population prevalence of, severe anaemia for each country and year were calculated.

Distributions for regions were calculated as population-weighted averages of the constituent countries.

The prevalence of haemoglobin values below the WHO-recommended population-specic haemoglobin

threshold concentration in blood was used to classify countries by the level of signicance of the public

health problem (18). Although esimates for each year (1995 to 2011) have been generated, the current

report only presents estimates for the year 2011.

An additional analysis was carried out to estimate the prevalence of anaemia that may be attributed

to iron deciency. In this analysis, the attribution of iron deciency to the prevalence of anaemia wascalculated as the population that would not be anaemic if iron supplements were given. Meta-analyses

of the effect of iron supplementation on mean blood haemoglobin concentration in children aged 059

months and pregnant women and non-pregnant women aged 1250 years were used to estimate the

percentage of anaemia that could be eliminated by increased iron intake (1921).

RESULTS

Population coverage

The analysis performed (1) included 257 surveys conducted between 1990 and 2012, of which 232

(90%) were nationally representative sources. Two-hundred and ve sources (80%) had data on women

and 224 (87%) had data on children. Of the 194 WHO Member States, estimates of the prevalence of

anaemia were not made for nine countries because covariate data were not available. Of the remaining

185 countries, 95 (51%) and 101 (55%) had at least one data source for children and women, respectively,

covering 8285% of the global population of children and women. Data were most sparse in the WHO

European Region. In contrast, all countries in the WHO South-East Asia Region had at least one data

source, as did 78% of countries in the African Region.

Data for non-pregnant women and pregnant women were summed and weighted by the prevalence of

pregnancy, to generate one value for all women of reproductive age. Although data for non-pregnant

women and all women of reproductive age are very similar, they are shown for all three groups of

women separately in the tables. The population covered by survey data at the regional and global level

was calculated by summing the population (number of children and women) in countries with survey

data and dividing by the total population in all countries in that region or globally. The proportion of

the population covered by surveys, by WHO region, was over 90% in the African, South-East Asia and

Western Pacic Regions and was lowest (1823%) in the European Region (see Table 1). Annex 2presents

the results by United Nations region.

The proportion of the population and number of individuals with anaemia

The 2011 estimates suggest anaemia affects around 800 million children and women (see Table 2).

1Estimates were made for children aged 659 months because few household surveys measure anaemia in children under 6 months

of age. However, the estimate was applied to the entire population of children aged less than 5 years; thus, the number of children

affected is for the age range 059 months.


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Globally, the mean blood haemoglobin concentration was 111 g/L (95% credibility interval1[CI]: 110113) in

children, 126 g/L (95% CI: 124128) in non-pregnant women, and 114 g/L (95% CI: 112116) in pregnant

women (see Table 2), indicating that, on average, all population groups were above the threshold for

mild anaemia (110 g/L for children and pregnant women and 120 g/L for non-pregnant women). In 2011,

the highest prevalence of anaemia was in children (42.6%, 95% CI: 3747), and the lowest prevalence

was in non-pregnant women (29.0%, 95% CI: 23.934.8). In addition, the global prevalence of anaemia

for pregnant women was 38.2% (95% CI: 33.542.6) and for all women of reproductive age was 29.4%

(95% CI: 24.535.0). Severe anaemia is associated with substantially worse mortality and cognitiveand functional outcomes; in 2011, its prevalence in children and women ranged from 0.9% to 1.5%.

Haemoglobin concentrations in pregnant women were lower than in non-pregnant women. However, as

the threshold for dening anaemia is lower for pregnant women, the prevalences of anaemia in pregnant

and non-pregnant women were only about nine percentage points apart. These prevalences translate to

273.2million (95% CI: 241.8303.7) children, 496.3 million (95% CI: 409.3595.1) non-pregnant women,

and 32.4 million (95% CI: 28.436.2) pregnant women, giving a total of 528.7 million (95% CI: 440.3629.4)

women of reproductive age with anaemia worldwide in 2011. Of these, 9.6 million (95% CI: 6.914.4)

children, 19.4 million (95% CI: 12.729.4) non-pregnant women and 0.8 million (95% CI: 0.51.1) pregnant

women had severe anaemia, giving a total of 20.2 million (95% CI: 13.330.5) women of reproductive

age.

Mean blood haemoglobin concentrations and prevalences of anaemia varied substantially across regions

and countries. In 2011, the WHO South-East Asia, Eastern Mediterranean and African Regions had the

lowest mean blood haemoglobin concentrations and the highest prevalences of anaemia across population

groups (see Table 2). Children in these three regions had a mean blood haemoglobin concentration

between 104 and 109 g/L (i.e. below the threshold for mild anaemia), with more than half of children in

the South-East Asia and African Regions (53.8% or more) classied as having anaemia; severe anaemia

was highest in the African Region, with 3.6% of children affected. While women in these regions had

higher blood haemoglobin levels than children, the mean blood haemoglobin concentration was also

lowest for all women in the same three regions. The prevalence of anaemia was 37.7% to 41.5% for

non-pregnant women and 38.9% to 48.7% for pregnant women in these regions. The countries with the

lowest blood haemoglobin levels and highest prevalences of anaemia were in the WHO African Region (see

Annex 3);this reects the high prevalence of factors affecting anaemia in this region, such as malaria, sickle

cell and thalassaemias. Children in the African Region represented the highest proportionof individuals

affected with anaemia, at 62.3% (95% CI: 59.664.8), while the greatest numberof children and women

with anaemia resided in the South-East Asia Region, including 96.7 million (95% CI: 71.7115.0) children

and 202.0 million (95% CI: 141.8254.3) women of reproductive age (see Table 2) in 2011. The Eastern

Mediterranean Region had the next highest anaemia burden for children, accounting for 35.7 million

(95% CI: 29.741.9) children with anaemia, and the Western Pacic Region had the next highest anaemia

burden for women, accounting for 96.2 million (95% CI: 53.5175.3) women with anaemia in 2011.

