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Worldwide prevalence of anaemia

19932005
WHO Global Database on Anaemia

Centers for Disease Control and Prevention Atlanta

Worldwide prevalence of anaemia


19932005
who Global database on anaemia
Editors Bruno de Benoist world health organization Geneva, switzerland Erin McLean world health organization Geneva, switzerland Ines Egli Institute of food science and nutrition, eth Zurich, switzerland Mary Cogswell centers for disease control and prevention atlanta, Georgia

WHO Library Cataloguing-in-Publication Data Worldwide prevalence of anaemia 19932005 : WHO global database on anaemia / Edited by Bruno de Benoist, Erin McLean, Ines Egli and Mary Cogswell. 1.Anemia prevention and control. 2.Anemia epidemiology. 3.Prevalence. I.World Health Organization. ISBN 978 92 4 159665 7 (NLM classification: WH 155)

World Health Organization 2008 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). 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 Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. Cover photographs by Virot Pierre, Armando Waak, Carlos Gaggero Designed by minimum graphics Printed in Spain

Contents

Preface Acknowledgements Abbreviations 1. Introduction 1.1 Anaemia: a public health problem 1.1.1 Etiology 1.1.2 Health consequences 1.1.3 Assessing anaemia 1.2 Control of anaemia 1.2.1 Correcting anaemia 2. Methods 2.1 Data sources The WHO Global Database on Anaemia 2.2 Selection of survey data 2.2.1 Administrative level 2.2.2 Population groups 2.3 Defining anaemia 2.3.1 Haemoglobin threshold 2.3.2 Estimated anaemia prevalence for countries with no survey data 2.3.3 Uncertainty of estimates 2.3.4 Combining national estimates 2.3.5 Global anaemia prevalence 2.3.6 Classification of anaemia as a problem of public health significance 2.4 Population coverage, proportion of population, and the number of individuals with anaemia 2.4.1 Population coverage 2.4.2 Proportion of population and the number of individuals affected 3. Results and Discussion 3.1 Results 3.1.1. Population coverage 3.1.2 Proportion of population and number of individuals with anaemia 3.1.3 Classification of countries by degree of public health significance of anaemia 3.2 Discussion 3.2.1 Population coverage 3.2.2 Strengths of estimates 3.2.3 Limitations of estimates 3.2.4 Proportion of population and the number of individuals with anaemia 3.2.5 Classification of countries by degree of public health significance of anaemia, based on haemoglobin concentration 3.2.6 Comparison to previous estimates 3.3 Conclusion References

v vi vii 1 1 1 1 1 1 1 3 3 3 3 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7 8 8 8 8 8 12 12 12 12 14

contents

iii

Annexes Annex 1

Annex 2

Annex 3

WHO Member States grouped by WHO and UN regions Table A1.1 WHO Member States grouped by WHO regions Table A1.2 WHO Member States grouped by UN regions and subregions Results by UN region Table A2.1 Population coverage by anaemia prevalence surveys (national or subnational) conducted between 1993 and 2005 by UN region Table A2.2 Anaemia prevalence by UN region National estimates of anaemia Table A3.1 Country estimates of anaemia prevalence in preschool-age children Table A3.2 Country estimates of anaemia prevalence in pregnant women Table A3.3 Country estimates of anaemia prevalence in non-pregnant women of reproductive age Table A3.4 Country references Haemoglobin thresholds used to define anaemia Prediction equations used to generate anaemia estimates for countries without survey data Classification of anaemia as a problem of public health significance Population coverage (%) by anaemia prevalence surveys (national or subnational) conducted between 1993 and 2005 Global anaemia prevalence and number of individuals affected Anaemia prevalence and number of individuals affected in preschool-age children, non-pregnant women and pregnant women in each WHO region Number of countries categorized by public health significance of anaemia

15 15 16 18 18 18 20 20 25 30 35 4 5 6 7 7 8 8

Tables Table 2.1 Table 2.2 Table 2.3 Table 3.1 Table 3.2 Table 3.3 Table 3.4

Figures Figure 3.1 Anaemia as a public health problem by country (a) Preschool-age children (b) Pregnant women (c) Non-pregnant women of reproductive age

9 10 11

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worldwIde prevalence of anaemIa 19932005

Preface

Anaemia is a public health problem that affects populations in both rich and poor countries. Although the primary cause is iron deficiency, it is seldom present in isolation. More frequently it coexists with a number of other causes, such as malaria, parasitic infection, nutritional deficiencies, and haemoglobinopathies. Given the importance of this pathology in the world, numerous countries conduct interventions to reduce anaemia; particularly in the groups most susceptible to its devastating effects: pregnant women and young children. In order to assess the impact of these interventions, the adequacy of the strategies implemented, and the progress made in the fight against anaemia, information on anaemia prevalence must be collected. This is the primary objective of the WHO Global Database on Anaemia. However, estimates of anaemia prevalence by themselves are only useful if they are associated with a picture of the various causal factors that contribute to the development of anaemia in specific settings. Indeed these factors are multiple and complex, and it is critical to collect accurate information about them to provide the basis for developing the best interventions for anaemia control. In the last three decades, there have been various attempts to produce estimates of the prevalence of anaemia at different levels including at the global level, but until the present time, there has never been a systematic review of all of the data collected and published with the objective of deriving regional and global estimates. The WHO Global Database on Anaemia has filled this gap: data from 93 countries, representing as much as 76% of the population in the case of preschool-age children, were analysed and used to develop statistical models to generate national prevalence estimates for countries with no data within the time frame specified. It is surprising that given the public health importance of anaemia, there are numerous countries lacking national prevalence data. Moreover, most survey data are related to the three population groups: preschool-age children, pregnant women, and non-pregnant women of reproductive age, which is why the report focuses on these groups.

The data available for school-age children, men, and the elderly were not sufficient to generate regional or countrylevel estimates for these groups, and therefore only global estimates for these groups are presented. In addition, despite the fact that iron deficiency is considered to be the primary cause of anaemia, there are few data on the prevalence of this deficiency. The likely reason is that iron assessment is difficult because the available indicators of iron status do not provide sufficient information alone and must be used in combination to obtain reliable information on the existence of iron deficiency. Furthermore, there is no real consensus on the best combination of indicators to use. Another reason is that the role of factors other than iron deficiency in the development of anaemia has been underestimated by public health officials, because for a long time anaemia has been confused with iron deficiency anaemia, and this has influenced the development of strategies and programmes designed to control anaemia. In this report, the prevalence of anaemia is presented by country and by WHO regions. Because these prevalence data may be used to identify programme needs by other United Nations agencies, we have presented the estimates classified by United Nations regions in the annexes. In addition, one chapter is dedicated to the criteria used to identify, revise, and select the surveys, and the methodology developed to generate national, regional, and global estimates. A lesson learned from producing this report is that in order for the database to reach its full potential, data should be collected on other vulnerable population groups such as the elderly and school-age children, and surveys should be more inclusive and collect information on iron status and other causes of anaemia. This report is written for public health officials, nutritionists, and researchers. We hope that readers find it useful and feel free to share any comments with us. Bruno de Benoist Coordinator, Micronutrient Unit World Health Organization

preface

Acknowledgements

The WHO Global Database on Anaemia was developed by the Micronutrient team in the Department of Nutrition for Health and Development with the financial support of the Centers for Disease Control and Prevention. The estimates for the database were produced by Erin McLean, Mary Cogswell, Ines Egli, and Daniel Wojdyla with contributions from Trudy Wijnhoven, Laurence Grummer-Strawn, and Bradley Woodruff, under the coordination of Bruno de Benoist. Grace Rob and Ann-Beth Moller assisted in data management.

WHO wishes to thank the numerous individuals, institutions, governments, non-governmental, and international organizations for providing data for the database. Without continual international collaboration in keeping the database up-to-date, this compilation on the global situation and trends in anaemia prevalence would not have been possible. Special thanks are due to ministries of health of the WHO Member States, WHO regional offices, and WHO country offices.

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worldwIde prevalence of anaemIa 19932005

Abbreviations

CDC Hb HDI IDA NHANES NPW PreSAC PW SD UN VMNIS WHO CRP

Centers for Disease Control and Prevention Haemoglobin Human Development Index: a composite indicator of wealth, life expectancy and education developed by the United Nations Development Programme. Iron deficiency anaemia National Health and Nutrition Examination Survey Non-pregnant women (15.0049.99 yrs) Preschool-age children (0.004.99 yrs) Pregnant women Standard deviation United Nations Vitamin and mineral nutrition information system World Health Organization C-reactive protein

aBBrevIatIons

vii

1. Introduction

1.1 Anaemia: a public health problem


Anaemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development. It occurs at all stages of the life cycle, but is more prevalent in pregnant women and young children. In 2002, iron deficiency anaemia (IDA) was considered to be among the most important contributing factors to the global burden of disease (1).

the negative consequences of IDA on cognitive and physical development of children, and on physical performance particularly work productivity in adults are of major concern (2).

1.1.3 Assessing anaemia


Hb concentration is the most reliable indicator of anaemia at the population level, as opposed to clinical measures which are subjective and therefore have more room for error. Measuring Hb concentration is relatively easy and inexpensive, and this measurement is frequently used as a proxy indicator of iron deficiency. However, anaemia can be caused by factors other than iron deficiency. In addition, in populations where the prevalence of inherited haemoglobinopathies is high, the mean level of Hb concentration may be lowered. This underlines that the etiology of anaemia should be interpreted with caution if the only indicator used is Hb concentration. The main objective for assessing anaemia is to inform decision-makers on the type of measures to be taken to prevent and control anaemia. This implies that in addition to the measurement of Hb concentration, the causes of anaemia need to be identified considering that they may vary according to the population.

1.1.1 Etiology
Anaemia is the result of a wide variety of causes that can be isolated, but more often coexist. Globally, the most significant contributor to the onset of anaemia is iron deficiency so that IDA and anaemia are often used synonymously, and the prevalence of anaemia has often been used as a proxy for IDA. It is generally assumed that 50% of the cases of anaemia are due to iron deficiency (2), but the proportion may vary among population groups and in different areas according to the local conditions. The main risk factors for IDA include a low intake of iron, poor absorption of iron from diets high in phytate or phenolic compounds, and period of life when iron requirements are especially high (i.e. growth and pregnancy). Among the other causes of anaemia, heavy blood loss as a result of menstruation, or parasite infections such as hookworms, ascaris, and schistosomiasis can lower blood haemoglobin (Hb) concentrations. Acute and chronic infections, including malaria, cancer, tuberculosis, and HIV can also lower blood Hb concentrations. The presence of other micronutrient deficiencies, including vitamins A and B12, folate, riboflavin, and copper can increase the risk of anaemia. Furthermore, the impact of haemoglobinopathies on anaemia prevalence needs to be considered within some populations.

1.2 Control of anaemia


1.2.1 Correcting anaemia
Given the multifactorial nature of this disease, correcting anaemia often requires an integrated approach. In order to effectively combat it, the contributing factors must be identified and addressed. In settings where iron deficiency is the most frequent cause, additional iron intake is usually provided through iron supplements to vulnerable groups; in particular pregnant women and young children. Foodbased approaches to increase iron intake through food fortification and dietary diversification are important, sustainable strategies for preventing IDA in the general population. In settings where iron deficiency is not the only cause of anaemia, approaches that combine iron interventions with other measures are needed. Strategies should include addressing other causes of

1.1.2 Health consequences


Anaemia is an indicator of both poor nutrition and poor health. The most dramatic health effects of anaemia, i.e., increased risk of maternal and child mortality due to severe anaemia, have been well documented (35). In addition,

1. IntroductIon

anaemia (6,7),1.2 and should be built into the primary health care system and existing programmes. These strategies should be tailored to local conditions, taking into account the specific etiology and prevalence of anaemia in a given setting and population group.

1 2

http://www.who.int/malaria/docs/TreatmentGuidelines2006.pdf http://www.who.int/wormcontrol/documents/en/Controlling%20 Helminths.pdf

worldwIde prevalence of anaemIa 19932005

2. Methods

2.1 Data sources The WHO Global Database on Anaemia


The estimates presented are based on data from the WHO Global Database on Anaemia; a part of the Vitamin and Mineral Nutrition Information System (VMNIS), maintained at WHO. Data are collected from the scientific literature and through collaborators, including WHO regional and country offices, United Nations organizations, ministries of health, research and academic institutions, and nongovernmental organizations. MEDLINE and WHO regional databases were searched systematically, and manual searches were conducted to find articles published in nonindexed medical and professional journals. For inclusion in the database, Hb must be measured in capillary, venous, or cord blood using quantitative photometric methods or automated cell counters. In addition, anaemia prevalence or mean Hb concentrations have to be reported. Surveys were excluded if they measured only clinical signs of anaemia or haematocrit. Data are included in the database if they are representative of any administrative level within a country, including nationally representative data and surveys representative of a region, the first administrative level boundary, second administrative level boundary or local surveys. As of December 31, 2005, 696 surveys were available in the database; the majority of these in women or preschool-age children.

country using two variables: the administrative level for which the survey was representative, and the population group surveyed.

2.2.1 Administrative level


Surveys were selected based on the administrative level they represented. Surveys were classified as national when they were based on a nationally representative sample. Subnational surveys were also available in the database and were classified according to the population that they represented as regional (multiple states), state (representative of the first administrative level boundary), district (representative of the second administrative level boundary), or local surveys. Data from the most recent national survey was used in preference to subnational surveys. For one country, where an area had been left out of a national survey because of security concerns, available data from the missing region was pooled with the national data and weighted by the general population estimate for that area to provide a national estimate for that country. This proportion was determined by using the most recent census data from the country. If two national surveys were conducted in the same year, survey results were pooled into a single summary measure and weighted by the survey sample size. In the absence of national data, surveys representative of at least the first administrative level boundary were used if two or more surveys at this level were available for the population group and country concerned within the acceptable time frame. Results were pooled into a single summary measure, weighted by the total general population for that region or state, and based on the most recent and available census data between 1993 and 2005. Local- and districtlevel surveys were not used in these estimates since they have the potential for more bias. Surveys with prevalence data based on a sample size of less than 100 subjects were excluded in most cases. This was done because with a sample size of 100 and a confidence level of 95%, the error around an estimate of anaemia prevalence of 50% would be +/-10 percentage points. A smaller sample size would have an even larger error. How-

2.2 Selection of survey data


The time frame for the current estimates is 19932005 and survey data for WHOs 1921 Member States were extracted from the database. Data on anaemia were selected for each

On 3 June 2006, the Permanent Representative of the Republic of Serbia to the United Nations and other International Organizations in Geneva informed the Acting Director-General of the WHO that the membership of the state union Serbia and Montenegro in the United Nations, including all organs and the organizations of the United Nations system, is continued by the Republic of Serbia on the basis of Article 60 of the Constitutional Charter of Serbia and Montenegro, activated by the Declaration of Independence adopted by the National Assembly of Montenegro on 3 June 2006. Estimates used or referred to in this document cover a period of time preceding that communication.

2. methods

ever, a few exceptions were made. National surveys with fewer than 100 subjects but more than 50 subjects were only accepted where the results were being extrapolated to fewer than 500,000 people; or to pregnant women, since the numbers in this group are frequently small, especially in populations with a lower rate of reproduction.

