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  • sigma receptor br In Gretchen Stevens and colleagues update

    2019-06-19


    In Gretchen Stevens and colleagues\' update of global, regional, and national trends in haemoglobin concentration and levels of anaemia emphasises both the massive extent of the problem, and its very slow rate of improvement. About 30% or more of women and children younger than 5 years are affected by the disorder—nearly 800 million people. Anaemia has improved by only 0·2–0·3 percentage points per year in the past two decades. By comparison, child underweight, affecting nearly 20% of children, has declined at an average of almost 0·6 percentage points per year. The trend rates are such that, globally, women\'s anaemia would take about 60 years or more before the prevalence rates of 15% noted in high-income regions are achieved; in south Asia, this rate would take more than a century to reach, and in for example central and west Africa, it would take more than 150 years. The global problem is not resolving as part of normal socioeconomic development. Assessment of the causes of anaemia suggests likely future trends, and needs for additional interventions. Gross national income and consumption of meat are significantly (and independently) associated with anaemia prevalences, so that countries transitioning to higher income and more diversified diets that include more animal products and fruits and vegetables might decrease anaemia prevalence. The exception is when diets exclude meat, which notably includes many of the estimated 300 million women in India, of whom about 50% have anaemia. Indeed, rapid improvements have been documented at the national level (eg, 1–3 percentage points per year in Thailand and Vietnam and Nicaragua), ascribed more to improvements in diet and infectious disease than to direct supplementation, although supplementation was widely implemented. For the millions of poor individuals who live in stagnant conditions of poverty, which are exacerbated by high food prices and unemployment, not much will change unless deliberate measures are taken. Implementation of effective direct intervention programmes, such as supplementation with iron (as iron and folic sigma receptor or multiple micronutrients), fortification of staple foods or condiments, and disease control (notably malaria and deworming), is urgently needed. The effectiveness of these solutions is well established and the effects are large relative to the slow rate of anaemia\'s decline, showing a missed opportunity. The challenge is how to implement these programmes on a wide enough scale, with well-known methods (). For supplementation, the key issues are how to develop and sustainably support the relevant systems and platforms. The shows options for implementation of interventions. Timely participation in antenatal care is restricted, and even for participating countries, supplies of supplement are rarely sufficient. Incentives are essential for use of antenatal care, including improvement of quality of services through conditional cash-transfer programmes and counselling, and overhaul of supply logistics, from central stores to health posts, is a prerequisite. Community-based health and nutrition programmes are operational in many countries and are mainly aimed at children, but could readily include women. Other opportunities are through family planning, child health days, and cash-transfer programmes. To address child anaemia, provision of suitable iron sources as drops or in multiple micronutrient powders is needed. Interventions to combat child marriage and early pregnancy, and to increase birth intervals, will contribute to the reduction of anaemia. Iron fortification of staple foods (especially wheat) has contributed to the reductions in anaemia prevalence reported in high-income regions. Fortification in low-income countries has expanded: the Flour Fortification Initiative reports that 76 countries now have mandatory flour fortification, and 31% of the world\'s wheat flour is fortified. Rice is the staple food in most of Asia, and thus for nearly half the world\'s population. Many such individuals are vegetarian and have high rates of anaemia. However, rice is not yet widely fortified, and substantial technical issues demand increased sigma receptor investment in research, both for added iron and biofortification. Fortification of widely used condiments, such as soy sauce and fish sauces, has also begun, notably in China. In countries where populations rely on wheat, additional benefit to anaemia can now be expected; populations that consume mainly rice might have to wait.