Classication of countries by degree of public health signicance of anaemia, based onblood haemoglobin concentration

The level of the public health problem across countries is illustrated by maps for children and women

of reproductive age in Figs. 1 and 2. Additional maps may also be customized and downloaded, using

the WHO Global targets tracking tool (22). The tracking tool was designed to allow users to explore

various scenarios that take into account different rates of progress for the six global nutrition targets for

improving maternal, infant and young child nutrition (3), including a 50% reduction of anaemia in women

of reproductive age (2).

There are no countries for which country-level estimates were generated where anaemia is not at least

a mild public health problem (i.e. the prevalence of anaemia is at least 5%) in children and women (see

Table 3).Anaemia is a moderate-to-severe public health problem for pregnant women in all but twoof the countries analysed. For children and women, the majority of WHO Member States (141 to 182,

1As a Bayesian statistical model was used, 95% credibility intervals were calculated. These are analogous to condence intervals, which

are used in frequentist statistics.


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depending on the population group) have a moderate-to-severe public health problem with anaemia.

The prevalence of anaemia attributed to iron deciency

Available meta-analyses suggest that iron supplementation would increase the mean blood haemoglobin

concentration by 8.0 g/L (95% CI: 5.011.0) in children, 10.2 g/L (95% CI: 6.114.2) in pregnant women

and 8.6 g/L (95% CI: 3.913.4) in non-pregnant women (1921). Applying these shifts to estimated bloodhaemoglobin concentrations indicates that about 42% of anaemia in children would be amenable to iron

supplementation and about 50% of anaemia in women could be eliminated by iron supplementation (see

Table 4).

DISCUSSION

The estimates presented in this document are based on data available in the Micronutrients Database of

the WHO VMNIS (23). Analyses were performed in a consistent manner for children and women, and by

pregnancy status, with reporting of uncertainty (1). Overall, a high proportion of countries had nationally

representative survey data available for the three population groups most vulnerable to anaemia:

preschool-age children (659 months), pregnant women (1549 years of age) and non-pregnant women

(1549 years of age).

Unfortunately, despite the extensive data search, data for blood haemoglobin concentrations are still

limited, compared to other nutritional indicators such as child anthropometry (1, 24);this was especially

true in the high-income countries of the WHO European Region. As a result, the estimates may not capture

the full variation across countries and regions, tending to shrink towards global means when data are

sparse (1). Additionally, it was not possible to incorporate into the analyses some potentially important

predictors of blood haemoglobin concentration, especially dietary iron and iron supplementation, becauseof limited data. At this time, other population groups, such as adolescents, the elderly and men, have

been excluded, also because of limited data. These additional population groups may account for around

45% of all cases of anaemia(25).

Despite the relatively limited data available, the proportion of the population covered by at least one

anaemia survey conducted between 1995 and 2011 is relatively high (greater than 80%) for all population

groups globally. Regionally, the WHO African, South-East Asia and Western Pacic Regions had very high

coverage, with over 90% of the population covered by anaemia survey data for children and women,

while the WHO European Region had only 1823% of the population covered by survey data.

For the year 2011, it is estimated that roughly 43% of children, 38% of pregnant women, and 29% of non-

pregnant women and 29% of all women of reproductive age have anaemia globally, corresponding to 273

million children, 496 million non-pregnant women and 32 million pregnant women. Previous estimates

of anaemia were published jointly by the WHO Department of Nutrition for Health and Development

and the United States Centers for Disease Control and Prevention in 2008 for the years 19932005 (25).

Different methodology was used in generating the estimates but the results were consistent. However,

because different methodology was used, the estimates should not be compared to infer trends in the

prevalence of anaemia.

Correcting anaemia requires an integrated approach based on identifying and addressing the contributing

factors. Low blood haemoglobin concentrations may be caused by genetic traits like sickle cell and

thalassaemias; inadequate bioavailable dietary iron, folic acid and/or vitamin B12

; malaria, schistosomiasis,

hookworm, or human immunodeciency virus (HIV) infections; and some noncommunicable diseases(8, 9, 18, 2629). The analysis conducted to better understand the prevalence of anaemia attributed to iron

deciency estimates that the proportion of all anaemia amenable to iron was around 50% in women and


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42% in children, but higher for severe anaemia (over 50% for children and non-pregnant women and over

60% for pregnant women) and in regions where there are fewer other causes of anaemia (e.g. in the WHO

Region of the Americas and European Region). The proportion was lowest where other factors contribute

to anaemia, for example,


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REFERENCES

1. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F et al. Global, regional,

and national trends in haemoglobin concentration and prevalence of total and severe anaemia

in children and pregnant and non-pregnant women for 19952011: a systematic analysis of

population-representative data. Lancet Glob Health. 2013;1:E16E25. doi:10.1016/S2214-

109X(13)70001-9.

2. Global nutrition targets 2025: anaemia policy brief. Geneva: World Health Organization; 2014

(WHO/NMH/NHD/14.4; http://apps.who.int/iris/bitstream/10665/148556/1/WHO_NMH_

NHD_14.4_eng.pdf?ua=1, accessed 7 May 2015).

3. Resolution WHA65.6. Comprehensive implementation plan on maternal, infant and young child

nutrition. In: Sixth-fth World Health Assembly, Geneva, 2126 May 2012. Resolutions and

decisions, annexes. Geneva: World Health Organization; 2012:5568 (WHA65/2012/REC/1;

http://apps.who.int/gb/DGNP/pdf_les/A65_REC1-en.pdf , accessed 7 May 2015).

4. Alczar L. The economic impact of anaemia in Peru. Lima: Group for the Analysis of Development

and Action Against Hunger; 2013 (http://www.paho.org/nutricionydesarrollo/wp-content/

uploads/2013/02/The-economic-impact-of-anaemia-in-Peru-GRADE-AAH-2013.pdf ; accessed 7

May 2015).