2.2.2 Population groups


Population groups are as follows: preschool-age children (04.99 yrs), school-age children (5.0014.99 yrs), pregnant women (no age range defined), non-pregnant women (15.0049.99 yrs), men (15.0059.99 yrs), and elderly (both sexes >60 yrs). Wherever possible, children below 0.5 yrs were excluded from the estimate for preschool-age children since the cut-off for anaemia is not defined in this age group. However, the estimate was applied to the entire population of children less than 5 yrs of age. Occasionally, in the non-pregnant women group, pregnant women could not be excluded because all women were included in the figure provided in the country report; but pregnant women were often a small proportion of the group and their exclusion would not be expected to change the figure significantly. If a survey reported results by physiological status, lactating women were combined with non-pregnant non-lactating women to provide the estimate for non-pregnant women. Data disaggregated by age closest to the defined age range for the population groups were used. If the age range overlapped two population groups, the survey was placed with the group with the greatest overlap in age. When the age range was unavailable, the mean age of the sample was used to classify the data. If this was unavailable or if the age range equally spanned two population groups, the population-specific Hb concentration threshold was used to classify the data. If data represented less than 20% of the age range of a population group, the survey was excluded.

and altitude (10), and therefore the prevalence of anaemia corrected for these factors was used when provided by the survey. No other corrections were accepted. Some surveys did not present data using the WHO Hb thresholds to define anaemia. When this occurred, prevalence was estimated by assuming that the Hb concentration was normally distributed within the population and estimating anaemia prevalence by using one of the following methods in order of preference: 1. The mean and standard deviation (SD) of the Hb concentration were used to estimate the proportion of individuals falling below the appropriate Hb cut-off for the population group (n=20 surveys). The correlation between the estimated and predicted prevalence of anaemia was determined using surveys from the database where a mean, an SD, and a prevalence for the WHO age- and sex-specific cut-off were provided. The relationship was plotted (n=508 surveys), and for most surveys, the two figures were extremely close (r20.95, p<0.001) for all four Hb thresholds (110, 115, 120, 130 g/l). On average, the predicted prevalence overestimated actual prevalence by 3.8 percentage points. For 6.5% of the surveys in the analysis, actual anaemia prevalence was overestimated by 10 percentage points or more. 2. When no SD was provided, but the prevalence for a nonWHO cut-off and mean Hb concentrations were available (n=3 surveys), we used these two figures to calculate the SD of the Hb concentration by assuming a normal distribution within the population and deriving the Z score in order to back calculate the SD [SD= (Provided cut-off Mean Hb)/ Z score for proportion]. Following this calculation, the mean and SD were used as above to derive the prevalence for the WHO cut-off. 3. For surveys (n=23) that did not present the mean and SD, nor the prevalence at the recommended threshold, the prevalence of anaemia was estimated from the prevalence at an alternative threshold. An average SD for the same population group was assumed to be similar to the actual SD in the survey. The mean SD of the Hb concentration for each population group was calculated from surveys included in the estimates, which had data available for subjects within the defined age range of the population group (preschool-age children, SD=13.8 g/l; school-age children, 11.3 g/l; non-pregnant women, 13.7 g/l; pregnant women, 14.0 g/l; and men, 14.5 g/l). The population mean Hb concentration was estimated from the prevalence at the cut-off provided in the survey and the assumed SD. Sometimes it was necessary to make adjustments for aggregated or disaggregated data. For example, one estimate was sometimes provided for school-age children utilizing 1)

2.3 Defining anaemia


2.3.1 Haemoglobin threshold
Normal Hb distributions vary with age, sex, and physiological status, e.g., during pregnancy (8). WHO Hb thresholds were used to classify individuals living at sea level as anaemic (Table 2.1) (2). Statistical and physiological evidence indicate that Hb distributions vary with smoking (9) Table 2.1 Haemoglobin thresholds used to define anaemia
Age or gender group Haemoglobin threshold (g/l)

children (0.504.99 yrs) children (5.0011.99 yrs) children (12.0014.99 yrs) non-pregnant women (15.00 yrs) pregnant women men (15.00 yrs)
Source: adapted from reference (2)

110 115 120 120 110 130

worldwide prevalence of anaemia 19932005

one non-WHO cut-off for anaemia where two should have been used; or 2) using two non-WHO cut-offs. In the first case, the prevalence was adjusted for the WHO cut-off that applied to the group in the majority. In the second case, the prevalence was adjusted by assuming that the cut-off applied to the group in the majority had been used for the entire group. Data provided for separate groups frequently had to be combined, such as data for women by physiological status or any other population group disaggregated by age. Prevalence estimates were combined and weighted by sample size, and where this information was unavailable for one of the groups, it was assumed to have the average number of subjects of the other groups. If sample size information was missing from all data pooled, equal weight was given to each survey.

Anaemia prevalence was estimated by using the prediction equations (Table 2.2) in countries where only explanatory variables were known. For one country, none of the covariates were available and therefore, a country-level estimate was not generated.

2.3.3 Uncertainty of estimates


For estimates based on survey data, each estimate was considered to be representative of the entire country whether from a national or subnational sample, and the variance was calculated in the logit scale using the sample size. A design effect of 2 was applied since most surveys utilized cluster sampling. From the prevalence, the variance and the design effect, a 95% confidence interval was generated in logit scale and then transformed to the original scale (17,18). For regression-based estimates, a point estimate and 95% prediction interval were computed by using the logit transformations in the regression models (19) and then back-transforming them to the original scale (20).

2.3.2 Estimated anaemia prevalence for countries with no survey data


Some countries did not have any survey data that met the criteria for the estimates. Therefore, a regression model was developed using countries with anaemia prevalence data and the 2002 United Nations Human Development Index (HDI) (11) which is a composite indicator of a life expectancy index, an education index, and a wealth index (12) and health indicators from the World Health Statistics Database (13), so that anaemia prevalence could be predicted for the countries without data. Separate prediction equations for each population group were based on countries with anaemia prevalence data for that group. Seventeen countries did not have an HDI, and so HDI was estimated using two of the components and a proxy indicator for education (average years of schooling in adults) (1416 ). HDI and estimated HDI were used to predict the prevalence of anaemia using a multiple regression model.

2.3.4 Combining national estimates


Country estimates were combined to provide estimates at the global level as well as by WHO region for women and preschool-age children by pooling the data and weighting it by the population that each estimate represented. Ninetyfive percent confidence intervals were constructed using the estimated variance of the weighted average. For one country without data, no proxy indicators were available and so no country estimate was generated, but the UN subregional estimate had to be applied to that country to make regional and global estimates.

2.3.5 Global anaemia prevalence


The global prevalence of anaemia was calculated by combining the estimates for all population groups, which covered the entire population except for one segment (women

Table 2.2 Prediction equations used to generate anaemia estimates for countries without survey data
Population group Number of countries Equation R2 p-value for model

preschool-age childrena school-age children non-pregnant women pregnant women men elderly
a b

82 35 79 60 32 13

= 3.5979-4.9093*hdIb-0.0657*exp on health0.0003*exp on health per capita0.0009*adult female mortality = 1.4248-2.6894*hdI+0.0087*urban population0.0129*Imm measles-0.0005*exp on health per capita = 0.94752.3447*hdI+0.1643*population growth rate0.0697 exp on health = 2.7783-2.8352*hdI-0.0085*Imm dtp30.0004*exp on health per capita0.0017*adult male mortality = 0.09914.6160*hdI+0.0209*Imm dtp3-0.0828*Gov exp on health = -1.6693+0.2872*hdI0.1359*exp on health+0.0047*adult male mortality

0.550 0.583 0.453 0.323 0.577 0.385

<0.0001 <0.0001 <0.0001 <0.0001 <0.0001 0.0627

population groups: preschool-age children (0.004.99 yrs), pregnant women (no age range defined), non-pregnant women (15.0049.99 yrs), school-age children (5.0014.99 yrs), men (15.0059.99 yrs), elderly (60.00 yrs). hdI = united nations human development Index, exp= expenditure, Imm dtp3 = immunization for diphtheria, tetanus and pertussis.

2. methods

50.0059.99 yrs). The estimate of anaemia prevalence in the elderly was applied to this segment of the population. Because the median age of menopause in women is approximately 50.5 yrs (21), menstrual iron losses have stopped for the majority of women in this age group, and we considered that the prevalence of anaemia may be more similar to the elderly than to women of reproductive age. Furthermore, the data from the National Health and Nutrition Examination Survey (NHANES) in the United States of America were compared among women 2049 yrs, 5059 yrs, and 60+ yrs, and women 5059 yrs had a Hb distribution more similar to women 60+ yrs than to women 2049 yrs.1 In addition, the distribution of C-reactive protein (CRP) was most similar between women 5059 yrs and women 60+ yrs. However, the proportion of anaemia attributable to elevated CRP in women 5059 yrs was more similar to women 2049 yrs.

2.4 Population coverage, proportion of population, and the number of individuals with anaemia
2.4.1 Population coverage
The population covered by survey data at the regional and global level was calculated by summing the number of individuals in the population group in countries with survey data divided by the total number of individuals in the population group in the entire region or globally for each population group. Coverage when including countries with a regressionbased estimate is not presented, since it was similar for all population groups and included all countries except for one (99.799.9%).

2.4.2 Proportion of population and the number of individuals affected


The number of individuals with anaemia was estimated in each population group for each country and each grouping of countries based on each countrys proportion of the population with anaemia. The proportion of the population group with anaemia was multiplied by the national population to provide the number of subjects with anaemia at the country level, and the 95% confidence interval was used as a measure of uncertainty. The population figures are for the 2006 projection from the 2004 revision of the United Nations population estimates (22). Population figures for pregnant women were derived from the total number of births (time period 20052010) by assuming one child per woman per year, not taking into account spontaneous and induced abortions. For 15 countries with a small total population (0.01% of all women), birth data were not provided in tabulations of the UN population division, and the number of pregnant women was estimated by applying a WHO regional average of births per reproductive-age woman (15.00 to 49.99 yrs) to the total number of reproductive-age women.

2.3.6 Classification of anaemia as a problem of public health significance


The prevalence of Hb values below the population-specific Hb threshold was used to classify countries by the level of the public health problem (Table 2.3) (2).

Table 2.3 Classification of anaemia as a problem of public health significance


Prevalence of anaemia (%) Category of public health significance

4.9 5.019.9 20.039.9 40.0

no public health problem mild public health problem moderate public health problem Severe public health problem

Source: adapted from reference (2)

M. Cogswell, unpublished data, 2006.

worldwide prevalence of anaemia 19932005

3. Results and Discussion

3.1 Results
3.1.1 Population coverage
Almost the entire population was covered by survey data or regression-based estimates, since all countries except for one had an estimate. The proportion of the population covered by survey data was high for preschool-age children (76.1%) and pregnant (69.0%) and non-pregnant women (73.5%), but lower for school-age children (33.0%), men (40.2%), and the elderly (39.1%) (Table 3.1). By WHO region, the coverage was highest in the Western Pacific and lowest in Europe. Based on this population coverage, it was decided that there were insufficient data in school-age children, men, and the elderly to generate regional estimates.

3.1.2 Proportion of population and number of individuals with anaemia


Globally, anaemia affects 1.62 billion people (95% CI: 1.501.74 billion), which corresponds to 24.8% of the population (95% CI: 22.926.7%) (Table 3.2). The highest prevalence is in preschool-age children (47.4%, 95% CI: 45.749.1), and the lowest prevalence is in men (12.7%, 95% CI: 8.616.9%). However, the population group with the greatest number of individuals affected is non-pregnant women (468.4 million, 95% CI: 446.2490.6). WHO regional estimates generated for preschool-age children and pregnant and non-pregnant women indicate that the highest proportion of individuals affected are in Africa (47.567.6%), while the greatest number af-

Table 3.1 Population coverage (%) by anaemia prevalence surveys (national or subnational) conducted between 1993 and 2005
WHO region PreSACa PW
c

NPW

SAC

Men

Elderly

All

africa (46) americas (35) South-east asia (11) europe (52) eastern mediterranean (21) western pacific (27)
b

74.6 (26) 76.7 (16) 85.1 (9) 26.5 (12) 67.4 (11) 90.4 (10)

65.8 (22) 53.8 (15) 85.6 (8) 8.3 (4) 58.7 (7) 90.2 (8) 69.0 (64)

61.4 (23) 56.2 (13) 85.4 (10) 28.0 (12) 73.5 (11) 96.9 (13) 73.5 (82)

13.2 (8) 47.1 (9) 13.6 (3) 9.3 (3) 15.5 (6) 83.1 (7) 33.0 (36)

21.9 (11) 34.3 (2) 4.1 (2) 14.1 (3) 27.5 (6) 96.2 (10) 40.2 (34)

0.0 (0) 47.6 (1) 5.2 (1) 8.0 (2) 3.2 (3) 93.3 (6) 39.1 (13)

40.7 58.0 14.9 22.9 84.3 13.8 48.8

Global (192)
a b c

76.1 (84)

population groups: preSac, preschool-age children (0.004.99 yrs); pw, pregnant women (no age range defined); npw, non-pregnant women (15.0049.99 yrs), Sac, school-age children (5.0014.99 yrs), men (15.0059.99 yrs), elderly (60.00 yrs). number of countries in each grouping. Total number of countries with data, no figure is provided for all since each country may be partially covered by some population groups, but few countries have data on all 6 population groups and no countries have data for women 5059 yrs of age.

Table 3.2 Global anaemia prevalence and number of individuals affected


Population group Prevalence of anaemia Percent 95% CI Population affected Number (million) 95% CI

preschool-age children School-age children pregnant women non-pregnant women men elderly Total population

47.4 25.4 41.8 30.2 12.7 23.9 24.8

45.749.1 19.930.9 39.943.8 28.731.6 8.616.9 18.329.4 22.926.7

293 305 56 468 260 164 1620

283303 238371 5459 446491 175345 126202 15001740

3. reSulTS and diScuSSion

Table 3.3 Anaemia prevalence and number of individuals affected in preschool-age children, pregnant women, and non-pregnant women in each WHO region
WHO region Preschool-age childrena Prevalence (%) # affected (millions) Pregnant women Prevalence (%) # affected (millions) Non-pregnant women Prevalence (%) # affected (millions)

africa americas south-east asia europe eastern mediterranean western pacific Global
a b

67.6 (64.371.0)b 29.3 (26.831.9) 65.5 (61.070.0) 21.7 (15.428.0) 46.7 (42.251.2) 23.1 (21.924.4) 47.4 (45.749.1)

83.5 (79.487.6) 23.1 (21.125.1) 115.3 (107.3123.2) 11.1 (7.914.4) 0.8 (0.41.1) 27.4 (25.928.9) 293.1 (282.8303.5)

57.1 (52.861.3) 24.1 (17.330.8) 48.2 (43.952.5) 25.1 (18.631.6) 44.2 (38.250.3) 30.7 (28.832.7) 41.8 (39.943.8)

17.2 (15.918.5) 3.9 (2.85.0) 18.1 (16.419.7) 2.6 (2.03.3) 7.1 (6.18.0) 7.6 (7.18.1) 56.4 (53.859.1)

47.5 (43.451.6) 17.8 (12.922.7) 45.7 (41.949.4) 19.0 (14.723.3) 32.4 (29.235.6) 21.5 (20.822.2) 30.2 (28.731.6)

69.9 (63.975.9) 39.0 (28.349.7) 182.0 (166.9197.1) 40.8 (31.550.1) 39.8 (35.843.8) 97.0 (94.0100.0) 468.4 (446.2490.6)

population subgroups: preschool-age children (0.004.99 yrs); pregnant women (no age range defined); non-pregnant women (15.0049.99 yrs). 95% confidence Intervals.

fected are in South-East Asia where 315 million (95% CI: 291340) individuals in these three population groups are affected (Table 3.3).

3.2 Discussion
3.2.1 Population coverage
The population covered by survey data is high for the three population groups considered to be the most vulnerable; preschool-age children, pregnant women, and non-pregnant women of childbearing age. A greater number of countries have undertaken surveys to assess anaemia in non-pregnant women than in pregnant women. However, since some of the surveys conducted in pregnant women are from countries with a large population, the proportion of the global population covered by these surveys is similar between the two population groups.

3.1.3 Classification of countries by degree of public health significance of anaemia


There are almost no countries where anaemia is not at least a mild public health problem in all three of the population groups for which country-level estimates were generated (Table 3.4). For pregnant women, over 80% of the countries have a moderate or severe public health problem. The level of the public health problem across countries is illustrated by maps for preschool-age children and pregnant and non-pregnant women in Figure 3.1. Table 3.4 Number of countries categorized by public health significance of anaemia
Public health problema
number of countries

3.2.2 Strengths of estimates


These estimates are based on a high proportion of nationally representative survey data. For the three most vulnerable population groups, preschool-age children, pregnant women, and non-pregnant women, nationally representative data covered more than two thirds of the population in each group. This eliminates the bias that comes from local data, which may greatly over- or under-represent the national situation. Regression-based estimates were used for countries without data, and these estimates explained a large amount of the variation in anaemia prevalence among countries with survey data (3258%).

Preschool-age childrenb

number of countries

Pregnant women

number of countries

Non-pregnant women

none mild moderate severe


a

2 40 81 69

0 33 91 68

1 59 78 54

the prevalence of anaemia as a public health problem is categorized as follows: <5%, no public health problem; 519.9%, mild public health problem; 2039.9%, moderate public health problem; 40%, severe public health problem. population groups: preschool-age children (0.004.99 yrs); pregnant women (no age range defined); non-pregnant women (15.0049.99 yrs).