5. Horton S, Levin C. Commentary on evidence that iron deciency anemia causes reduced work

capacity. J Nutr. 2001;131:691S6S.

6. Horton S, Ross J. The economics of iron deciency. Food Policy. 2003;28:5175. doi:10.1016/

S0306-9192(02)00070-2.

7. United Nations Childrens Fund, United Nations University, World Health Organization. Iron

deciency anaemia assessment, prevention, and control: a guide for programme managers.

Geneva: World Health Organization; 2001 (WHO/NHD/01.3; http://www.who.int/nutrition/

publications/en/ida_assessment_prevention_control.pdf, accessed 7 May 2015).

8. Stoltzfus RJ, Mullany L, Black RE. Iron deciency anaemia. In: Ezzati M, Lopez Ad, Rodgers A,

Murray CJL, editors. Comparative quantication of health risks: global and regional burden of

disease attributable to selected major risk factors. Geneva: World Health Organization; 2004:163

210 (http://www.who.int/publications/cra/chapters/volume1/0163-0210.pdf?ua=1 ; accessed 20

May 2015).

9. Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and

middle-income countries. Lancet. 2011;378:212335. doi:10.1016/S0140-6736(10)62304-5.

10. Tolentino K, Friedman JF. An update on anemia in less developed countries. Am J Trop Med Hyg.

2007;77:4451.

11. Haas JD, Brownlie T. Iron deciency and reduced work capacity: a critical review of the research

to determine a causal relationship. J Nutr. 2001;131:676S88S.

12. Kozuki N, Lee AC, Katz J, Child Health Epidemiology Reference Group. Moderate to severe,

but not mild, maternal anemia is associated with increased risk of small-for-gestational-age

outcomes. J Nutr. 2012;142:35862. doi:10.3945/jn.111.149237.

13. Steer PJ. Maternal hemoglobin concentration and birth weight. Am J Clin Nutr. 2000;71(5

Suppl.):1285S7S.

14. United Nations Childrens Fund, World Health Organization, The World Bank, United Nations

Population Division. Levels and trends in child mortality: report 2014. Estimates developed by
http://apps.who.int/iris/bitstream/10665/148556/1/WHO_NMH_NHD_14.4_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/148556/1/WHO_NMH_NHD_14.4_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/148556/1/WHO_NMH_NHD_14.4_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/148556/1/WHO_NMH_NHD_14.4_eng.pdf?ua=1http://apps.who.int/gb/DGNP/pdf_files/A65_REC1-en.pdfhttp://www.paho.org/nutricionydesarrollo/wp-content/uploads/2013/02/The-economic-impact-of-anaemia-in-Peru-GRADE-AAH-2013.pdfhttp://www.paho.org/nutricionydesarrollo/wp-content/uploads/2013/02/The-economic-impact-of-anaemia-in-Peru-GRADE-AAH-2013.pdfhttp://www.paho.org/nutricionydesarrollo/wp-content/uploads/2013/02/The-economic-impact-of-anaemia-in-Peru-GRADE-AAH-2013.pdfhttp://www.paho.org/nutricionydesarrollo/wp-content/uploads/2013/02/The-economic-impact-of-anaemia-in-Peru-GRADE-AAH-2013.pdfhttp://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdfhttp://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdfhttp://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdfhttp://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdfhttp://www.who.int/publications/cra/chapters/volume1/0163-0210.pdf?ua=1http://www.who.int/publications/cra/chapters/volume1/0163-0210.pdf?ua=1http://www.who.int/publications/cra/chapters/volume1/0163-0210.pdf?ua=1http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdfhttp://www.paho.org/nutricionydesarrollo/wp-content/uploads/2013/02/The-economic-impact-of-anaemia-in-Peru-GRADE-AAH-2013.pdfhttp://apps.who.int/gb/DGNP/pdf_files/A65_REC1-en.pdfhttp://apps.who.int/iris/bitstream/10665/148556/1/WHO_NMH_NHD_14.4_eng.pdf?ua=1


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the UN Inter-agency Group for Child Mortality Estimation. New York: United Nations Childrens

Fund; 2014 (http://www.data.unicef.org/fckimages/uploads/1410869227_Child_Mortality_

Report_2014.pdf, accessed 7 May 2015).

15. World Health Organization, United Nations Childrens Fund, United Nations Population

Fund, The World Bank, United Nations Population Division. Trends in maternal mortality:

1990 to 2010. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations

Population Division. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1; accessed 7 May 2015).

16. Global health estimates 2014 summary tables: deaths by cause, age and sex, by WHO region,

20002012. Geneva: World Health Organization; 2014 (http://www.who.int/healthinfo/global_

burden_disease/estimates/en/index1.html , accessed 25 March 2015).

17. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F et al. Global, regional,

and national trends in haemoglobin concentration and prevalence of total and severe anaemia

in children and pregnant and non-pregnant women for 19952011: a systematic analysis of

population-representative data. Lancet Glob Health. 2013;1:web appendices (http://www.

thelancet.com/cms/attachment/2019279915/2039454081/mmc1.pdf, accessed 7 May 2015).

18. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin

and Mineral Nutrition Information System. Geneva: World Health Organization; 2011 (http://

www.who.int/vmnis/indicators/haemoglobin/en/index.html , accessed 7 May 2015).

19. De-Regil LM, Jefferds ME, Sylvetsky AC, Dowswell T. Intermittent iron supplementation for

improving nutrition and development in children under 12 years of age. Cochrane Database Syst

Rev. 2011;(12):CD009085. doi:10.1002/14651858.CD009085.pub2.