3.2.3 Limitations of estimates


There were fewer surveys that collected data in school-age children, men, and the elderly, and in some cases there were no data for an entire region. Thus, country- or regional-

worldwIde prevalence of anaemIa 19932005

Figure 3.1a Anaemia as a public health problem by country: Preschool-age children

3. results and dIscussIon 9

Category of public health significance (anaemia prevalence) Normal (<5.0%) Mild (5.019.9%) Moderate (20.039.9%) Severe ( _ 40.0%) > No data

Figure 3.1b Anaemia as a public health problem by country: Pregnant women

10 worldwIde prevalence of anaemIa 19932005

Category of public health significance (anaemia prevalence) Normal (<5.0%) Mild (5.019.9%) Moderate (20.039.9%) Severe ( _ 40.0%) > No data

Figure 3.1c Anaemia as a public health problem by country: Non-pregnant women of reproductive age

3. results and dIscussIon 11

Category of public health significance (anaemia prevalence) Normal (<5.0%) Mild (5.019.9%) Moderate (20.039.9%) Severe ( _ 40.0%) > No data

level estimates for these population groups were not presented. Even the global estimates should be interpreted with caution since they are based primarily on regressionbased estimates for these population groups. Furthermore, the estimates generated for women (5059 yrs) were not based on any data from this population group since it is not routinely collected. It is why this estimate was used for the global figure only and not as an estimate for this group of women. These estimates were based on a number of assumptions. All surveys were treated equally, although in fact their quality varied greatly. For example, some surveys used sampling proportionate to the population distribution within the country, while others did not, and in some national surveys, specific areas had to be left out due to security or accessibility issues. Furthermore for some population groups (e.g., children 0.54.99 yrs), the population sampled covered only a portion of the desired age range (e.g., children 11.99 yrs). For the purpose of our analysis, these surveys were considered equal to those that covered the entire age range. However, an estimate from children in only the lower or higher end of the range would significantly impact the prevalence estimate, since children below two years of age are much more likely to be anaemic than those above this age. While there were only three countries for which subnational data were used to generate prevalence estimates in preschool-age children, these data may result in an over- or under-estimation of anaemia prevalence for those countries. In some cases, anaemia prevalence was calculated using Hb concentration and assuming that it was distributed normally. This may have lead to a slight over-estimation of anaemia prevalence, since Hb distributions tend to be negatively skewed in populations with a high prevalence of deficiency. The estimates for pregnant women did not account for the trimester of pregnancy since this information is not routinely reported in publications. Prevalence would be expected to vary by trimester, and thus the estimates for pregnant women may have been biased if there was not an even distribution of women at various stages of pregnancy. Furthermore, we do not have prevalence figures for the third trimester when anaemia is most likely to affect the risk of maternal mortality.

the main burden is concentrated in South-East Asia, where about 40% of anaemic preschool-age children and nonpregnant women, and about 30% of pregnant women reside.

3.2.5 Classification of countries by degree of public health significance of anaemia, based on haemoglobin concentration
Anaemia is a public health problem for pregnant women in all of WHOs Member States. Given the consequences of anaemia during pregnancy, this problem urgently needs to be addressed. The situation is similar in preschool-age children and non-pregnant women for whom only one or two countries do not have an anaemia public health problem. For women and young children, the majority of WHO Member States (132 to 159, depending on the population group) have a moderate-to-severe public health problem with anaemia; meaning that over 20% of the population group in these countries is affected. This should draw the attention of the public health authorities on the need to re-evaluate current strategies to control anaemia by making sure that the various factors contributing to anaemia have been identified and addressed properly through an integrated approach.

3.2.6 Comparison to previous estimates


It is a challenge to assess global progress in the control of anaemia, since the methodology used for these estimates is so different from those used in previous estimates. Previous global estimates made by DeMaeyer in 1985 indicated that approximately 30% of the worlds population was anaemic (23). These estimates seem to be based on an extrapolation of the prevalence in preschool-age children, school-age children, women, and men. These estimates, which excluded China where 20% of the global population resides, indicated that 43% of preschool-age children, 35% of all women, and 51% of pregnant women were anaemic. Current estimates, excluding China, are 52%, 34%, and 44%, respectively. Variations in the methods employed, and a larger proportion of nationally representative data, are more likely to account for the differences between these estimates than a change in anaemia prevalence. In 1992, WHO estimates for the year 1988 indicated that 37%, 51%, and 35% of all women and pregnant and non-pregnant women were anaemic (24). These estimates included subnational data for China. The current estimates which use nationally representative data for China (31%, 42%, and 30%) may or may not be lower, since the methodologies used are substantially different.

3.2.4 Proportion of population and the number of individuals with anaemia


One in four people is affected by anaemia, and pregnant women and preschool-age children are at the greatest risk. The WHO regions of Africa and South-East Asia have the highest risk, where about two thirds of preschool-age children and half of all women are affected. In numbers,

3.3 Conclusion
The data available for these estimates are the most representative data to date, and we can consider that these esti-

12

worldwIde prevalence of anaemIa 19932005

mates are the most accurate reflection of the global anaemia prevalence published so far. However, countries without survey data should be encouraged to collect data, since regression-based estimates are good at the regional and global level, but may not be the most accurate reflection of the situation for an individual country. The generation of these estimates and the maintenance of the anaemia database provide a reliable tool to track the global progress towards the elimination of anaemia and the effectiveness of the current strategies for anaemia control. However, since information on causal factors is

not routinely collected, the database does not provide information on the ability of the strategies to address these factors. Hopefully, these estimates will encourage countries to plan surveys which assess the prevalence of factors that contribute to anaemia not only iron deficiency, but also infectious diseases and other micronutrient deficiencies. The understanding of how these factors vary by geography, level of development, and other social and economic factors will make it easier to design interventions that are more effective and integrative in addressing multiple contributing factors at the same time.

3. results and dIscussIon

13

References

1. World Health Organization. The World Health Report 2002: Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002. 2. Iron deficiency anaemia: assessment, prevention, and control. A guide for programme managers. Geneva, World Health Organization, 2001 (WHO/NHD/01.3). 3. Macgregor M. Maternal anaemia as a factor in prematurity and perinatal mortality. Scottish Medical Journal, 1963, 8:134. 4. Scholl TO, Hediger ML. Anemia and iron-deficiency anemia: compilation of data on pregnancy outcome. American Journal of Clinical Nutrition, 1994, 59:492S 500S. 5. Bothwell T, Charlton R, eds. Iron deficiency in women. Washington DC, Nutrition Foundation, 1981. 6. Guidelines for the treatment of malaria. Geneva, Roll Back Malaria Department, World Health Organization, 2006 (WHO/HTM/MAL/2006.1108). 7. Crompton DWT et al., eds. Controlling disease due to helminth infections. Geneva, World Health Organization, 2003. 8. Koller O. The clinical significance of hemodilution during pregnancy. Obstetrical and Gynecological Survey, 1982, 37:649652. 9. Nordenberg D, Yip R, Binkin NJ. The effect of cigarette smoking on hemoglobin levels and anemia screening. Journal of the American Medical Association, 1990, 264:15561559. 10. Hurtado A., Merino C, Delgado E. Influence of anoxemia on haematopoietic activities. Archives of Internal Medicine, 1945, 75:284323. 11. Human Development Report 2002, Deepening democracy in a fragmented world. New York, United Nations Development Programme, 2002.

12. Human Development Indicators. In: Cait Murphy BRL, ed. Human Development Report 2004. New York, United Nations Development Programme, 2004: 139 250. 13. World Health Organization. World Health Statistics 2005. Geneva, World Health Organization, 2005. 14. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 2006, 3:e442. 15. World Health Organization. The World Health Report 2000: Health systems: improving performance. Geneva, World Health Organization, 2000. 16. World Health Organization. The World Health Report: 2004: Changing History. Geneva, World Health Organization, 2004. 17. Wackerly D, Mendenhall W, Scheaffer RL. Mathematical Statistics with Applications, 6th edition. Pacific Grove, CA, Duxbury Press, 2001. 18. Lohr SL. Sampling: Design and Analysis, 1st edition. Pacific Grove, CA, Duxbury Press, 1998. 19. Neter J et al. Applied Linear Statistical Models, 4th edition. New York, McGraw-Hill/Irwin, 1996. 20. Allison PD. Logistic Regression using the SAS System. Indianapolis, IN, WA (Wiley-SAS), 2001. 21. Whelan EA et al. Menstrual and reproductive characteristics and age at natural menopause. American Journal of Epidemiology, 1990, 131:625632. 22. United Nations PD. World Population Prospects the 2004 revision. New York, 2005. 23. DeMaeyer E, Adiels-Tegman M. The prevalence of anaemia in the world. World Health Statistics Quarterly, 1985, 38:302316. 24. World Health Organization. The Prevalence of Anaemia in Women: A Tabulation of Available Information. 1992 (WHO/MCH/MSM/92.2).

14

worldwIde prevalence of anaemIa 19932005

Annex 1

WHO Member States grouped by WHO region as of 2005

Table A1.1 WHO Member States grouped by WHO region

Africa
Algeria Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African Republic 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

Saint Vincent and the Grenadines Suriname Trinidad and Tobago United States of America Uruguay Venezuela (Bolivarian Republic of)

Americas
Antigua and Barbuda Argentina Bahamas Barbados Belize Bolivia 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 Saint Lucia

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

Europe
Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina
1

Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia and Montenegro1

On 3 June 2006, the Permanent Representative of the Republic of Serbia to the United Nations and other International Organizations in Geneva informed the Acting Director-General of the WHO that the membership of the state union Serbia and Montenegro in the United Nations, including all organs and the organizations of the United Nations system, is continued by the Republic of Serbia on the basis of Article 60 of the Constitutional Charter of Serbia and Montenegro, activated by the Declaration of Independence adopted by the National Assembly of Montenegro on 3 June 2006. Estimates used or referred to in this document cover a period of time preceding that communication.

Annex 1

15

Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom of Great Britain and Northern Ireland Uzbekistan

Eastern Mediterranean
Afghanistan Bahrain Djibouti Egypt Iran (Islamic Republic of) Iraq Jordan Kuwait Lebanon Libyan Arab Jamahiriya Morocco Oman Pakistan Qatar Saudi Arabia Somalia Sudan

Syrian Arab Republic Tunisia United Arab Emirates Yemen

Western Pacific
Australia Brunei Darussalam Cambodia China Cook Islands Fiji Japan Kiribati Lao Peoples Democratic Republic Malaysia

Marshall Islands Micronesia (Federated States of) Mongolia Nauru New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

Table A1.2 WHO Member States grouped by UN region and subregion1

Africa
Eastern Africa
Burundi Comoros Djibouti Eritrea Ethiopia Kenya Madagascar Malawi Mauritius Mozambique Rwanda Seychelles Somalia Uganda United Republic of Tanzania Zambia Zimbabwe

Gabon Sao Tome and Principe

Northern Africa
Algeria Egypt Libyan Arab Jamahiriya Morocco Sudan Tunisia

Niger Nigeria Senegal Sierra Leone Togo

Pakistan Sri Lanka

South-eastern Asia
Brunei Darussalam Lao Peoples Democratic Republic Malaysia Myanmar Philippines Singapore Thailand Timor-Leste Viet Nam

Asia
Central Asia
Kazakstan Kyrgyzstan Tajikistan Turkmenistan Uzbekistan

Southern Africa
Botswana Lesotho Namibia South Africa Swaziland

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

Western Asia
Armenia Azerbaijan Bahrain Cyprus Georgia Iraq Israel Jordan Kuwait Lebanon Oman

Western Africa
Benin Burkina Faso Cape Verde Cte dIvoire Gambia Ghana Guinea Guinea-Bissau Liberia Mali Mauritania

Middle Africa
Angola Cameroon Central African Republic Chad Congo Democratic Republic of The Congo Equatorial Guinea
1

Southern Asia
Afghanistan Bangladesh Bhutan India Iran (Islamic Republic of) Maldives Nepal

http://unstats.un.org/unsd/methods/m49/m49regin.htm

16

worldwide prevAlence of AnAemiA 19932005

Qatar Saudi Arabia Syrian Arab Republic Turkey United Arab Emirates Yemen

Southern Europe
Albania Andorra Bosnia and Herzegovina Croatia Greece Italy Malta Portugal San Marino Serbia and Montenegro Slovenia Spain The former Yugoslav Republic of Macedonia

Europe
Eastern Europe
Belarus Bulgaria Czech Republic Hungary Poland Republic of Moldova Romania Russian Federation Slovakia Ukraine

Cuba Dominica Dominican Republic Grenada Haiti Jamaica Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Trinidad and Tobago

Uruguay Venezuela (Bolivarian Republic of)

Northern America
Canada United States of America

Oceania
Australia-New Zealand
Australia New Zealand

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

Melanesia
Fiji Papua New Guinea Solomon Islands Vanuatu

Western Europe
Austria Belgium France Germany Luxembourg Monaco Netherlands Switzerland

Micronesia
Kiribati Marshall Islands Micronesia (Federated States of) Nauru Palau

Northern Europe
Denmark Estonia Finland Iceland Ireland Latvia Lithuania Norway Sweden United Kingdom of Great Britain and Northern Ireland

South America
Argentina Bolivia Brazil Chile Colombia Ecuador Guyana Paraguay Peru Suriname

Americas
Latin America and the Caribbean Caribbean
Antigua and Barbuda Bahamas Barbados

Polynesia
Cook Islands Niue Samoa Tonga Tuvalu

Annex 1

17

annex 2

Results by UN region

Table A2.1 Population coverage (%) by anaemia prevalence surveys (national or subnational) conducted between 1993 and 2005, by UN region
UN region PreSACa
b

PW
c

NPW

SAC

Men

Elderly

All

africa (53) asia (47) europe (41) l am and the caribbean (33) n america (2) oceania (16) Global (192)
a b c

76.7 (30) 82.1 (30) 19.2 (5) 70.5 (15) 92.4 (1) 5.1 (3)

65.3 (25) 80.9 (21) 0.9 (1) 38.4 (14) 92.8 (1) 4.7 (2) 69.0 (64)

63.6 (26) 88.8 (34) 23.9 (5) 37.5 (12) 89.9 (1) 16.5 (4) 73.5 (82)

18.6 (10) 37.0 (11) 12.9 (3) 28.9 (8) 91.3 (1) 15.1 (3) 33.0 (36)

32.0 (14) 47.6 (13) 15.9 (2) 0.1 (1) 89.9 (1) 15.6 (3) 40.2 (34)

1.8 (1) 54.1 (7) 8.7 (2) 0.0 (0) 89.6 (1) 15.1 (2) 39.1 (13)

40.7 58.0 14.9 22.9 84.3 13.8 48.8

76.1 (84)

population groups: presac, preschool-age children (0.004.99 yrs); pw, pregnant women (no age range defined); npw, non-pregnant women (15.0049.99 yrs), sac, school-age children (5.0014.99 yrs), men (15.0059.99 yrs), elderly (60.00 yrs). number of countries in each grouping. total number of countries with data. no figure is provided for all since each country may be partially covered by some population groups, but few countries have data on all 6 population groups and no countries have data for women 5059 yrs of age.

Table A2.2 Anaemia prevalence and number of individuals affected in preschool-age children, pregnant women, and non-pregnant women in each UN region
UN regiona Preschool-age childrenb Prevalence (%) # affected (millions) Pregnant women Prevalence (%) # affected (millions) Non-pregnant women Prevalence (%) # affected (millions)

africa asia europe lac na oceania Global


a b c

64.6 (61.767.5)c 47.7 (45.250.3) 16.7 (10.523.0) 39.5 (36.043.0) 3.4 (2.04.9) 28.0 (15.840.2) 47.4 (45.749.1)

93.2 (89.197.4) 170.0 (161.0178.9) 6.1 (3.88.4) 22.3 (20.324.3) 0.8 (0.41.1) 0.7 (0.41.0) 293.1 (282.8303.5)

55.8 (51.959.6) 41.6 (39.044.2) 18.7 (12.325.1) 31.1 (21.840.4) 6.1 (3.48.8) 30.4 (17.043.9) 41.8 (39.943.8)

19.3 (18.020.7) 31.7 (29.733.6) 1.4 (0.91.8) 3.6 (2.54.7) 0.3 (0.20.4) 0.2 (0.10.2) 56.4 (53.859.1)

44.4 (40.947.8) 33.0 (31.334.7) 15.2 (10.519.9) 23.5 (15.931.0) 7.6 (5.99.4) 20.2 (9.530.9) 30.2 (28.731.6)

82.9 (76.589.4) 318.3 (302.0334.6) 26.6 (18.434.9) 33.0 (22.443.6) 6.0 (4.67.3) 1.5 (0.72.4) 468.4 (446.2490.6)

un regions: africa, asia, europe, latin america and the caribbean (lac), northern america (na), and oceania. population groups: presac, preschool-age children (0.004.99 yrs); pw, pregnant women (no age range defined); npw, non-pregnant women (15.0049.99 yrs). 95% confidence Intervals.