20. Fernndez-Gaxiola AC, De-Regil LM. Intermittent iron supplementation for reducing anaemia

and its associated impairments in menstruating women. Cochrane Database Syst Rev.

2011;(12):CD009218. doi:10.1002/14651858.CD009218.pub2.

21. Haider BA, Olon I, Wang M, Spiegelman D, Ezzati M, Fawzi WW; Nutrition Impact Model StudyGroup (anaemia). Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic

review and meta-analysis. BMJ. 2013;346:f3443. doi:10.1136/bmj.f3443.

22. World Health Organization. Global targets tracking tool (http://www.who.int/nutrition/

trackingtool/en/, accessed 7 May 2015).

23. World Health Organization. Vitamin and Mineral Information System (VMNIS) Micronutrients

database (http://www.who.int/vmnis/database/en/ , accessed 19 May 2015).

24. World Health Organization. Global database on child growth and nutrition (http://www.who.int/

nutgrowthdb/en/, accessed 19 May 2015).

25. World Health Organization, Centers for Disease Control and Prevention. Worldwide prevalenceof anaemia 19932005: WHO Global Database on Anaemia. Geneva: World Health Organization;

2008 (http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf , accessed 7 May

2015).

26. Crompton DWT, Montresor A, Nesheim MC, Savioli L, editors. Controlling disease due to

helminth infections. Geneva: World Health Organization, 2003 (http://apps.who.int/iris/bitstre

am/10665/42707/1/9241562390.pdf?ua=1, accessed 7 May 2015).

27. Korenromp EL, Armstrong-Schellenberg JR, Williams BG, Nahlen BL, Snow RW. Impact of

malaria control on childhood anaemia in Africa a quantitative review. Trop Med Int Health.

2004;9:105065.

28. Smith JL, Brooker S. Impact of hookworm infection and deworming on anaemia in non-pregnant

populations: a systematic review. Trop Med Int Health. 2010;15:77695. doi: 10.1111/j.1365-

3156.2010.02542.x.
http://www.data.unicef.org/fckimages/uploads/1410869227_Child_Mortality_Report_2014.pdfhttp://www.data.unicef.org/fckimages/uploads/1410869227_Child_Mortality_Report_2014.pdfhttp://www.data.unicef.org/fckimages/uploads/1410869227_Child_Mortality_Report_2014.pdfhttp://www.data.unicef.org/fckimages/uploads/1410869227_Child_Mortality_Report_2014.pdfhttp://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlhttp://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlhttp://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlhttp://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlhttp://www.thelancet.com/cms/attachment/2019279915/2039454081/mmc1.pdfhttp://www.thelancet.com/cms/attachment/2019279915/2039454081/mmc1.pdfhttp://www.thelancet.com/cms/attachment/2019279915/2039454081/mmc1.pdfhttp://www.thelancet.com/cms/attachment/2019279915/2039454081/mmc1.pdfhttp://www.who.int/vmnis/indicators/haemoglobin/en/index.htmlhttp://www.who.int/vmnis/indicators/haemoglobin/en/index.htmlhttp://www.who.int/vmnis/indicators/haemoglobin/en/index.htmlhttp://www.who.int/vmnis/indicators/haemoglobin/en/index.htmlhttp://www.who.int/nutrition/trackingtool/en/http://www.who.int/nutrition/trackingtool/en/http://www.who.int/nutrition/trackingtool/en/http://www.who.int/nutrition/trackingtool/en/http://www.who.int/vmnis/database/en/http://www.who.int/vmnis/database/en/http://www.who.int/nutgrowthdb/en/http://www.who.int/nutgrowthdb/en/http://www.who.int/nutgrowthdb/en/http://www.who.int/nutgrowthdb/en/http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdfhttp://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdfhttp://apps.who.int/iris/bitstream/10665/42707/1/9241562390.pdf?ua=1http://apps.who.int/iris/bitstream/10665/42707/1/9241562390.pdf?ua=1http://apps.who.int/iris/bitstream/10665/42707/1/9241562390.pdf?ua=1http://apps.who.int/iris/bitstream/10665/42707/1/9241562390.pdf?ua=1http://apps.who.int/iris/bitstream/10665/42707/1/9241562390.pdf?ua=1http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdfhttp://www.who.int/nutgrowthdb/en/http://www.who.int/vmnis/database/en/http://www.who.int/nutrition/trackingtool/en/http://www.who.int/vmnis/indicators/haemoglobin/en/index.htmlhttp://www.thelancet.com/cms/attachment/2019279915/2039454081/mmc1.pdfhttp://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlhttp://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1http://www.data.unicef.org/fckimages/uploads/1410869227_Child_Mortality_Report_2014.pdf


13/48


9

29. Weatherall DJ, Clegg JB. Inherited haemoglobin disorders: an increasing global health problem.

Bull World Health Organ. 2001;79:70412.

30. Guideline: Intermittent iron and folic acid supplementation in menstruatingwomen. Geneva: World

Health Organization; 2011 (http://apps.who.int/iris/bitstream/10665/44649/1/9789241502023_

eng.pdf?ua=1, accessed 7 May 2015).

31. Guideline: Use of multiple micronutrient powders for home fortication of foods consumed by

infants and children 623 months of age. Geneva: World Health Organization; 2011 (http://apps.

who.int/iris/bitstream/10665/44651/1/9789241502047_eng.pdf?ua=1, accessed 7 May 2015).

32. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva: World Health

Organization; 2012 (http://apps.who.int/iris/bitstream/10665/77770/1/9789241501996_eng.pdf,

accessed 7 May 2015).

33. Guideline: Intermittent iron and folic acid supplementation in non-anaemic pregnant

women. Geneva: World Health Organization; 2012 (http://apps.who.int/iris/bitstre

am/10665/75335/1/9789241502016_eng.pdf?ua=1, accessed 7 May 2015).