18

worldwIde prevalence of anaemIa 19932005

annex 3

20

National estimates of anaemia


Table A3.1 Country estimates of anaemia prevalence in preschool-age children
Member State Population 2006a 04.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

afghanistan albania algeria andorra angola antigua and Barbuda argentina armenia australia austria azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and herzegovina Botswana Brazil Brunei darussalam Bulgaria Burkina faso Burundi cambodia cameroon canada cape verde central african republic chad chile china colombia comoros congo cook Islands

5732 252 3218 4 3058 8 3346 162 1252 379 604 30 64 17491 16 452 559 34 1478 297 1243 182 215 18074 40 334 2527 1394 1869 2465 1691 73 644 1927 1233 83929 4718 129 773 2

31082 3147 33354 67 16400 82 39134 3007 20366 8205 8471 327 739 144437 270 9700 10437 275 8703 2211 9354 3912 1760 188883 382 7671 13634 7834 14351 16601 32566 519 4093 10032 16465 1331217 46279 819 4117 18

2004

19981999 19961997 2000

2001

2001

2001 2002 20032004 1994 1993, 1997, 1998

n r r r n n r n r r n r r n r r r r n n n r n f r r n n n n r r n r r n r r r r

0.504.99

870

5173

adjusted for altitude

0.004.99 1.004.99 0.504.99

825 81 1334

2839 3758 3208

sample size <100 adjusted for altitude

1.004.99

2017

4682

0.504.99

1148

3256

national survey in rural areas

0.504.99 0.505.07 0.504.99 0.504.99 ns 4.99

2284 100 2693 149 6556

3461 5150 5095 2805 2375, 2843, 614

adjusted for altitude 1800 subjects recruted, final sample size not specified, adjusted for altitude.

37.9 31.0 42.5 12.0 29.7 49.4 18.1 23.9 8.0 10.5 31.8 21.9 24.7 47.0 17.1 27.4 8.7 35.9 81.9 80.6 51.6 26.8 38.0 54.9 24.2 26.7 91.5 56.0 63.4 68.3 7.6 39.7 84.2 71.1 24.4 20.0 27.7 65.4 66.4 24.7

33.542.6 9.465.9 14.776.1 2.938.4 25.534.3 34.564.4 4.849.2 20.827.3 1.829.6 2.535.3 29.034.7 6.154.8 7.058.9 42.951.1 4.547.3 8.161.9 2.031.0 11.670.6 79.684.0 67.389.3 48.954.3 7.661.9 27.749.5 53.256.6 6.858.5 7.861.1 89.992.9 51.960.0 59.866.8 66.170.4 1.628.9 13.373.8 80.887.1 36.091.5 6.958.2 19.120.9 8.162.4 30.089.2 31.089.7 7.058.8

2172 78 1369 0 908 4 605 39 101 40 192 7 16 8221 3 124 48 12 1210 239 641 49 82 9923 10 89 2313 780 1185 1684 129 29 542 1370 301 16786 1307 84 513 0

19182439 24166 4732448 01 7791048 35 1601646 3444 22371 9134 175210 217 438 75128937 18 37280 11173 424 11761242 200265 608675 14113 60106 961410229 324 26204 22732347 723836 11181249 16291736 28489 1054 520561 6941763 86718 1604117556 3832945 39115 240693 01

moderate moderate severe mild moderate severe mild moderate mild mild moderate moderate moderate severe mild moderate mild moderate severe severe severe moderate moderate severe moderate moderate severe severe severe severe mild moderate severe severe moderate moderate moderate severe severe moderate

worldwIde prevalence of anaemIa 19932005

prevelance pooled from three studies at state level

2003 2003 2000 2004

0.504.99 0.004.99 0.504.99 0.504.99

2786 1150 1461 3530

4948 5782 3206 5214

adjusted for altitude

1999

0.502.99

1055

1722

2002

0.004.99

15073

5287

weighted prevalence

Table A3.1 Country estimates of anaemia prevalence in preschool-age children


Member State Population 2006a 04.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

annex 3 21

costa rica cote dIvoire croatia cuba cyprus czech republic democratic peoples republic of Korea democratic republic of congo denmark djibouti dominica dominican republic ecuador egypt el salvador equatorial Guinea eritrea estonia ethiopia fiji finland france Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala

393 2794 205 674 49 455 1682 11602 322 121 7 1008 1440 9054 805 91 782 66 13269 91 278 3723 193 233 237 3489 3128 511 10 2049

4399 18454 4556 11294 845 10209 22583 59320 5446 807 80 9021 13419 75437 6999 515 4560 1325 79289 854 5262 60723 1406 1556 4434 82716 22556 11140 104 12911

1996

n r r r r r n n r r n r r n n r r r r n r r r n r r n r r n

1.004.99

590

3555

pooled data disaggregated by age, adjusted for altitude.

20.9 69.0 23.4 26.7 18.6 18.4 31.7 70.6 9.0 65.8 34.4 34.6 37.9 29.9 18.4 40.8 69.6 23.4 75.2 39.1 11.5 8.3 44.5 79.4 40.6 7.8 76.1 12.1 32.0 38.1

16.625.9 33.990.6 6.656.9 7.761.5 5.049.9 4.949.6 28.734.8 68.772.5 2.032.1 30.789.3 24.845.5 11.069.4 12.572.4 28.131.8 16.720.2 13.775.9 34.490.9 6.557.0 40.793.1 33.345.2 2.837.1 1.830.5 15.777.5 75.882.6 13.774.7 1.729.3 73.978.2 3.038.3 9.966.8 36.040.2

82 1928 48 180 9 84 533 8191 29 79 3 349 546 2707 148 37 544 15 9979 36 32 310 86 185 96 273 2380 62 3 781

65102 9462533 13116 52415 225 22226 483586 79678407 7103 37108 23 111699 1801043 25432877 135162 1269 269710 437 540312347 3041 8103 691135 30150 177193 32177 601022 23112446 15196 16 738824

moderate severe moderate moderate mild mild moderate severe mild severe moderate moderate moderate moderate mild severe severe moderate severe moderate mild mild severe severe severe moderate severe mild moderate moderate

1998 2005

0.506.99 0.004.99

1787 4435

3090 5764

survey covers 71% of population, exclusion for accessibility

19961997

1.004.99

157

3758

2000 20022003

0.504.99 1.004.99

4708 3882

1940 5171

adjusted for altitude

1993

0.504.99

512

2699

1999

1.005.99

1111

2806

2003

0.504.99

2992

4943

2002

0.504.99

4016

4586

data disaggregated by age pooled, prevalence calculated for recommended hb cut-off; adjusted for altitude

Guinea Guinea-Bissau Guyana haiti honduras hungary Iceland India

1615 320 73 1156 984 474 21 119906

9603 1634 752 8650 7362 10071 297 1119538

2000 19961997 2000 2001

19981999, 2000

n r n n n r r n, f

0.504.99 0.004.99 0.504.99 1.004.99

1446 140 2751 4605

2780 3094 3264 3096

adjusted for altitude

0.502.99

20221

2972, 3780a

prevalence pooled from national survey and one state survey excluded from it and completed later, adjustment for altitude.

79.0 74.9 47.9 65.3 29.9 18.8 7.8 74.3

75.981.8 40.393.0 36.559.5 62.767.8 28.131.8 5.050.1 1.729.2 73.475.1

1276 240 35 755 294 89 2 89090

12251321 129298 2744 725783 276313 24237 06 8805990100

severe severe severe severe moderate mild mild severe

Indonesia Iran (Islamic republic of) Iraq Ireland

21598 6204 4364 310

225465 70324 29551 4210

r r r r

44.5 35.0 55.9 10.3

15.677.6 11.269.8 22.384.8 2.435.2

9608 2174 2440 32

337816758 6954328 9743702 7109

severe moderate severe mild

Table A3.1 Country estimates of anaemia prevalence in preschool-age children


Member State Population 2006a 04.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

22 worldwIde prevalence of anaemIa 19932005

Israel Italy Jamaica Japan Jordan

669 2658 254 5840 732

6847 58140 2662 128219 5837

19971998 2002

r r n r n

1.004.99 0.504.99

272 2573

3093 3389, 4382 prevalence pooled from two national surveys carried out in the same year, adjusted for altitude (3389 only). data disaggregated by age pooled, adjusted for altitude. data disaggregated by sex pooled, prevalence calculated from mean adjusted for altitude

11.8 10.9 48.2 10.6 28.3

2.937.7 2.636.1 39.956.6 2.535.2 25.930.8

79 291 123 617 207

19253 69959 102144 1462056 190225

mild mild severe mild moderate

Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan lao peoples democratic republic latvia lebanon

1073 5927 12 247 543 906 102 320

14812 35106 101 2765 5325 6058 2295 3614

1999 1999

n n r n n n r n

ns4.99 0.175.99

574 2734

2675 3442

36.3 69.0 41.9 32.4 49.8 48.2 26.7 28.3

30.942.0 66.571.4 14.275.8 30.334.6 45.554.1 34.861.8 7.761.1 20.937.1

390 4089 5 80 270 437 27 90

332451 39414231 29 7585 247294 315560 862 67119

moderate severe severe moderate severe severe moderate moderate

19982002 1997 2000 19971998

0.504.99 ns2.99 0.005.99 1.004.99

3693 1021 100 234

4375 2295 770 3221

lesotho liberia libyan arab Jamahiriya lithuania luxembourg madagascar malawi malaysia maldives mali malta marshall Islands mauritania mauritius mexico

229 647 649 148 29 3149 2363 2725 47 2667 20 8 539 98 10726

1791 3356 5968 3417 471 19105 13166 25796 337 13918 403 64 3158 1256 108327

20042005 1999

20032004 20042005 1994 2001

1995 19981999

n n r r r n n r n n r r r n n

0.504.99 0.502.99

1435 708

5356 1242

prevalence pooled from data disaggregated by age, adjusted for altitude. adjusted for altitude

0.504.99 0.504.99 ns4.99 ns4.99

1793 2173 1932 2826

5190 5201 831 3446

adjusted for altitude adjusted for altitude.

3.006.99 0.504.99

523 5526

395 2997

micronesia (federated states of) monaco mongolia morocco mozambique myanmar namibia nauru

16 2 270 3408 3325 4586 265 2

111 36 2679 31943 20158 51009 2052 14

1993, 2000

f r n n n r r r

2.004.99

841

4942, 2548 5247 3469 589

prevalence pooled from the Islands of mauritius and rodrigues data disaggregated by age pooled, prevalence calculated for recommended cut-off, adjusted for altitude data pooled from 2 surveys at state level adjusted for altitude

48.6 86.7 33.9 23.8 9.4 68.3 73.2 32.4 81.5 82.8 16.3 30.0 68.2 16.8 29.4

45.052.3 82.889.9 10.569.1 6.757.5 1.935.2 65.271.3 70.575.7 10.067.5 78.983.8 80.784.7 4.246.4 8.765.8 33.190.3 12.721.8 27.731.1

111 561 220 35 3 2151 1730 883 38 2208 3 2 368 16 3153

103120 536582 68448 1085 110 20532244 16661790 2711841 3739 21532258 19 15 178487 1221 29743339

severe severe moderate moderate mild severe severe moderate severe severe mild moderate severe mild moderate

18.7 5.0 21.4 31.5 74.7 63.2 40.5 20.0

15.322.7 0.923.8 18.424.8 28.334.9 69.979.0 28.188.3 13.475.0 5.452.5

3 0 58 1073 2483 2899 107 0

24 01 5067 9631190 23242625 12904050 35199 01

mild mild moderate moderate severe severe severe moderate

2004 2000 20012002

0.504.99 0.504.99 0.504.99

1241 1486 707

Table A3.1 Country estimates of anaemia prevalence in preschool-age children


Member State Population 2006a 04.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

annex 3 23

nepal netherlands new Zealand nicaragua niger nigeria niue norway oman pakistan palau panama papua new Guinea paraguay peru philippines poland portugal Qatar republic of Korea republic of moldova romania russian federation rwanda saint Kitts and nevis saint lucia saint vincent and the Grenadines samoa san marino sao tome and principe saudi arabia senegal serbia and montenegro d seychelles sierra leone singapore slovakia slovenia solomon Islands somalia south africa spain sri lanka sudan

3646 962 273 734 2925 22548 0 280 303 21339 2 344 810 836 2996 9839 1804 559 69 2335 206 1046 7384 1532 4 15 12 25 1 23 3225 1870 603 6 985 208 253 86 72 1518 5183 2262 1622 5252

27678 16367 4063 5600 14426 134375 1 4643 2612 161209 20 3288 6001 6301 28380 84477 38499 10545 839 47983 4195 21629 142537 9230 43 162 120 186 28 160 25193 11936 10497 81 5679 4380 5401 1966 490 8496 47594 43379 20912 36992

19971998

20022003 1993

1995 2001 1999

2004 2003

1995 1995 20042005 1996

n r r n r n r r n n r n r r n n r r n n r n r n r r r n r r r r n r r r r r r n r n f

0.504.99

3900

1083

adjusted for altitude

0.504.99 0.504.99

494 2287

4466 50

adjusted for altitude data disaggregated by age pooled

0.004.99 0.504.99 1.004.99

5015 7015 1010

5204 4640 3097

ns4.99 0.50

12788 4.99

5359 2962

adjusted for altitude 5242

nsns 0.006.99 see note 0.004.99

1449 443 100 969

820 3327 164 2558

age ranges from < 1 to >2 y of age prevalence calculated for recommended cut-off

78.0 8.7 11.3 17.0 81.3 76.1 21.6 6.4 50.5 50.9 22.2 36.0 59.8 30.2 50.4 36.3 22.7 12.7 26.2 16.5

76.179.8 2.031.3 2.736.5 12.822.2 49.195.1 73.578.5 5.755.7 1.326.3 48.552.5 49.252.6 6.155.6 31.940.3 25.786.5 9.065.3 49.251.6 33.938.8 6.456.0 3.139.4 23.129.5 12.222.0 13.774.6 27.353.8 7.760.9 37.646.3 6.456.3 9.967.1 10.067.2 27.244.8 1.934.0 11.272.7 10.368.1 34.891.1 23.436.5 6.757.6 51.995.8 5.051.0 6.656.9 3.541.9 19.982.1 22.226.1 3.239.8 27.033.0 82.286.7

2844 84 31 125 2377 17159 0 18 153 10862 1 124 485 252 1510 3572 410 71 18 385 83 416 1959 642 1 5 4 9 0 9 1067 1310 178 2 819 39 59 12 37 1249 292 485 4443

27752909 19301 8100 94163 14352783 1658317697 00 473 147159 1050911214 01 110139 208701 75546 14731547 33353816 1151010 18220 1620 284513 28153 285563 5714496 576710 02 110 18 711 00 317 3322196 6511703 141220 04 511943 10106 17144 336 1459 11501354 73901 437536 43174554

severe mild mild mild severe severe moderate mild severe severe moderate moderate severe moderate severe moderate moderate mild moderate mild severe moderate moderate severe moderate moderate moderate moderate mild moderate moderate severe moderate moderat severe mild moderate mild severe moderate mild moderate severe

1999

0.504.99

224

3226

2000

0.504.99

369

2441

1994 2001 1994, 1995

0.504.99 0.504.99 0.506.99

3597 1749 1970

48 4972 1553, 1443

40.6 prevalence calculated from 2 age 39.8 groups: 1.001.99 and 4.924.99 yrs 26.5 data disaggregated by age pooled 41.9 22.9 32.2 32.3 data disaggregated by age pooled 35.5 9.1 36.7 33.1 70.1 29.5 23.8 83.2 18.9 23.4 14.0 51.7 no estimate possible data disaggregated by age pooled 24.1 12.9 adjusted for altitude 29.9 pooled data from one regional and 84.6 one state level survey

Table A3.1 Country estimates of anaemia prevalence in preschool-age children


Member State Population 2006a 04.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

24 worldwIde prevalence of anaemIa 19932005

suriname swaziland sweden switzerland syrian arab republic tajikistan thailand the former Yugoslav republic of macedonia timor leste togo tonga trinidad and tobago tunisia turkey turkmenistan tuvalu uganda ukraine united arab emirates united Kingdom of Great Britain and northern Ireland united republic of tanzania united states of america uruguay uzbekistan

45 134 492 346 2563 831 4992 116 198 1030 12 91 808 7195 491 1 6210 1922 346 3339 6079 20568 281 2861

452 1029 9070 7264 19512 6591 64762 2037 1007 6306 103 1309 10210 74175 4899 10 29857 45986 4657 59847 39025 301029 3487 26980

2003 1995 1999 2003

r r r r r n n n n r r r n r n r n n r n n n r n

0.504.99 0.005.99 0.504.99 0.004.99

1910 3260 1079 5029

4182 3961 1609 5050

adjusted for altitude

25.7 46.7 8.6 6.3 41.0 37.7 25.2 25.8 31.5 52.4 27.6 30.4 21.7 32.6 35.8 34.2 64.1 22.2 27.7 8.0 71.8 3.1 19.1 38.1

7.360.3 15.680.6 1.930.7 1.326.1 13.974.9 34.740.8 23.227.4 22.329.7 29.733.3 19.683.3 8.162.3 9.165.5 18.225.6 10.167.4 33.438.3 10.669.4 62.365.8 18.626.3 8.062.9 5.910.8 70.373.2 2.04.7 5.051.3 35.340.9

12 63 42 22 1050 313 1258 30 62 540 3 28 175 2344 176 0 3981 427 96 267 4365 638 54 1090

327 21108 10151 490 3571918 288339 11561366 2634 5966 202858 17 859 148207 7284853 164188 01 38714087 357505 28218 196361 42754452 418968 14144 10111171

moderate severe mild mild severe moderate moderate moderate moderate severe moderate moderate moderate moderate moderate moderate severe moderate moderate mild severe no public health problem mild moderate

adjusted for altitude

19961997 2000 20002001 2002 19921993 20042005 19992002 2002

0.005.99 0.004.99 0.504.99 0.503.07 1.504.57 0.504.99 1.004.99 0.504.99

965 2950 5833 896 951 7300 1357 2305

2485 3209 3207 5172 3279 5221 4738 4950 adjusted for altitude.

data disaggregated by age, prevalence calculated for recommended cut-off for age group 34 years, adjusted for altitude.

vanuatu venezuela vietnam Yemen Zambia Zimbabwe


a b c d

30 2877 8002 3762 2033 1750

215 27216 85344 21639 11861 13085

20002001 2003 1999

r r n r n n

0.004.99 0.504.99 1.005.99

7024 729 327

3408 5098 2641

59.0 33.1 34.1 68.3 52.9 19.3

24.986.2 10.368.1 32.635.7 33.090.5 47.858.0 14.026.1

18 953 2729 2571 1075 338

726 2971958 26052855 12403403 9711179 244456

severe moderate moderate severe severe mild

population figures are based on the 2006 projection from the 2004 revision from the united nations population division. level of survey: n=nationally representative, f=2+ surveys at the first administrative level boundary, r=regression-based estimate. corresponds to the numerical reference available in the who Global database on anaemia (http://www.who.int/vmnis/en/). on 3 June 2006, the permanent representative of the republic of serbia to the united nations and other International organizations in Geneva informed the acting director-General of the who that the membership of the state union serbia and montenegro in the united nations, including all organs and the organizations of the united nations system, is continued by the republic of serbia on the basis of article 60 of the constitutional charter of serbia and montenegro, activated by the declaration of Independence adopted by the national assembly of montenegro on 3 June 2006. estimates used or referred to in this document cover a period of time preceding that communication.

Table A3.2 Country estimates of anaemia prevalence in pregnant women


Member State Population 2006a PW (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

annex 3 25

afghanistan albania algeria andorra angola antigua and Barbuda argentina armenia australia austria azerbaijan

1567 54 712 1 811 2 696 37 254 72 141

31082 3147 33354 67 16400 82 39134 3007 20366 8205 8471

2000

2001

r r r r r r r n r r n

15.0049.99

169

3208

adjusted for altitude.

15.0044.99

157

4682

different hb cut-off for gestational age (hb <110 g/l gestation 13, 7 mo, <106 g/l 4 mo, <105 g/l 5 mo, <107 g/l 6 mo, <114 g/l 8 mo, <119 g/l 9 mo)

61.0 34.0 42.8 15.5 57.1 29.5 25.4 12.0 12.4 15.5 38.4

28.885.9 12.066.1 16.673.8 4.144.0 25.483.9 10.061.3 8.156.9 6.620.8 2.741.6 3.845.6 28.349.6

956 18 305 0 463 1 177 4 32 11 54

4511345 635 118525 00 206680 01 56396 28 7106 333 4070

severe moderate moderate mild severe moderate moderate mild mild mild moderate

Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and herzegovina Botswana Brazil Brunei darussalam Bulgaria Burkina faso Burundi cambodia cameroon canada cape verde central african republic chad chile china colombia comoros congo cook Islands costa rica cote dIvoire croatia cuba

6 12 3759 3 92 108 7 366 66 263 36 44 3697 8 64 655 395 444 562 327 16 151 508 251 17566 962 28 190 0 80 670 41 129

327 739 144437 270 9700 10437 275 8703 2211 9354 3912 1760 188883 382 7671 13634 7834 14351 16601 32566 519 4093 10032 16465 1331217 46279 819 4117 18 4399 18454 4556 11294

2001

19941995 2001 20032004

1995 2003 2003 2000 2004

1999

2002

1996

r r n r r r n n r n r r r n r n n n n r r n r r n r r r r n r r r

16.0045.99

108

3256

national survey in rural areas

nsns 15.0049.99 15.0049.99

4661 364 357

1062 3461 5095

adjusted for altitude

13.00ns 15.0049.99 nsns 15.0049.99 15.0049.99

817 441 153 209 535

3328 4948 5782 3206 5214

adjusted for altitude

15.0049.99

330

1722

nsns

3160

5287

nsns

68

1634

adjusted for altitude.

23.3 27.7 47.0 23.0 25.8 12.9 51.7 72.7 49.6 37.0 34.8 21.3 29.1 38.9 29.7 68.3 47.1 66.4 50.9 11.5 41.3 54.8 60.4 28.3 28.9 31.1 55.0 55.3 27.2 27.9 55.1 28.4 39.1

7.254.2 9.159.4 34.260.2 7.054.1 8.257.6 3.041.7 49.753.7 65.878.7 20.379.2 30.244.3 12.466.9 5.655.1 9.860.8 34.343.7 10.061.5 61.974.1 36.258.2 56.874.8 44.956.8 2.440.9 15.772.6 47.262.2 28.185.6 9.460.1 26.731.2 10.763.0 24.382.3 24.282.7 8.958.8 15.545.0 24.282.5 9.560.2 14.071.6

1 3 1767 1 24 14 4 266 33 97 13 9 1077 3 19 448 186 295 286 38 6 83 307 71 5076 299 16 105 0 22 369 12 51

03 17 12862263 02 753 345 34 241288 1353 79116 424 224 3632248 34 640 405486 143230 252332 253320 8134 211 7194 143435 24151 46935478 103606 723 46157 00 1236 162553 425 1893

moderate moderate severe moderate moderate mild severe severe severe moderate moderate moderate moderate moderate moderate severe severe severe severe mild severe severe severe moderate moderate moderate severe severe moderate moderate severe moderate moderate

Table A3.2 Country estimates of anaemia prevalence in pregnant women


Member State Population 2006a PW (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

26 worldwIde prevalence of anaemIa 19932005

cyprus czech republic democratic peoples republic of Korea democratic republic of congo denmark djibouti dominica dominican republic ecuador egypt el salvador

10 91 326

845 10209 22583

1998

r r n

nsns

72

3090

survey covers 71% of population, exclusion of counties due to accessibility

25.2 22.3 34.7

8.056.5 6.952.9 21.151.3

3 20 113

16 648 69167

moderate moderate moderate

3094 60 27 2 211 292 1939 165

59320 5446 807 80 9021 13419 75437 6999

2005

19961997

2000 1998

n r r n r r n n

nsns

949

5764

nsns

148

3758

15.0049.99 15.0049.99

602 451

1940 3107

data disaggregated by trimester pooled, prevalence calculated for recommended cut-off from non-who cut-off, adjusted for altitude.

67.3 12.4 56.2 35.1 39.9 37.8 45.4 10.5

63.071.4 2.841.0 25.383.0 25.146.6 14.672.1 13.969.6 39.951.1 7.115.2

2082 7 15 1 84 110 880 17

19482208 225 723 01 31152 41203 773990 1225

severe mild severe moderate moderate moderate severe moderate

equatorial Guinea eritrea estonia ethiopia fiji finland france Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala

23 180 14 3201 19 55 731 41 52 47 671 688 100 6 447

515 4560 1325 79289 854 5262 60723 1406 1556 4434 82716 22556 11140 104 12911

1993

1999

2003

2002

r r r r n r r r n r r n r r n

15.00ns

54

2699

15.0049.99

401

2806

15.0049.99

400

4943

15.0049.99

541

4586

hb <110 g/l for 13 months gestational age, hb <106, 105, 107, 110, 114, 119 g/l for 4, 5, 6, 7, 8, 9 months of gestational age respectively, adjusted for altitude.

41.7 55.3 22.7 62.7 55.6 15.0 11.5 46.2 75.1 41.6 12.3 64.9 18.6 31.4 22.1

13.676.5 24.282.7 6.953.8 30.186.7 37.072.8 3.943.3 2.539.6 17.078.3 68.780.6 15.773.1 2.642.2 58.071.2 5.149.2 10.863.2 17.627.4

10 100 3 2006 10 8 84 19 39 19 83 447 19 2 99

318 44149 17 9652776 714 224 18290 732 3642 734 18283 400490 549 14 78122

severe severe moderate severe severe moderate mild severe severe severe mild severe moderate moderate moderate

Guinea Guinea-Bissau Guyana haiti honduras hungary Iceland India

396 85 14 257 209 92 4 25753

9603 1634 752 8650 7362 10071 297 1119538

2000 19961997 2000 1996

19981999, 2000

n r n n n r r n, f

ns49.99 nsns 15.0049.99 nsns

291 269 381 105

2780 3094 3264 3095

adjusted for altitude.

15.0049.99

5718

2972, 3780a

data pooled from national survey and state survey excluded from national survey and completed later, adjustment for altitude, smoking. adjusted for altitude.

63.2 57.7 52.0 63.2 32.4 20.7 11.8 49.7

55.170.6 25.984.2 43.660.3 56.169.7 21.246.1 6.250.6 2.540.8 47.951.5

250 49 7 162 68 19 0 12799

218280 2271 69 144179 4496 646 02 1232813271

severe severe severe severe moderate moderate mild severe

Indonesia Iran (Islamic republic of)

4399 1447

225465 70324

1994-1995

r n

15.0049.99

79

3015

44.3 40.5

17.375.2 26.556.2

1950 586

7613308 384814

severe severe

Table A3.2 Country estimates of anaemia prevalence in pregnant women


Member State Population 2006a PW (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

annex 3 27

Iraq Ireland Israel Italy Jamaica Japan Jordan

987 66 134 516 51 1146 151

29551 4210 6847 58140 2662 128219 5837

1999 2002

r r r r n r n

13.0046.99 15.0049.99

541 336

3759 3389, 4382 data pooled from two national surveys carried out in same year. adjusted for altitude (3389 only). adjusted for altitude

38.2 14.8 17.4 15.5 40.7 14.8 38.7

14.070.1 3.645.1 4.747.4 3.945.1 35.046.7 3.843.6 31.646.3

377 10 23 80 21 170 58

138692 230 664 20232 1824 43500 4870

moderate mild mild mild severe mild moderate

Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan lao peoples democratic republic latvia lebanon lesotho liberia libyan arab Jamahiriya lithuania luxembourg madagascar malawi malaysia maldives mali malta marshall Islands mauritania mauritius mexico micronesia (federated states of) monaco mongolia morocco mozambique myanmar namibia nauru nepal netherlands new Zealand nicaragua niger nigeria

238 1447 2 54 116 208 21 66 49 175 140 31 6 732 567 540 10 698 4 1 131 20 2099 3 0 57 723 781 938 55 0 793 178 54 155 793 5481

14812 35106 101 2765 5325 6058 2295 3614 1791 3356 5968 3417 471 19105 13166 25796 337 13918 403 64 3158 1256 108327 111 36 2679 31943 20158 51009 2052 14 27678 16367 4063 5600 14426 134375

1999

r n r r r r r r n n r r r n n n n n r r r n n r r r n r r r r n r r n r n

ns50.99

390

3442

2004 1999

15.0049.99 14.0049.99

172 199

5356 1242

national data, but small sample size, 20. prevalence adjusted for altitude and smoking.

26.0 55.1 38.4 31.3 34.1 56.4 25.0 31.6 25.4 62.1 34.5 24.2 10.3 50.1 47.3 38.3 55.4 73.4 26.1 38.1 52.7 37.5 26.2 37.8 6.3 37.3 37.2 52.4 49.6 30.6 19.2 74.6 12.5 17.6 32.9 65.5 66.7

8.258.1 48.161.9 14.270.1 10.763.5 12.066.3 24.983.4 7.956.4 10.963.5 17.335.6 52.271.1 12.266.7 7.555.5 2.038.8 41.059.1 40.054.7 38.038.6 39.470.4 67.778.4 8.457.7 13.970.1 22.880.7 32.542.8 21.931.1 14.069.4 0.934.7 13.669.1 31.243.6 22.281.0 20.878.6 10.063.6 5.450.0 68.380.0 2.941.0 4.847.7 23.244.3 32.388.3 59.073.6

62 797 1 17 40 117 5 21 12 109 48 7 1 367 268 207 6 513 1 1 69 7 550 1 0 21 269 409 465 17 0 591 22 9 51 520 3656

19138 695896 02 634 1477 52173 212 742 817 91124 1793 217 02 301433 227310 205208 47 473547 02 01 30105 68 459652 02 00 840 226315 173632 196738 635 00 541634 573 326 3669 257701 32354033

moderate severe moderate moderate moderate severe moderate moderate moderate severe moderate moderate mild severe severe moderate severe severe moderate moderate severe moderate moderate moderate mild moderate moderate severe severe moderate mild severe moderate moderate moderate severe severe

20032004 2004 2004 2001 2001

15.0049.99 15.0049.99 nsns 15.0049.99 15.0049.99

229 352 224958 74 524

5190 5201 5795 2987 3446

adjusted for altitude and smoking. adjusted for altitude and smoking.

1995 19981999

nsns 12.0049.99

664 697

395 2997

data pooled from the Islands of mauritius and rodrigues adjusted for altitude.

2000

15.0044.99

462

3469

19971998

nsns

418

1083

adjusted for altitude.

2000 1993

15.00ns 15.0045.99

149 318

3109 50

Table A3.2 Country estimates of anaemia prevalence in pregnant women


Member State Population 2006a PW (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

28 worldwIde prevalence of anaemIa 19932005

niue norway oman pakistan palau panama papua new Guinea paraguay peru philippines poland portugal Qatar republic of Korea republic of moldova romania russian federation rwanda saint Kitts and nevis saint lucia saint vincent and the Grenadines samoa san marino sao tome and principe saudi arabia senegal serbia and montenegrod seychelles sierra leone singapore slovakia slovenia solomon Islands somalia south africa spain sri lanka sudan suriname swaziland sweden switzerland

0 54 66 4890 0 70 172 181 632 1997 371 109 15 447 44 206 1580 393 1 3 2 5 0 5 684 432 118 4 268 38 51 17 15 382 1048 463 324 1167 9 29 97 65

1 4643 2612 161209 20 3288 6001 6301 28380 84477 38499 10545 839 47983 4195 21629 142537 9230 43 162 120 186 28 160 25193 11936 10497 81 5679 4380 5401 1966 490 8496 47594 43379 20912 36992 452 1029 9070 7264 19512 6591 64762 2037

2000 2001 1999

2004 2003

1996

r r n n r n r r n n r r r r r r r n r r r r r r r r r r r r r r r

15.0049.99 nsns nsns

375 179 143

4218 4640 3097

15.0049.99 nsns

962 585

5359 5242

adjusted for altitude.

nsns

161

2558

national data, but small sample size, 20.

31.7 9.3 42.7 39.1 27.3 36.4 55.2 39.3 42.7 43.9 25.3 17.3 29.1 22.6 36.5 30.0 20.8 10.6 25.6 33.4 32.7 33.4 11.3 40.4 32.0 57.6 33.6 24.9 59.7 23.8 25.2 18.9 51.1

10.764.2 1.738.4 35.849.9 29.649.5 9.058.7 26.148.1 24.282.6 14.671.1 38.447.2 38.349.6 8.156.5 4.846.6 9.761.2 7.053.2 13.268.4 10.261.9 6.051.8 5.519.4 8.356.9 11.765.5 11.464.7 11.765.4 2.241.5 15.371.8 11.163.9 26.183.9 11.865.8 7.956.1 27.185.5 7.455.1 8.156.3 5.448.8 21.679.9 6.353.8 4.946.9 26.332.5 26.084.1 10.965.1 6.659.2 3.041.6 6.214.8 14.671.0 17.775.2 15.830.6 11.063.8

0 5 28 1912 0 26 95 71 270 877 94 19 4 101 16 62 329 42 0 1 1 2 0 2 219 249 40 1 160 9 13 3 8 229 82 95 674 3 7 13 6 214 83 221 7

00 121 2433 14462422 00 1834 42142 26129 242298 765991 30210 551 19 31238 630 21128 95818 2276 01 02 02 13 00 14 76437 113363 1478 02 73229 321 429 18 312 66563 23217 85105 304982 16 217 340 410 80387 33140 157304 315

moderate mild severe moderate moderate moderate severe moderate severe severe moderate moderate moderate moderate moderate moderate moderate mild moderate moderate moderate moderate mild severe moderate severe moderate moderate severe moderate moderate mild severe moderate mild moderate severe moderate moderate mild mild moderate severe moderate moderate

no estimate possible r r n r r r r n r r n r 21.8 17.6 29.3 57.7 32.4 24.3 12.9 9.7 39.3 44.6 22.3 31.8

2001

nsns

1696

4972

adjusted for altitude.