34. Lutter CK, Daelmans BM, de Onis M, Kothari MT, Ruel MT, Arimond M et al. Undernutrition, poor

feeding practices, and low coverage of key nutrition interventions. Pediatrics. 2011;128:E1418E27. doi:10.1542/peds.2011-1392.

35. Recommendations on wheat and maize our fortication. Meeting report: interim consensus

statement. Geneva: World Health Organization; 2009 (WHO/NMH/NHD/MNM/09.1; http://apps.

who.int/iris/bitstream/10665/111837/1/WHO_NMH_NHD_MNM_09.1_eng.pdf?ua=1&ua=1 ,

accessed 7 May 2015).

36. Allen L, de Benoist B, Dary O, Hurrell R, editors. Guidelines on food fortication with

micronutrients. Geneva: World Health Organization; 2006 (http://whqlibdoc.who.int/

publications/2006/9241594012_eng.pdf?ua=1&ua=1, accessed 13 Mar 2015).

37.Food Fortication Initiative. Global progress (http://www.fnetwork.org/global_progress/ ,accessed 7 May 2015).

38. Gething PW, Patil AP, Smith DL, Guerra CA, Elyazar IRF, Johnston GL et al. A new world malaria

map: Plasmodium falciparumendemicity in 2010. Malaria J. 2011;10:378. doi:10.1186/1475-

2875-10-378.

39. Guideline: Intermittent iron supplementation in preschool and school-age children. Geneva: World

Health Organization; 2011 (http://apps.who.int/iris/bitstream/10665/44648/1/9789241502009_

eng.pdf?ua=1, accessed 7 May 2015).

40. Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service

indicators. Bull World Health Organ. 2008;86:4807.

41. Piel FB, Patil AP, Howes RE, Nyangiri OA, Gething PW, Williams TN et al. Global distribution

of the sickle cell gene and geographical conrmation of the malaria hypothesis. Nat Commun.

2010;1:104.

42. Brooker S. Estimating the global distribution and disease burden of intestinal nematode

infections: Adding up the numbers a review. Int J Parasitol. 2010;40:113744. doi:10.1016/j.

ijpara.2010.04.004.

43. United Nations. Composition of macro geographical (continental) regions, geographical sub-

regions, and selected economic and other groupings (http://unstats.un.org/unsd/methods/m49/

m49regin.htm, accessed 7 May 2015).
http://apps.who.int/iris/bitstream/10665/44649/1/9789241502023_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44649/1/9789241502023_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44649/1/9789241502023_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44649/1/9789241502023_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44651/1/9789241502047_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44651/1/9789241502047_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44651/1/9789241502047_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44651/1/9789241502047_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/77770/1/9789241501996_eng.pdfhttp://apps.who.int/iris/bitstream/10665/77770/1/9789241501996_eng.pdfhttp://apps.who.int/iris/bitstream/10665/77770/1/9789241501996_eng.pdfhttp://apps.who.int/iris/bitstream/10665/75335/1/9789241502016_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/75335/1/9789241502016_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/75335/1/9789241502016_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/75335/1/9789241502016_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/111837/1/WHO_NMH_NHD_MNM_09.1_eng.pdf?ua=1&ua=1http://apps.who.int/iris/bitstream/10665/111837/1/WHO_NMH_NHD_MNM_09.1_eng.pdf?ua=1&ua=1http://apps.who.int/iris/bitstream/10665/111837/1/WHO_NMH_NHD_MNM_09.1_eng.pdf?ua=1&ua=1http://apps.who.int/iris/bitstream/10665/111837/1/WHO_NMH_NHD_MNM_09.1_eng.pdf?ua=1&ua=1http://whqlibdoc.who.int/publications/2006/9241594012_eng.pdf?ua=1&ua=1http://whqlibdoc.who.int/publications/2006/9241594012_eng.pdf?ua=1&ua=1http://whqlibdoc.who.int/publications/2006/9241594012_eng.pdf?ua=1&ua=1http://whqlibdoc.who.int/publications/2006/9241594012_eng.pdf?ua=1&ua=1http://apps.who.int/iris/bitstream/10665/44648/1/9789241502009_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44648/1/9789241502009_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44648/1/9789241502009_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44648/1/9789241502009_eng.pdf?ua=1http://unstats.un.org/unsd/methods/m49/m49regin.htmhttp://unstats.un.org/unsd/methods/m49/m49regin.htmhttp://unstats.un.org/unsd/methods/m49/m49regin.htmhttp://unstats.un.org/unsd/methods/m49/m49regin.htmhttp://unstats.un.org/unsd/methods/m49/m49regin.htmhttp://apps.who.int/iris/bitstream/10665/44648/1/9789241502009_eng.pdf?ua=1http://whqlibdoc.who.int/publications/2006/9241594012_eng.pdf?ua=1&ua=1http://apps.who.int/iris/bitstream/10665/111837/1/WHO_NMH_NHD_MNM_09.1_eng.pdf?ua=1&ua=1http://apps.who.int/iris/bitstream/10665/75335/1/9789241502016_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/77770/1/9789241501996_eng.pdfhttp://apps.who.int/iris/bitstream/10665/44651/1/9789241502047_eng.pdf?ua=1http://apps.who.int/iris/bitstream/10665/44649/1/9789241502023_eng.pdf?ua=1


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Table 1. Number of countries and percentage of population covered by surveys of anaemia prevalence

(national or subnational), by WHO region

WHO

region

Numberof

countries

in regiona

Children aged659 months

Non-pregnant womenaged 1549 years

Pregnant womenaged 1549 years

All women ofreproductive age

(1549 years)

Countries

Coverage

(%) Countries

Coverage

(%) Countries

Coverage

(%) Countries

Coverage

(%)

African

Region46 35 93.7 36 90.8 35 93.9 36 91.1

Region

of the

Americas

34 15 86.0 14 64.3 13 65.8 14 64.4

South-East

Asia Region11 9 96.8 11 100.0 10 97.8 11 100.0

European

Region51 12 22.7 13 18.4 11 21.7 13 18.6

Eastern

Mediter-raneanRegion

21 12 77.2 13 81.1 11 69.2 13 80.9

Western

Pacic

Region

22 12 90.3 14 96.7 14 95.1 14 96.6

Global 185 95 85.0 101 81.3 94 83.2 101 81.5

a Excludes WHO Member States of Cook Islands (Western Pacic Region), Monaco (European Region), Nauru (Western Pacic

Region), Niue (Western Pacic Region), Palau (Western Pacic Region), Saint Kitts and Nevis (Region of the Americas), San

Marino (European Region) and Tuvalu (Western Pacic Region). Former Sudan is included in lieu of Sudan and South Sudan,

consistent with the situation from 1 January to 9 July 2011.

Table 2. Global and WHO regional mean blood haemoglobin concentration and prevalence of anaemia

by population group for 2011

WHO region

Mean

(95% CI) bloodhaemoglobinconcentration

(g/L)

Percentage(95% CI) of

population with

anaemiaa

Number (95% CI) ofpeople with anaemia

(millions)b

Percentage

(95% CI) ofpopulationwith severe

anaemiac

Number

(95%CI) ofpeople with

severe anaemia

(millions)b

Children aged 659 months

African Region 104 (103 to 105) 62.3 (59.6 to 64.8)c

84.5 (81.0 to 87.9)c

3.6 (2.9 to 4.4) 4.9 (4.0 to 6.0)Region of the

Americas119 (117 to 121) 22.3 (17.7 to 27.9) 17.1 (13.5 to 21.3) 0.2 (0.1 to 0.5) 0.18 (0.1 to 0.4)

South-East Asia

Region107 (104 to 112) 53.8 (39.9 to 63.9) 96.7 (71.7 to 115.0) 1.5 (0.4 to 3.7) 2.7 (0.8 to 6.6)

European


EasternMediterraneanRegion

109 (106 to 112) 48.6 (40.4 to 57.0) 35.8 (29.7 to 41.9) 2.0 (1.0 to 3.1) 1.5 (0.7 to 2.3)

Western Pacic


Global 111 (110 to 113) 42.6 (37.7 to 47.4) 273.2 (241.8 to 303.7) 1.5 (1.0 to 2.2) 9.6 (6.9 to 14.1)


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WHO region

Mean

(95% CI) bloodhaemoglobinconcentration

(g/L)

Percentage

(95% CI) ofpopulation with

anaemiaa

Number (95% CI) ofpeople with anaemia

(millions)b


populationwith severe

anaemiac

Number(95%CI) of

people withsevere anaemia

(millions)b

Non-pregnant women aged 1549 years

African Region 124 (121 to 126) 37.8 (31.8 to 43.7) 69.9 (58.8 to 80.7) 1.8 (1.3 to 2.7) 3.3 (2.4 to 5.1)

Region of the


South-East Asia


European


EasternMediterranean

Region

123 (120 to 126) 37.7 (30.7 to 45.6) 55.2 (44.9 to 66.8) 1.8 (1.1 to 2.6) 2.6 (1.6 to 3.8)

Western Pacic



Pregnant women aged 1549 years

African Region 111 (110 to 114) 46.3 (40.6 to 51.0) 9.2 (8.13 to 10.1) 1.5 (1.0 to 2.3) 0.3 (0.2 to 0.5)

Region of the


South-East Asia


European


Eastern

Mediterranean

Region

113 (111 to 116) 38.9 (32.7 to 46.3) 3.9 (3.3 to 4.6) 1.1 (0.6 to 1.6) 0.1 (0.1 to 0.2)

Western Pacic



All women of reproductive age (1549 years)

African Region 123 (120 to 125) 38.6 (32.9 to 44.2) 79.1 (67.3 to 90.5) 1.8 (1.3 to 2.7) 3.6 (2.6 to 5.5)Region of the


South-East Asia


European


Eastern

Mediterranean

Region

122 (120 to 125) 37.8 (31.0 to 45.5) 59.1 (48.4 to 71.2) 1.8 (1.1 to 2.5) 2.7 (1.7 to 3.9)

Western Pacic



CI: credibility interval.a Anaemia is dened as blood haemoglobin concentration


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Table 3. Number of countriesacategorized by public health signicance of anaemia, 2011

Category of public health problembChildren

(659 months)

Non-pregnant

women(15-49 years)

Pregnant women(1549 years)

All women of

reproductive age(1549 years)

None 0 0 0 0

Mild 32 44 2 42

Moderate 84 109 146 110

Severe 69 32 37 33

aExcludes WHO Member States of Cook Islands (Western Pacic Region), Monaco (European Region), Nauru (Western Pacic

Region), Niue (Western Pacic Region), Palau (Western Pacic Region), Saint Kitts and Nevis (Region of the Americas), San

Marino (European Region) and Tuvalu (Western Pacic Region). Former Sudan is included in lieu of Sudan and South Sudan,

consistent with the situation from 1 January to 9 July 2011.b

The prevalence of anaemia as a public health problem is categorized as follows:


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Fig.1. Global estimates of the prevalence of anaemia in infants and children aged 659 months, 2011

0 1,700 3,400850 Kilometers

Percentage (%)


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b. Prevalence of anaemia, pregnant women aged 1549 years, 2011

0 1,700 3,400850 Kilometers

Percentage (%)


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ANNEX 1. WHO MEMBER STATES GROUPED BY

REGION, AS OF 2011

Table A1.1. WHO Member States grouped by WHO region

WHO region WHO Member States, as of 1 January 2011

African Region Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cabo Verde, Cameroon, Central AfricanRepublic, Chad, Comoros, Congo, Cte dIvoire, Democratic Republic of the Congo, Equatorial Guinea,

Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar,

Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and

Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Togo, Uganda, United Republic of

Tanzania, Zambia, Zimbabwe

Region of the

Americas

Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Bolivia (Plurinational State of), Brazil,

Canada, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador,

Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru,

Saint Kitts and Nevis,bSaint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago,

United States of America, Uruguay, Venezuela (Bolivarian Republic of)

Eastern Mediterranean

Region

Afghanistan, Bahrain, Djibouti, Egypt, Iran (Islamic Republic of), Iraq, Jordan, Kuwait, Lebanon, Libya,

Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, former Sudana, Syrian Arab Republic, Tunisia,

United Arab Emirates, Yemen

European Region Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria,

Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece,

Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg,

Malta, Monaco,bMontenegro, Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania,

Russian Federation, San Marino,bSerbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan,

the former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, United Kingdom of

Great Britain and Northern Ireland, Uzbekistan

South-East Asia Region Bangladesh, Bhutan, Democratic Peoples Republic of Korea, India, Indonesia, Maldives, Myanmar,Nepal, Sri Lanka, Thailand, Timor-Leste

Western Pacic Region Australia, Brunei Darussalam, Cambodia, China, Cook Islands,bFiji, Japan, Kiribati, Lao Peoples

Democratic Republic, Malaysia, Marshall Islands, Micronesia (Federated States of), Mongolia, Nauru,b

New Zealand, Niue,bPalau,bPapua New Guinea, Philippines, Republic of Korea, Samoa, Singapore,

Solomon Islands, Tonga, Tuvalu,bVanuatu, Viet Nam

a Former Sudan is included in lieu of Sudan and South Sudan, consistent with the situation from 1 January to 9 July 2011.b Estimates were not made for these WHO Member States because covariate data were not available.


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Table A1.2. WHO Member States grouped by United Nations region and subregion

(43)

United Nationsregion and subregion WHO Member States, as of 1 January 2011

Africa

Eastern AfricaBurundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mozambique,

Rwanda, Seychelles, Somalia, Uganda, United Republic of Tanzania, Zambia, Zimbabwe

Middle AfricaAngola, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of the Congo,

Equatorial Guinea, Gabon, Sao Tome and Principe

Northern Africa Algeria, Egypt, Libya, Morocco, former Sudan,aTunisia

Southern Africa Botswana, Lesotho, Namibia, South Africa, Swaziland

Western AfricaBenin, Burkina Faso, Cabo Verde, Cte dIvoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali,

Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo

Americas

Latin America and the Caribbean

Caribbean

Antigua and Barbuda, Bahamas, Barbados, Cuba, Dominica, Dominican Republic, Grenada, Haiti,

Jamaica, Saint Kitts and Nevis,bSaint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago

Central America Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama

South AmericaArgentina, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru,

Suriname, Uruguay, Venezuela (Bolivarian Republic of)

Northern America Canada, United States of America

Asia

Central Asia Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan

Eastern Asia China, Democratic Peoples Republic of Korea, Japan, Mongolia, Republic of Korea

Southern AsiaAfghanistan, Bangladesh, Bhutan, India, Iran (Islamic Republic of), Maldives, Nepal, Pakistan, Sri

Lanka

South-Eastern AsiaBrunei Darussalam, Cambodia, Indonesia, Lao Peoples Democratic Republic, Malaysia, Myanmar,

Philippines, Singapore, Thailand, Timor-Leste, Viet Nam

Western AsiaArmenia, Azerbaijan, Bahrain, Georgia, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi

Arabia, Syrian Arab Republic, Turkey, United Arab Emirates, Yemen

Europe

Eastern EuropeBelarus, Bulgaria, Czech Republic, Hungary, Poland, Republic of Moldova, Romania, Russian

Federation, Slovakia, Ukraine

Northern EuropeDenmark, Estonia, Finland, Iceland, Ireland, Latvia, Lithuania, Norway, Sweden, United Kingdom of

Great Britain and Northern Ireland

Southern Europe Albania, Andorra, Bosnia and Herzegovina, Croatia, Greece, Italy, Malta, Montenegro, Portugal, SanMarino,bSerbia, Slovenia, Spain, the former Yugoslav Republic of Macedonia

Western Europe Austria, Belgium, France, Germany, Luxembourg, Monaco,bNetherlands, Switzerland

Oceania

Australia and

New ZealandAustralia, New Zealand

Melanesia Fiji, Papua New Guinea, Solomon Islands, Vanuatu

Micronesia Kiribati, Marshall Islands, Micronesia (Federated States of), Nauru,bPalau,b

Polynesia Cook Islands,bNiue,bSamoa, Tonga, Tuvalub

a Former Sudan is included in lieu of Sudan and South Sudan, consistent with the situation from 1 January to 9 July 2011b Estimates were not made for these WHO Member States because covariate data were not available.


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ANNEX 2. RESULTS BY UNITED NATIONS REGION,

AS OF 2011

Table A2.1. Number of countries and percentage of population covered by surveys of anaemia prevalence

(national or subnational), by United Nations region

UnitedNations

region

Number

of coun-tries in

regiona

Children aged659 months

Non-pregnant womenaged 1549 years

Pregnant womenaged 1549 years

All women of

reproductive age(1549 years)

Countries

Coverage

(%) Countries

Coverage

(%) Countries

Coverage

(%) Countries

Coverage

(%)

Africa 53 40 94.0 41 91.8 40 94.2 41 92.0

Asia 47 30 89.6 36 94.7 32 89.5 36 94.7

Americas 34 15 86.0 14 64.3 13 65.8 14 64.4

Europe 40 5 12.3 5 10.9 4 11.9 5 10.9

Oceania 11 5 5.4 5 16.3 5 15.2 5 16.2

Global 185 95 85.0 101 81.3 94 83.2 101 81.5

a Excludes WHO Member States of Cook Islands (Oceania), Monaco (Europe), Nauru (Oceania), Niue (Oceania), Palau (Oceania), Saint Kitts andNevis (Americas), San Marino (Europe), Tuvalu (Oceania). Former Sudan is included in lieu of Sudan and South Sudan, consistent with thesituation from 1 January to 9 July 2011.