1999

16.0042.99

381

3402

prevalence calculated from mean and sd

syrian arab republic 545 tajikistan 186 thailand 993 the former Yugoslav republic of macedonia 23

1995

nsns

242

3961

Table A3.2 Country estimates of anaemia prevalence in pregnant women


Member State Population 2006a PW (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<110 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

annex 3 29

timor leste

56

1007

2003

15.0049.99

549

5050

prevalence for recommended cut-off calculated from prevalence for 120 g/l, adjusted for altitude.

22.9

18.328.2

13

1016

moderate

togo tonga trinidad and tobago tunisia turkey turkmenistan tuvalu uganda ukraine united arab emirates united Kingdom of Great Britain and northern Ireland united republic of tanzania united states of america uruguay uzbekistan vanuatu venezuela vietnam Yemen Zambia Zimbabwe
a b c d

242 2 19 168 1486 109 0 1616 395 74 654 1414 4233 56 623 6 598 1642 895 482 384

6306 103 1309 10210 74175 4899 10 29857 45986 4657 59847 39025 301029 3487 26980 215 27216 85344 21639 11861 13085

19961997

20002001

r r r n r r r n r r r n n r n n r n r n n

19.0040.99

70

2485

small sample size

15.0049.99

860

3207

50.2 34.0 29.7 32.3 40.2 29.9 33.1 41.2 27.3 27.9 15.2 58.2 5.7 27.1 53.8 57.3 39.6 32.2 58.1 46.9 18.8

21.179.2 12.066.1 10.061.7 19.049.2 14.872.2 10.062.2 11.465.5 36.645.9 8.759.6 9.259.6 3.844.7 54.062.3 3.68.9 8.858.7 40.067.0 48.265.9 14.471.9 29.834.7 26.684.1 33.660.6 10.232.0

121 1 6 54 597 33 0 666 108 21 100 823 241 15 335 4 237 529 520 226 72

51191 02 212 3283 2211073 1168 00 592742 34235 744 25292 763881 152377 533 250418 34 86430 489570 238753 162292 39123

severe moderate moderate moderate severe moderate moderate severe moderate moderate moderate severe mild moderate severe severe moderate moderate severe severe moderate

20042005 19992002 1996 1996 20002001 1998 1999

15.0049.99 13.00ns 15.0049.99 15.0049.99 nsns nsns 15.0049.99

1075 615 100 234 2744 100 100

5221 4738 2293 3196 3408 2477 2641

adjusted for altitude and smoking.

prevalence calculated for recommended cut-off from non-who cut-off.

population figures are based on the 2006 projection from the 2004 revision from the united nations population division. level of survey: n=nationally representative, f=2+ surveys at the first administrative level boundary, r=regression-based estimate. corresponds to the numerical reference available in the who Global database on anaemia (http://www.who.int/vmnis/en/). on 3 June 2006, the permanent representative of the republic of serbia to the united nations and other International organizations in Geneva informed the acting director-General of the who that the membership of the state union serbia and montenegro in the united nations, including all organs and the organizations of the united nations system, is continued by the republic of serbia on the basis of article 60 of the constitutional charter of serbia and montenegro, activated by the declaration of Independence adopted by the national assembly of montenegro on 3 June 2006. estimates used or referred to in this document cover a period of time preceding that communication.

Table A3.3 Country estimates of anaemia prevalence in non-pregnant women of reproductive age
Member State Population 2006a Women 15.0049.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<120 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

30 worldwIde prevalence of anaemIa 19932005

afghanistan albania algeria andorra angola antigua and Barbuda argentina armenia australia austria azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and herzegovina Botswana Brazil Brunei darussalam

6645 831 9524 17 3764 22 9828 885 5114 1993 2551 91 185 37148 76 2643 2421 72 1988 533 2308 1001 455 52301 110

31082 3147 33354 67 16400 82 39134 3007 20366 8205 8471 327 739 144437 270 9700 10437 275 8703 2211 9354 3912 1760 188883 382

2004

n r r r r r r n r r n r n n r r r r n n n r n r n

15.0049.99

1142

5173

adjusted for altitude and smoking.

24.7 21.1 31.4 16.2 52.3 26.5 18.0 12.4 14.7 14.8 40.2 22.7 51.3 33.2 17.2 19.4 13.5 31.2 63.2 54.8 32.9 21.3 32.7 23.1 20.4

21.328.4 7.546.8 12.459.8 5.539.0 25.078.3 9.954.0 6.342.1 11.313.6 4.936.6 5.036.5 37.043.5 8.348.9 44.358.3 29.537.1 5.940.6 6.744.5 4.534.4 12.259.6 60.665.7 41.067.9 31.234.7 7.647.2 25.840.4 8.449.4 11.433.8

1254 164 2770 3 1544 5 1647 105 714 283 969 19 88 11085 13 496 313 20 1025 256 673 206 135 11213 21

10841442 58364 10905272 16 7372312 211 5713841 96116 2381780 95701 8921048 742 76100 986312379 430 1721136 104795 839 9831065 191 317 638709 73455 106166 409324033 1234

moderate moderate moderate mild severe moderate mild mild mild mild severe moderate severe moderate mild mild mild moderate severe severe moderate moderate moderate moderate moderate

2000

15.0049.99

5968

3208

data pooled for npnlwd and lw, adjusted for altitude.

2001 2002 2001

15.0044.99 14.0049.99 15.0045.99

1749 384 1195

4682 5391 3256

national survey in rural areas; data pooled for npnlw, lw adolescents.

2001 2002 2003-2004

15.0049.99 16.00ns 15.0049.99

2762

3461 5150

5577

5095

data pooled for npnlw and lw, adjusted for altitude. 1800 subjects recruted, final sample size not specified, adjusted for altitude. data pooled for npnlw and lw

1994 1996-1997

15.0049.99 15.0049.99

315

2805 3334 data disaggregated by age pooled, prevalence calculated for recommended cut-off from non-who cut-off. no data available data pooled for npnlw and lw data pooled for npnlw and lw data pooled for npnlw and lw, adjusted for altitude.

Bulgaria Burkina faso Burundi cambodia cameroon canada cape verde central african republic chad chile china colombia comoros

1872 3038 1856 3795 4009 8166 137 953 2202 4422 365828 12541 200

7671 13634 7834 14351 16601 32566 519 4093 10032 16465 1331217 46279 819

2003 2003 2000 2004

r n n n n r r n r n n r r

15.0049.99 nsns 15.0049.99 15.0049.99

3830 973 3402 4549

4948 5782 3206 5214

17.7 52.0 28.0 57.3 44.3 14.3 32.5 49.8 52.4 4.8

6.041.9 49.854.2 24.232.2 54.959.6 42.346.3 4.735.9 12.861.0 47.052.6 24.978.6 3.07.5 19.420.4 8.650.2 21.875.1

319 1239 409 1920 1527 1122 39 399 888 200 69304 2729 82

108757 11861292 354470 18411999 14571598 3722812 1674 376422 4221331 126314 6763871001 9985813 37129

mild severe moderate severe severe mild moderate severe severe no public health problem moderate moderate severe

1999 2003 2002

15.0049.99 17.0044.99 15.0049.99

2396 731 52463

1722 5783 5287 weighted prevalence

19.9 23.6 47.8

Table A3.3 Country estimates of anaemia prevalence in non-pregnant women of reproductive age
Member State Population 2006a Women 15.0049.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<120 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

annex 3 31

congo cook Islands costa rica cote dIvoire croatia cuba cyprus czech republic democratic peoples republic of Korea democratic republic of congo denmark djibouti dominica dominican republic ecuador egypt el salvador equatorial Guinea eritrea estonia ethiopia fiji finland france Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana haiti honduras hungary Iceland India

906 4 1195 4307 1090 3046 224 2503 6145 13096 1239 195 21 2447 3486 19480 1865 114 1081 337 18358 224 1174 14086 343 377 1194 19505 5558 2723 28 3103 2110 356 217 2252 1838 2433 74 284397

4117 18 4399 18454 4556 11294 845 10209 22583 59320 5446 807 80 9021 13419 75437 6999 515 4560 1325 79289 854 5262 60723 1406 1556 4434 82716 22556 11140 104 12911 9603 1634 752 8650 7362 10071 297 1119538

1996

r r n r r r r r n n r r r r r n n r r r r n r n r n r r n r r n n r n n n r r n, f

nsns

906

3556, 4524

data pooled for women reproductive age and lw, adjusted for altitude.

52.8 18.2 18.9 47.4 17.5 19.5 19.6 16.9 34.7 52.8 14.3 46.4 23.7 27.1 29.2 27.6 26.8 38.4 52.1 17.7 52.3 31.8 15.3 9.1 36.7 59.1 22.7 12.3 43.1 14.6 24.0 20.2 50.4 52.9 53.9 54.4 14.7 16.6 14.1 52.0

25.278.8 6.143.1 15.622.8 21.574.8 6.041.3 6.944.3 6.944.5 5.840.2 31.138.5 49.056.5 4.835.6 20.973.9 8.750.4 10.354.7 11.357.2 26.328.9 24.928.8 15.867.4 24.778.2 6.042.1 24.978.4 27.935.9 5.237.4 7.910.4 15.165.3 53.364.7 7.850.3 4.032.3 41.145.1 4.936.4 8.850.9 18.322.3 47.253.6 25.378.9 47.360.3 52.356.5 13.116.4 5.639.7 4.735.6 51.552.5

378 1 211 1725 183 570 42 408 2019 5281 168 78 5 607 931 4841 455 35 469 57 7927 65 171 1215 111 192 260 2322 2099 384 5 537 864 143 109 1086

180564 02 173254 7832721 63433 2011292 1595 140971 18082241 49065653 56420 35124 210 2311222 3591827 46185071 422490 1461 223705 19136 377611878 5774 58419 10571394 46197 173210 90578 7496087 20042195 128954 211 485592 809918 69214 96122 10441127

severe moderate mild severe mild mild mild mild moderate severe mild severe moderate moderate moderate moderate moderate moderate severe mild severe moderate mild mild moderate severe moderate mild severe mild moderate moderate severe severe severe severe mild mild mild severe

2004 2005

20.00 ns nsns

1253 1366

5068 5764

2000 20022003

15.0049.99 15.0049.99

9210 3777

1940 5171

data pooled for npw, lw and women 15.0019.99 yrs. adjusted for altitude.

1993 1994

15.0044.99 35.0049.99

1039 4000

2699 2392 data disaggregated by age pooled, prevalence calculated from mean and sd. lw

1999

15.0049.99

572

2806

2003

15.0049.99

4872

4943

data pooled for npnlw and lw

2002 2000 19961997 2000 2001

15.0049.99 ns49.99 15.0050.99 15.0049.99 15.0049.99

3062 1887 447 4449 3589

4586 2780 3094 3264 3096

npw, adjusted for altitude. npw data disaggregated by age pooled. data pooled for npnlw and lw, adjusted for altitude. npw

19981999, 2000

15.0049.99

74974

2972, 3780a

data pooled from national survey and 1 state survey excluded from national survey completed later; data pooled for npnlw and lw, adjusted for altitude and smoking.

239 214267 388 132930 10 325 134495 133187135802

Table A3.3 Country estimates of anaemia prevalence in non-pregnant women of reproductive age
Member State Population 2006a Women 15.0049.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<120 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

32 worldwIde prevalence of anaemIa 19932005

Indonesia Iran (Islamic republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan

62530 20354 7263 1117 1650 13479 709 28009 1474

225465 70324 29551 4210 6847 58140 2662 128219 5837 19941995

r n r r r r r n n 15.0049.99 1351 3015

1 study at state level and 3 local studies npw, adjusted for altitude.

33.1 33.0 45.3 17.5 18.6 14.4 23.8 21.3 28.6

13.161.8 29.636.6 19.873.5 6.041.2 6.343.6 4.835.9 8.850.5 18.224.8 26.331.0

19240 6239 2842 183 282 1868 157 5722 378

763835925 55886926 12454610 63433 96661 6254654 58332 48796665 349410

moderate moderate severe mild mild mild moderate moderate moderate

2002 2002

20.0049.99 15.0049.99

1164 5177a 2925 3389, 4382

Kazakhstan Kenya

4243 8454

14812 35106

1999 1999

n n

15.0049.99 ns50.99

2269 2735

2675 3442

data disaggregated by age pooled. data pooled for npnlw, lw and npw from 2 national surveys from the same year. adjusted for altitude (3389 only). sample includes pw prevalence calculated for recommended cut-off from mean and sd, adjusted for altitude. data disaggregated by age pooled, prevalence calculated from mean (15.0018.99 years) sample includes pw, adjusted for altitude.

35.5 46.4

32.838.3 43.849.0

1422 3251

13121535 30673437

moderate severe

Kiribati Kuwait

26 690

101 2765

19982002

r n

15.0050.99

2993

4375

30.7 28.7

11.959.1 26.531.0

7 183

314 168197

moderate moderate

Kyrgyzstan lao peoples democratic republic latvia lebanon lesotho liberia libyan arab Jamahiriya lithuania luxembourg madagascar malawi malaysia maldives mali malta marshall Islands mauritania mauritius mexico micronesia (federated states of) monaco

1456 1480 587 985 474 748 1647 893 118 4442 2883 6670 82 3066 96 17 745 344 30363 28 8

5325 6058 2295 3614 1791 3356 5968 3417 471 19105 13166 25796 337 13918 403 64 3158 1256 108327 111 36

1997

n r r n n n r r r n n r n n r r r n n r r

15.0049.99

3767

2295

38.0 46.1 18.9 25.2 27.3 58.0 29.9 17.9 18.8

35.840.2 20.773.7 6.444.0 20.430.7 24.929.8 54.361.6 11.558.5 6.142.1 6.543.3 42.848.4 41.046.8 11.558.7 45.753.5 58.663.3 5.338.1 8.751.4 23.676.9 7.424.8 19.921.8 8.951.2 4.334.3

509 587 107 232 116 333 451 154 21 1691 1017 1844 35 1444 14 4 310 45 5879 6 1

480539 263938 36249 187282 106127 311353 173881 53363 749 15871797 9501084 7083596 3338 13881499 535 18 145473 2480 56196148 212 03

moderate severe mild moderate moderate severe moderate mild mild severe severe moderate severe severe mild moderate severe mild moderate moderate mild

19971998 2004 1999

15.0049.99 15.0049.99 14.0049.99

539 2532 1376

3221 5356 1242

data pooled for npnlw and lw, adjusted for altitude and smoking. data pooled for npnlw and lw, prevalence adjusted for altitude and smoking.

20032004 20042005 2001 2001

15.0049.99 15.0049.99 15.0049.99 15.0049.99

2383 2268 1287 3264

5190 5201 2987 3446

data pooled for npnlw and lw, adjusted for altitude and smoking. data pooled for npw and lw, adjusted for altitude and smoking.

45.6 43.9 30.1 49.6 61.0 15.6 24.1 50.4 14.0 20.8 24.2 13.3

data pooled for npnlw and lw

1995 19981999

25.0050.99 15.0049.99

128 14451

395 2997

only mauritius Island. data disaggregated by age pooled, adjusted for altitude.

Table A3.3 Country estimates of anaemia prevalence in non-pregnant women of reproductive age
Member State Population 2006a Women 15.0049.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<120 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

annex 3 33

mongolia morocco mozambique myanmar namibia nauru nepal netherlands new Zealand nicaragua niger nigeria niue norway oman pakistan palau panama papua new Guinea paraguay peru philippines poland portugal Qatar republic of Korea republic of moldova romania russian federation rwanda saint Kitts and nevis saint lucia saint vincent and the Grenadines samoa san marino sao tome and principe saudi arabia senegal serbia and montenegro e seychelles sierra leone singapore slovakia slovenia

787 8839 4843 14248 499 4 6969 3872 1022 1447 3043 30591 0 1078 611 39205 5 865 1483 1580 7469 21977 9975 2580 165 13219 1193 5611 39140 2335 12 45 33 42 7 41 6031 2923 2545 22 1315 1160 1433 489

2679 31943 20158 51009 2052 14 27678 16367 4063 5600 14426 134375 1 4643 2612 161209 20 3288 6001 6301 28380 84477 38499 10545 839 47983 4195 21629 142537 9230 43 162 120 186 28 160 25193 11936 10497 81 5679 4380 5401 1966

2004 2000 20012002 2001

19971998 19961997 20022003 1993

n n n n r r n r n n r n r r n n r n r r n n r r r n r r r r r r r n r r r r n r r n r r

15.0049.99 15.0049.99 nsns 15.0044.99

211 1784 707 1200

5247 3469 589 5246

adjusted for altitude.

npnlw

nsns 15.0044.99 nsns 15.0045.99

3437 1088 432 1859

1083 3192 4466 50

npw, adjusted for altitude. data disaggregated by age pooled, prevalence calculated from mean. adjusted for altitude.

13.6 32.6 48.2 44.9 35.0 25.7 66.7 14.2 10.2 9.0 62.2 62.0 11.9 13.3 34.0 27.9 21.1 40.3 43.1 26.2 40.4 42.1 18.7 15.0 36.2 14.0 23.4 20.1 19.8 59.4 20.8 25.0 24.1 19.7 16.5 26.2 32.3 48.4 26.7 21.1 62.9 18.4 19.4 15.1

8.321.5 29.635.7 43.053.4 41.048.9 14.363.6 9.553.3 64.468.9 4.835.6 7.913.0 5.813.6 32.884.7 58.865.1 3.632.6 4.434.0 31.636.5 24.231.9 7.546.8 36.943.8 18.971.1 9.754.0 39.441.4 38.246.1 6.543.1 5.036.9 13.767.0 6.826.6 8.450.5 7.045.5 6.945.1 29.183.9 7.446.2 9.352.1 8.950.9 13.527.8 5.739.5 9.554.4 12.661.2 22.375.4 23.430.2 7.646.8 33.585.1 16.320.7 6.844.2 5.137.1

99 2646 1958 5976 156 1 4120 526 99 116 1398 15568 0 136 185 9574 1 320 565 367 2762 8412 1792 370 54 1788 269 1085 7448 1153 2 10 7 7 1 9 1727 1206 648 4 658 207 268 71

60157 24032901 17482169 54526509 63283 02 39804255 1761316 77126 76176 7391904 1477416338 00 45348 172199 829810962 02 293348 248933 136756 26912834 76319213 6244138 124912 21100 8723393 97580 3792461 260516931 5651629 15 422 316 510 02 319 6733275 5551879 569734 19 350891 183232 94610 24175

mild moderate severe severe moderate moderate severe mild mild mild severe severe mild mild moderate moderate moderate severe severe moderate severe severe mild mild moderate mild moderate moderate mild severe moderate moderate moderate mild mild moderate moderate severe moderate moderate severe mild mild mild

2000 2001 1999

15.0049.99 nsns nsns

2766 1022 1523

4218 4640 3097

data pooled for women and female adolescents 1519 years.

2004 2003

15.0049.99 nsns

17058 1189

5359 5242

data pooled for npnlw and lw, adjusted for altitude. only lw

2001

15.0049.99

5249

data disaggregated by age pooled; sample includes pw.

1999

nsns

240

3226

2000

15.0049.99

1296

2441

1998

18.0069.99

2467

760

sample includes pw.

Table A3.3 Country estimates of anaemia prevalence in non-pregnant women of reproductive age
Member State Population 2006a Women 15.0049.99y (000) General (000) Date of survey (years) Level of surveyb Age range Survey Information Sample Size Referencec Notes Proportion of the population with Hb<120 g/L Estimate 95% CI Population with anaemia (number of individuals)(000) Estimate 95% CI Public health problem

34 worldwIde prevalence of anaemIa 19932005

solomon Islands somalia south africa spain sri lanka sudan suriname swaziland sweden switzerland syrian arab republic tajikistan thailand the former Yugoslav republic of macedonia timor leste togo tonga trinidad and tobago tunisia turkey turkmenistan tuvalu uganda ukraine united arab emirates united Kingdom of Great Britain and northern Ireland united republic of tanzania united states of america uruguay uzbekistan vanuatu venezuela viet nam Yemen Zambia Zimbabwe
a b c d e

120 2000 12675 11200 5665 9083 121 263 2036 1759 5199 1739 18156 530 230 1494 24 381 2939 20065 1392 3 6254 12180 922 14426 9226 74273 842 7476 53 7221 24297 4895 2657 3281

490 8496 47594 43379 20912 36992 452 1029 9070 7264 19512 6591 64762 2037 1007 6306 103 1309 10210 74175 4899 10 29857 45986 4657 59847 39025 301029 3487 26980 215 27216 85344 21639 11861 13085

r no estimate possible. r r n r r r r r r n n n n r r r n r n r n n r n n n r n n r n r n n

39.2 26.4 16.3 31.6 43.5 20.4 36.5 13.3 12.2 33.4 41.2 17.8 12.2 adjusted for altitude. 31.5 38.4 21.5 24.3 26.3 26.3 47.3 26.3 28.7 9.2 43.9 8.8 47.2 6.9 16.9 64.8 54.1 28.3 24.3 51.0 29.1

16.567.8 9.954.0 5.639.1 29.733.5 19.171.5 7.345.7 14.965.4 4.433.8 3.932.1 13.362.1 38.244.2 15.919.8 9.615.3 29.433.6 15.568.0 7.747.2 8.951.5 23.629.2 9.953.6 45.748.9 9.853.9 27.130.4 6.812.3 16.276.0 5.813.1 45.848.7 5.98.1 5.840.3 50.876.7 50.757.4 10.856.3 22.925.7 24.077.5 24.334.4

41 3074 1751 1688 3443 23 85 257 207 1555 640 3055 62 55 481 5 88 729 4885 607 1 1331 1084 372 1212 3687 4833 133 4440 25 1874 5505 2042 633 994

1771 11516282 5984203 15881790 15155656 851 35153 85656 66544 6192891 594687 27353404 4978 5159 194851 210 32187 655808 18419966 586627 01 12551410 8021452 138644 8031800 35743801 40995686 45317 34785255 2427 7143727 51935830 9613099 529748 6531400

moderate moderate mild moderate severe moderate moderate mild mild moderate severe moderate mild moderate moderate moderate moderate moderate moderate severe moderate moderate mild severe mild severe mild mild severe severe moderate moderate severe moderate

2001

15.0049.99

4625

4972

adjusted for altitude.

2003 1995 1999 2003

15.0049.99 15.0059.99 15.0045.99 15.0049.99

2042 2953 1018 3745

4182 3961 1609 5050

adjusted for altitude. data pooled for npnlw, lw and women of working population.

19961997 2000 20002001 2002 2002001 20042005 19992002 1996 1996 20002001 2003 1999

17.0059.99 15.0049.99 15.0049.99 15.0044.99 19.0049.99 15.0049.99 15.0059.99 15.0049.99 15.0049.99 15.0049.99 15.0049.99 15.0049.99

1951 7714 5688 859 486 9065 3866

2485 3209 3207 5172 4154 5221 4738 2293

data pooled for women and lw. sample includes pw. data pooled for npnlw and lw.

npnlw data pooled for npnlw and lw, adjusted for altitude and smoking. data disaggregated by age pooled, weighted prevalence. prevalence calculated for recommended cut-off ; npnlw. data pooled for npnlw and lw.

1685 7135 623

3196 3408 5098 2641

population figures are based on the 2006 projection from the 2004 revision from the united nations population division. level of survey: n=nationally representative, f=2+ surveys at the first administrative level boundary, r=regression-based estimate. corresponds to the numerical reference available in the who Global database on anaemia (http://www.who.int/vmnis/en/). lw = lactating women, npnlw = non-pregnant non-lactating women, pw = pregnant women on 3 June 2006, the permanent representative of the republic of serbia to the united nations and other International organizations in Geneva informed the acting director-General of the who that the membership of the state union serbia and montenegro in the united nations, including all organs and the organizations of the united nations system, is continued by the republic of serbia on the basis of article 60 of the constitutional charter of serbia and montenegro, activated by the declaration of Independence adopted by the national assembly of montenegro on 3 June 2006. estimates used or referred to in this document cover a period of time preceding that communication.

A3.4 Country references


Afghanistan
Ministry of Public Health of the Islamic Republic of Afghanistan et al. Summary Report of the National Nutrition Survey, Afghanistan, 2004. Ministry of Public Health of the Islamic Republic of Afghanistan, 2005. Ref 5173.

Bhutan
Royal Government of Bhutan Ministry of Health and Education. Anemia among men, women and children in Bhutan: How big is the problem? Bhutan, Ministry of Health and Education, 2003. Ref 5150.

Bolivia
Gutirrez Sardn M et al. Bolivia Encuesta Nacional de Demografa y Salud 2003 [Bolivia National Demographic and Health Survey 2003]. La Paz, Ministerio de Salud y Deportes, Instituto Nacional de Estadstica, 2004. Ref 5095.

Angola
Ministry of Health et al. Assessing vitamin A and iron deficiency anaemia, nutritional anaemia among children aged 060 months in the Republic of Angola [technical report]. Ministry of Health, 2000. Ref 2839.

Botswana
Ministry of Health Botswana et al. Micronutrient malnutrition in Botswana. A national survey to assess the status of iodine, iron, and vitamin A. Gaborone, Ministry of Health, 1996. Ref 2805.

Antigua and Barbuda


Micronutrient Working Group. Iron and vitamin A status in five Caribbean countries. Cajanus, 2002, 35 (1): 434. Ref 3758.

Armenia
National Statistical Service et al. Armenia Demographic and Health Survey 2000. Calverton, MD, National Statistical Service, 2001. Ref 3208.

Brazil
Governo de Sergipe et al. III Pesquisa de sade materno-infantil e nutrio do estado de Sergipe. Pesmise 98. Brasilia, Governo de Sergipe, Secretaria de Estado da Sade, 2001. Ref 614. Torres MAA et al. Anemia em crianas menores de dois anos atendidas nas unidades bsicas de sade no Estado de So Paulo, Brasil [Anemia in children under 2 years in basic health care units in the State of So Paulo, Brazil]. Revista de Sade Pblica, 1994, 28 (4): 290294. Ref 2375. Osrio MM et al. Prevalence of anemia in children 659 months old in the state of Pernambuco, Brazil. Revista Panamericana de Salud Pblica, 2001, 10 (21): 101107. Ref 2843.

Azerbaijan
Serbanescu F et al., eds. Reproductive health survey Azerbaijan, 2001. Atlanta, Centers for Disease Control and Prevention, 2003. Ref 4682.

Bahrain
Al-Dallal ZS et al. Impact of the national flour fortification program on the prevalence of iron deficiency and anemia among women at reproductive age in the Kingdom of Bahrain. Kingdom of Bahrain, Ministry of Health, Public Health Directorate, Nutrition Section, 2003. Ref 5391.

Bangladesh
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Brunei Darussalam
Ministry of Health. National Nutritional Status Survey, 1997. Negara, Ministry of Health, 1997. Ref 3334. Nutritional status of children under five years old and pregnant women in Brunei Darussalam. A collaborative study between Institute of Medical Research, Ministry of Health, Malaysia, Ministry of Health, Brunei Darussalam, Ministry of Health, Lao PDR,19951996. Negara, Brunei Darussalam, 1996. Ref 3328.

Belize
Ministry of Health et al. Study of iron deficiency anaemia among pregnant women in Belize. Belmopan, Ministry of Health, 1996. (BZ-NUT/F/003). Ref 1062.

Burkina Faso
Institut National de la Statistique et de la Dmographie [Burkina Faso] et al. Burkina Faso Enqute Dmographique et de Sant 2003 [Burkina Faso Demographic and Health Survey 2003]. Calverton, MD, ORC Macro, 2004. Ref 4948.

Benin
Institut National de la Statistique et de lAnalyse conomique et al. Enqute Dmographique et de Sant au Bnin, 2001. Calverton, MD, Institut National de la Statistique et de lAnalyse conomique et ORC Macro, 2002. Ref 3461.

Burundi
Kimboka S. Burundi National Anaemia Survey. Bujumbura, Burundi, Ministere de la Sante Publique, 2004. Ref 5782.

annex 3

35

Cambodia
Ministry of Health et al. Cambodia Demographic and Health Survey 2000. Phnom Penh, Ministry of Health, 2001. Ref 3206.

Democratic Peoples Republic of Korea


UNICEF et al. The Multiple Indicator Cluster Survey in the Democratic Peoples Republic of Korea, 1998. Pyongyang, United Nations Childrens Fund, 1998. Ref 3090. Central Bureau of Statistics et al. DPRK 2004 Nutrition assessment report of survey results. The Democratic Peoples Republic of Korea, Central Bureau of Statistics, Institute of Child Nutrition, 2005. Ref 5068.

Cameroon
Institut National de la Statistique et al. Enqute Dmographique et de Sant: Cameroon 2004. [Demographic Health Survey: Cameroon 2004]. Calverton, MD, ORC Macro, 2005. Ref 5214.

Democratic Republic of Congo


Ministre du Sant, Programme National de Nutrition PRONANUT. Enquete sur la prevalence de lanemie en Rpublique Dmographique du Congo. Rpublique Dmocratique du Congo, Programme National de Nutrition PRONANUT, 2005. Ref 5764.

Central African Republic


Ministere Delegue a lEconomie au Plan et a la Cooperation Internationale et al. Enqute nationale sur lavitaminose A, la carence en fer et la consommation du sel iode. Republique Centrafricaine, 2000. Ref 1722.

Chile
Ministerio de Salud. Resultados 1: Encuesta de Salud, Chile 2003. Santiago, Departmento de Epidemiologa, Ministerio de Salud, 2003. Ref 5783.

Dominica
Micronutrient Working Group. Iron and vitamin A status in five Caribbean countries. Cajanus, 2002, 35 (1):434. Ref 3758.

China
Chinese Center for Disease Control and Prevention. The prevalence of anemia in China, 2002, by age and gender. Beijing, Chinese Center for Disease Control and Prevention, 2005. Ref 5287.

Egypt
El-Zanaty F et al. Egypt Demographic and Health Survey. Calverton, MD, Ministry of Health and Population, Egypt, National Population Council and ORC Macro, 2001. Ref 1940.

Costa Rica
Ministerio de Salud. Encuesta Nacional de Nutricin: 2 Fascculo Micronutrientes [National nutrition survey: Part 2 micronutrients]. San Jos, Ministerio de Salud, 1996. Ref 1634. Cunningham L et al. Prevalencia de anemia, deficiencia de hierro y folatos en nios menores de siete aos: Costa Rica, 1996 [Prevalence of anemia, iron and folate deficiency in children smaller than seven years: Costa Rica, 1996]. Archivos Latinoamericanos de Nutricin, 2001, 51 (1): 3743. Ref 3555. Rodriguez S et al. Prevalencia de las anemias nutricionales de mujeres en edad frtil, Costa Rica: encuesta nacional de nutricin, 1996 [Prevalence of nutritional anemia in women of reproductive age, Costa Rica: national nutrition survey, 1996]. Archivos Latinoamericanos de Nutricin, 2001, 51 (1): 1924. Ref 3556. Blanco A et al. Anemias nutricionales en mujeres lactantes de Costa Rica [Nutritional anemia in nursing women in Costa Rica]. Archivos Latinoamericanos de Nutricin, 2003, 53 (1): 2834. Ref 4524.

El Salvador
Salvadoran Demographic Association (ADS) et al. Encuesta Nacional de Salud Familiar FESAL-98. [National Family Health Survey FESAL-98]. San Salvador, Salvadoran Demographic Association, 2000. Ref 3107. Salvadoran Demographic Association (ADS) et al. Encuesta Nacional de Salud Familiar FESAL 20022003: Informe final. San Salvador, 2004. Ref 5171.

Fiji
Saito S. 1993 national nutrition survey. Suva, National Food and Nutrition Committee, 1995. Ref 2699.

France
Galn P et al. Determining factors in the iron status of adult women in the SU.VI.MAX study. European Journal of Clinical Nutrition, 1998, 52 (6): 383388. Ref 2392.

Gambia
Bah A et al. Nationwide survey on the prevalence of vitamin A and iron deficiency in women and children in the Gambia. Banjul, National Nutrition Agency, 2001. Ref 2806.