Table A2.2. Global and United Nations regional mean blood haemoglobin concentration and prevalenceof anaemia by population group for 2011

United Nationsregion

Mean(95%CI) bloodhaemoglobinconcentration

(g/L)


population withanaemiaa

Number(95% CI) of people

with anaemia(millions)b

Percentage (95%CI) of population

with severeanaemiac

Number (95% CI)of people with

severe anaemia(millions)b

Children aged 659 months

Africa 105 (103 to 106) 60.2 (57.0 to 63.1) 95.0 (90.0 to 99.6) 3.3 (2.7 to 4.0) 5.2 (4.2 to 6.3)

Latin America

and theCaribbean

117 (114 to 120) 29.1 (22.5 to 36.9) 15.5 (12.0 to 19.6) 0.3 (0.2 to 0.7) 0.2 (0.1 to 0.4)

Northern

America124 (122 to125) 7.0 (4.9 to 12.3) 1.6 (1.2 to 2.9) 0.0 (0.0 to 0.2) 0.0 (0.0 to 0.0)

Asia 112 (109 to 115) 42.0 (34.1 to 49.9) 152.2 (123.5 to 180.9) 1.1 (0.5 to 2.3) 4.1 (1.8 to 8.2)

Europe 120 (116 to 123) 19.3 (10.9 to 30.7) 7.8 (4.4 to 12.4) 0.2 (0.0 to 0.8) 0.1 (0.0 to 0.3)

Oceania 117 (112 to 122) 26.2 (14.5 to 41.6) 0.8 (0.4 to 1.3) 0.3 (0.0 to 1.3) 0.0 (0.0 to 0.0)



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18

United Nationsregion

Mean(95%CI) bloodhaemoglobinconcentration

(g/L)


population withanaemiaa

Number(95% CI) of people

with anaemia(millions)b

Percentage (95%CI) of population

with severeanaemiac

Number (95% CI)of people with

severe anaemia(millions)b

Non-pregnant women aged 1549 years


Latin America

and the

Caribbean

131 (127 to 134) 18.7 (12.7 to 29.4) 28.7 (19.4 to 45.0) 0.7 (0.3 to 1.6) 1.1 (0.5 to 2.4)

Northern

America132 (130 to 134) 12.2 (9.1 to 17.0) 9.6 (7.2 to 13.4) 0.2 (0.1 to 0.5) 0.2 (0.7 to 0.4)

Asia 125 (122 to 128) 31.6 (24.1 to 40.5) 337.0 (257.4 to 432.4) 1.3 (0.7 to 2.2) 13.4 (7.3 to 23.1)




Pregnant women aged 1549 years


Latin America

and the

Caribbean

118 (114 to 123) 28.3 (20.1 to 38.6) 1.9 (1.4 to 2.6) 0.4 (0.2 to 0.9) 0.0 (0.0 to 0.1)

Northern


Asia 113 (111 to 116) 39.3 (31.8 to 46.5) 18.5 (15.0 to 21.9) 0.9 (0.5 to 1.5) 0.4 (0.2 to 0.7)




All women of reproductive age (1549 years)


Latin Americaand the

Caribbean

130 (126 to 134) 19.1 (13.1 to 29.4) 30.6 (20.9 to 46.9) 0.7 (0.3 to 1.6) 1.1 (0.5 to 2.5)

Northern


Asia 124 (122 to 127) 31.9 (24.6 to 40.6) 355.5 (274.5 to 452.8) 1.2 (0.7 to 2.1) 13.8 (7.5 to 23.7)




CI: credibility interval.a Anaemia is dened as blood haemoglobin concentration


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19

ANNEX 3. NATIONAL ESTIMATES OF ANAEMIA FOR

THE YEAR 2011

Table A3.1. Country estimates for children aged 659 months

Country

Mean bloodhaemoglobin

concentration (g/L)

Percentage of childrenwith blood haemo-globin concentration


24/48


20

Country


concentration (g/L)

Percentage of childrenwith blood haemo-

globin concentration


25/48


21

Country


concentration (g/L)




26/48


22

Country


concentration (g/L)




27/48


23

Country


concentration (g/L)




28/48


24

Country


concentration (g/L)




29/48


30/48


26

Country


concentration (g/L)

Percentage of non-pregnant women with

blood haemoglobinconcentration


31/48


27

Country


concentration (g/L)




32/48


28

Country


concentration (g/L)




33/48


29

Country


concentration (g/L)




34/48


30

Country


concentration (g/L)




35/48


31

Table A3.3. Country estimates for pregnant women aged 1549 years

Country

Mean blood haemoglobinconcentration (g/L)

Percentage ofpregnant women

with blood haemo-globin concentration


36/48


32

Country





37/48


33

Country





38/48


34

Country





39/48


35

Country





40/48


36

Country





41/48


37

Table A3.4 Country estimates for all women of reproductive age (1549 years)

Country


concentration (g/L)

Percentage of womenwith anaemia (bloodhaemoglobin concen-tration


42/48


38

Country


concentration (g/L)



43/48


39

Country


concentration (g/L)



44/48


40

Country


concentration (g/L)



45/48


41

Country


concentration (g/L)



46/48


42

Country


concentration (g/L)



47/48


43

Country


concentration (g/L)



48/48


For more information, please contact:

Department of Nutrition for Health and Development

World Health Organization

Avenue Appia 20, CH-1211 Geneva 27, Switzerland

Fax: +41 22 791 4156

Email: [email protected]

www.who.int/nutrition

anaemia who

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