36

worldwIde prevalence of anaemIa 19932005

Ghana
Ghana Statistical Service (GSS) et al. Ghana Demographic and Health Survey 2003. Calverton, MD, ORC Macro, 2004. Ref 4943.

Jamaica
WHO Pan American Health Organization et al. Micronutrient study report: an assessment of the vitamin A, E, betacarotene, and iron status in Jamaica. Kingston, WHO, Pan American Health Organization, Caribbean Food and Nutrition Institute, 1998 (PAHO/CFNI/98.J1). Ref 3093. Micronutrient Working Group. Assessment of the iron supplementation programme for pregnant women in Jamaica. Cajanus, 2002, 35 (1): 3549. Ref 3759.

Guatemala
Ministerio de Salud Publica y Asistencia Social et al. Guatemala, Encuesta Nacional de Salud Materno Infantil 2002. Guatemala, Ministerio de Salud Publica y Asistencia Social, 2003. Ref 4586.

Guinea
Ministre de la Sant Publique. Enqute nationale sur lanmie ferriprive en Guine. Rapport Final: rsum. Guinee, 2001. Ref 2780.

Japan
National Institute of Health and Nutrition. National Nutrition Survey of Japan in 2001 and 2002. Japan, National Institute of Health and Nutrition, 2002. Ref 5177.

Guyana
Ministry of Health [Guyana] et al. Executive summary micronutrient study report Guyana. An assessment of the vitamin A, E, beta-carotene, iron and iodine status in the population. Georgetown, Ministry of Health, 1997. Ref 3094.

Jordan
Department of Statistics et al. Jordan Population and Family Health Survey 2002. Calverton, MD, Department of Statistics Jordan, ORC Macro, 2003. Ref 3389. Ministry of Health Jordan et al. National baseline survey on iron deficiency anemia and vitamin A deficiency. Amman, Ministry of Health, 2002. Ref 4382.

Haiti
Republique dHaiti et al. Enqute Mortalit, Morbidit et Utilisation des Services EMMUS-III Hati 2000. Republique dHaiti, 2001. Ref 3264.

Kazakhstan
Academy of Preventive Medicine Kazakhstan et al. Kazakhstan Demographic and Health Survey 1999. Calverton, MD, Academy of Preventive Medicine and Macro International Inc, 1999. Ref 2675.

Honduras
Ministerio de Salud Pblica et al. Encuesta Nacional de Micronutrientes Honduras, 1996. Tegucigalpa, Secretaria de Salud, Ministerio de Salud Pblica, 1997. Ref 3095. Secretara de Salud et al. Encuesta Nacional de Salud Masculina ENSM-2001. Tegucigalpa, Secretara de Salud, 2002. Ref 3096.

Kenya
Mwaniki DL et al. Anaemia and status of iron, vitamin A and zinc in Kenya. The 1999 National Survey. Nairobi, Ministry of Health, 2002. Ref 3442.

India
International Institute for Population Sciences et al. National Family Health Survey (NFHS-2), 19981999: India. Mumbai, International Institute for Population Sciences, 2000. Ref 2972. International Institute for Population Sciences et al. National Family Health Survey (NFHS-2), India, 19981999, Northeastern States: Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland and Tripura. Mumbai, International Institute for Population Sciences, 2002. Ref 3780.

Kuwait
Jackson RT et al. Gender and age differences in anemia prevalence during the lifecycle in Kuwait. Ecology of Food and Nutrition, 2004, 43 (12):6175. Ref 4375.

Kyrgyzstan
Research Institute of Obstetrics and Pediatrics et al. Kyrgyz Republic Demographic and Health Survey, 1997. Calverton, MD, Research Institute of Obstetrics and Pediatrics, Ministry of Health of the Kyrgyz Republic and Macro International Inc, 1998. Ref 2295.

Iran (Islamic Republic of)


Ministry of Health and Medical Education et al. Multicentre study on iron deficiency anemia among 15 to 49 year old women in the Islamic Republic of Iran. Islamic Republic of Iran, Nutrition Department, Ministry of Health and Medical Education, 1995. Ref 3015.

Lao Peoples Democratic Republic


Ministry of Health, Lao Peoples Democratic Republic. Report on national health survey: health status of the People of LAO PDR. Vientiane, Ministry of Health, 2001. Ref 770.

annex 3

37

Lebanon
Hwalla N et al. Prevalence and selected determinant of iron deficiency anemia in women and under five children in Lebanon. Beirut, 1998. Ref 3221.

Micronesia (Federated States of)


Auerbach SB. Maternal-Child Health Survey: Pohnpei, Federated States of Micronesia, 1993 [summary table]. Palikir, Pohnpei, US Public Health Service/Department of Health Services [Federated States of Micronesia], 1999. Ref 4942. Socorro P et al. Results of vitamin A, anemia and blood lead survey among 24 year old children and reproductive-aged women in Yap proper and Kosrae State, Federated States of Micronesia. Atlanta, Centers for Disease Control and Prevention, 2000. Ref 2548.

Lesotho
Ministry of Health and Social Welfare et al. Lesotho Demographic and Health Survey 2004. Calverton, MD, ORC Macro, 2005. Ref 5356.

Liberia
Mulder-Sibanda M et al. National Micronutrient Survey. A national prevalence study on vitamin A deficiency, iron deficiency anemia, iodine deficiency. Monrovia, Ministry of Health and Social Welfare, Family Health Division, United Nations Childrens Fund, 1999. Ref 1242.

Mongolia
Enkhbat S. Third National Nutrition Survey 2004 [personal communication]. Mongolia, Ministry of Health, 2004. Ref 5247.

Madagascar
Institut National de la Statistique et al. Enqute Dmographique et de Sant de Madagascar 20032004. Calverton, MD, ORC Macro, 2005. Ref 5190.

Morocco
Ministre de la Sant Maroc. Enqute nationale sur la carence en fer lutilisation du sel iod et la supplmentation par la vitamine A, 2000. Morocco, 2000. Ref 3469.

Malaysia
Ministry of Health Malaysia. Family Health. Sub System Health Management Information System, 2004. Malaysia, Ministry of Health, 2005. Ref 5795.

Mozambique
Ministrio da Sade et al. Inqurito nacional seovre a deficincia de vitamina A, prevalncia de anemia e malria em crianas dos 659 meses e respectivas mes. Maputo, Instituto Nacional de Sade, 2003. Ref 589.

Malawi
National Statistical Office et al. Malawi Demographic and Health Survey 2004. Calverton, MD, ORC Macro, 2005. Ref 5201.

Myanmar
National Nutrition Center et al. A study on hemoglobin status and food practices of Myanmar women. Myanmar, National Nutrition Center, Department of Health, 2001. Ref 5246.

Maldives
Ministry of Health and Welfare et al. Nutritional status and child feeding practices of Maldivian children Report of the National Nutrition Survey. Mal, 1994. Ref 831. Minister of Health, Republic of Maldives. Multiple Indicator Cluster Survey (MICS 2), Maldives. Mal, Ministry of Health, 2001. Ref 2987.

Nepal
Ministry of Health Nepal et al. Nepal Micronutrient Status Survey 1998. Kathmandu, Ministry of Health, 1999. Ref 1083.

New Zealand
Russell D et al. NZ Food: NZ People: key results of the 1997 National Nutrition Survey. New Zealand, Ministry of Health, 1999. Ref 3192.

Mali
Cellule de Planification et de Statistique du Ministre de la Sant et al. Enqute Dmographique et de Sant au Mali 2001. Calverton, MD, ORC Macro, 2002. Ref 3446.

Nicaragua
Ministerio de Salud. Encuesta nacional de micronutrientes (ENM 2000) [National survey of micronutrients (ENM 2000)]. Managua, Ministerio de Salud, 2002. Ref 3109. Ministerio de Salud. Sistema integrado de vigilancia de intervenciones nutricionales (SIVIN): primer informe de progreso 20022003 [Integrated system of monitoring nutrition interventions (SIVIN): first progress report 20022003]. Managua, Ministerio de Salud, 2004. Ref 4466.

Mauritius
Ministry of Health Mauritius. A survey of nutrition in Mauritius and Rodrigues (1995). Port Louis, Ministry of Health, 1995. Ref 395.

Mexico
Instituto Nacional de Salud Publica. Encuesta Nacional de Nutricin 1999. Mexico City, Instituto Nacional de Salud Publica, 1999. Ref 2997.

38

worldwIde prevalence of anaemIa 19932005

Nigeria
Federal Ministry of Health and Social Services et al. Nigeria National Micronutrient Survey, 1993. Nigeria, Federal Ministry of Health and Social Services, 1996. Ref 50.

Rwanda
Ministre de la Sant et al. National Nutrition Survey of Women and Children in Rwanda in 1996 [final report]. Kigali, Ministre de la Sant, 1997. Ref 2558.

Oman
Al-Riyami A et al. National Health Survey, 2000. Volume II Reproductive Health Study. Ministry of Health the Sultanate of Oman, 2000. Ref 4218. Al-Riyami A et al. Genetic Blood Disorders Survey in the Sultanate of Oman. Journal of Tropical Pediatrics, 2003, 49 (Suppl 1): i120. Ref 5204.

Samoa
Mackerras D et al. Samoa national nutritional survey 1999, part 1: anaemia survey [technical report]. Apia, Department of Health, 2002. Ref 3226.

Serbia and Montenegro1


Petrovic O et al. Multiple Indicator Cluster Survey II. The report for the Federal Republic of Yugoslavia. Belgrade, UNICEF, 2000. Ref 2441.

Pakistan
Pakistan Institute of Development Economics et al. National Nutrition Survey 20012002. Islamabad, Government of Pakistan, Planning Commission, 2003. Ref 4640.

Singapore
Department of Nutrition et al. National Nutrition Survey 1998. Singapore, Ministry of Health, 2001. Ref 760.

Panama
Ministerio de Salud, et al. Encuesta nacional de vitamina A y anemia por deficiencia de hierro [National survey of vitamin A and iron deficiency anemia]. Panama City, Ministerio de Salud, 2000. Ref 3097.

South Africa
South African Vitamin A Consultation Group (SAVACG). Children aged 6 to 71 months in South Africa, 1994: their anthropometric, vitamin A, iron and immunisation coverage status. Johannesburg, South African Vitamin A Consultative Group, 1995. Ref 48.

Peru
Ministerio de Salud Publica et al. Monitoreo nacional de indicadores nutricionales 2004. Lima, Ministerio de Salud Publica, Instituto Nacional de Salud, 2004. Ref 5359.

Sri Lanka
Piyasena C et al. Assessment of anaemia status in Sri Lanka 2001 [survey report]. Colombo, Ministry of Health, Nutrition and Welfare, Department of Health Services, Medical Research Institute, 2003. Ref 4972.

Philippines
Food and Nutrition Research Institute, Philippines. The Sixth National Survey 2003 [personal communication]. Manila, 2003. Ref 5242.

Sudan
Federal Ministry of Health et al. Comprehensive Nutrition Survey. Khartoum, Federal Ministry of Health, National Nutrition Department, 1997. Ref 1443. Elnour A et al. Endemic goiter with iodine sufficiency: a possible role for the consumption of pearl millet in the etiology of endemic goiter. American Journal of Clinical Nutrition, 2000, 71 (1): 5966. Ref 1553.

Qatar
Amine EK. Nutritional assessment in Qatar; 1995 Oct 20 Nov 3 [assignment report]. Qatar, WHO Regional Office for the Eastern Mediterranean, 1995. Ref 820.

Republic of Korea
WHO Regional Office for the Eastern Mediterranean. 1995 National Nutrition Survey Report. Republic of Korea, Ministry of Health and Welfare, 1997. Ref 3327. Korean Ministry of Health and Welfare. National Health and Nutrition Survey, 2001. Seoul, Korean Ministry of Health and Welfare, 2005. Ref 5249.

Romania
Alfred Rusescu Institute for Mother and Child Protection. Nutritional status of pregnant women, children under 5 years and school children aged 67 years. Alfred Rusescu Institute for Mother and Child Protection, 2005. Ref 164.

On 3 June 2006, the Permanent Representative of the Republic of Serbia to the United Nations and other International Organizations in Geneva informed the Acting Director-General of the WHO that the membership of the state union Serbia and Montenegro in the United Nations, including all organs and the organizations of the United Nations system, is continued by the Republic of Serbia on the basis of Article 60 of the Constitutional Charter of Serbia and Montenegro, activated by the Declaration of Independence adopted by the National Assembly of Montenegro on 3 June 2006. Estimates used or referred to in this document cover a period of time preceding that communication.

annex 3

39

Switzerland
Hess SY et al. A national survey of iron and folate status in pregnant women in Switzerland. International Journal for Vitamin and Nutrition Research, 2001, 71 (5): 268273. Ref 3402.

Ruston D et al. The National Diet & Nutrition Survey: adults aged 19 to 64 years. Volume 4: nutritional status (anthropometry and blood analytes), blood pressure and physical activity. London, Her Majestys Stationery Office, 2004. Ref 4154.

Tajikistan
Branca F et al. Micro-nutrient status survey in Tajikistan. Rome, National Institute for Research on Food and Nutrition, Kazakh Academy of Nutrition, 2004. Ref 4182.

United Republic of Tanzania


National Bureau of Statistics (NBS) Tanzania et al. Tanzania Demographic and Health Survey 200405. Dar es Salaam, National Bureau of Statistics, ORC Macro. 2005. Ref 5221.

Thailand
Ministry of Public Health et al. The Fourth National Nutrition Survey of Thailand 1995. Bangkok, Ministry of Public Health, Department of Health, 1998. Ref 3961.

United States of America


Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey 19992000, 20012002 [personal communication], 2002. Ref 4738.

The former Yugoslav Republic of Macedonia


Branca F et al. Multiple indicator cluster survey in FYR Macedonia with micronutrient component. Rome, National Institute of Nutrition, 2000. Ref 1609.

Uzbekistan
Institute of Obstetrics and Gynecology et al. Uzbekistan Demographic and Health Survey, 1996. Calverton, MD, Institute of Obstetrics and Gynecology, Macro International Inc, 1997. Ref 2293. Analytical and Information Center et al. Uzbekistan Health Examination Survey 2002. Calverton, MD, Analytical and Information Center, State Department of Statistics, ORC Macro, 2004. Ref 4950.

Timor-Leste
Ministry of Health Timor-Leste et al. Timor Leste 2003 Demographic and Health Survey. Newcastle, Australia, Ministry of Health/University of Newcastle, 2003. Ref 5050.

Tunisia
Ministre de la Sant Publique et al. Rapport national: valuation de l tat nutritionnel de la population tunisienne [National report: evaluation of the nutritional status of the Tunisian population]. Tunis, Ministre de la Sant Publique, 1996. Ref 2485.

Vanuatu
Harvey P et al. Report of the second national nutrition survey 1996. Port Vila, Department of Health, 1998. Ref 3196.

Viet Nam
Khoi HH et al. Report on Vietnam National anemia Survey, 2000. Hanoi, National Institute of Nutrition, 2001. Ref 3408.

Turkmenistan
Gurbansoltan Eje Clinical Research Center for Maternal and Child Health et al. Turkmenistan Demographic and Health Survey 2000. Calverton, MD, ORC Macro, 2001. Ref 3209.

Zambia
Luo C et al. National baseline survey on prevalence and aetiology of anaemia in Zambia: a random cluster community survey involving children, women and men. Lusaka, National Food and Nutrition Commission, 1999. Ref 2477. Micronutrient Operational Strategies and Technologies (MOST) et al. Report of the national survey to evaluate the impact of vitamin A interventions in Zambia, July and November 2003. Zambia, Micronutrient Operational Strategies and Technologies, United States Agency for International Development (USAID) Micronutrient Program, 2003. Ref 5098.

Uganda
Uganda Bureau of Statistics (UBOS) et al. Uganda Demographic and Health Survey 20002001. Calverton, MD, ORC Macro, 2001. Ref 3207.

Ukraine
Academy of Medical Science of Ukraine et al. Report of the National Micronutrient Survey Ukraine. Ukraine, Academy of Medical Science of Ukraine, 2004. Ref 5172.

United Kingdom of Great Britain and Northern Ireland


Gregory JR et al. National Diet and Nutrition Survey: children aged 1 to 4 years. Volume 1: report of the diet and nutrition survey. London, Her Majestys Stationery Office, 1995. Ref 3279.

Zimbabwe
Ministry of Health and Child Welfare, Nutrition Unit. Zimbabwe National Micronutrient Survey: 1999. Harare, Ministry of Health and Child Welfare, 2001. Ref 2641.

40

worldwIde prevalence of anaemIa 19932005

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