Addressing Anemia in Women and Children in Rural Communities of Cambodia and Kenya: Experiences from an Integrated Program
Authors: Aidam Bridget A , Edward Anbrasi , Paden Anna C , Wong Rebecca Y.S , Chege Jane 
Published: November 2023

Background and Objective

Over two billion people globally are estimated to be anemic, primarily due to iron deficiency anemia. The prevalence of anemia is exacerbated in countries with extreme resource poor rural populations, resulting in debilitating consequences of impaired health and productivity. In Kenya and Cambodia, the national estimates are 46.0% and 55.5% for children aged 6–59 months in contrast to 25.0% and 45.4% for women aged 15–49 years. World Vision is conducting a collaborative multi‐stakeholder research that engages academic and research institutions, NGOs and Ministries of Health. The study is aimed at determining the impact of a multifaceted integrated package of Maternal Child Health and Nutrition (MCHN) intervention to tackle major disease burden and under‐nutrition including anemia in Zambia, Cambodia, Kenya and Guatemala. The objective of this presentation is to describe the effect of this integrated program on anemia in Kenya and Cambodia.

Methods

The study was designed as a mixed methods research using a quasi‐experimental design with comparison communities in World Vision's Area Development Programs in Cambodia and Kenya. A package of MCHN interventions targeting pregnant women and children under age two is being implemented to address anemia which includes iron supplementation, deworming, use of insecticide‐treated nets (ITNs) to prevent malaria, as well as nutrition education and counseling. Baseline surveys included 3,597 women aged 15–49 years and 3,813 children under age five in Cambodia, and 4,142 women and 6,407 children in Kenya. Testing for hemoglobin levels using HemoCue was conducted on a sub‐sample of eligible women and children, i.e. 1,240 women and 1,184 children in Cambodia, and 1,582 women and 843 children in Kenya. Delivery of iron supplementation, deworming and ITNs is conducted through the existing health system, and community health workers are used to provide nutrition counseling. The coverage, capacity and quality of the delivery systems for the control of anemia was assessed at midterm.

Results

The baseline prevalence of anemia in children was higher than expected, i.e. 75.0% in Cambodia and 57.2% in Kenya, of which 46.9% and 1.5% as well as 32.0% and 4.0% respectively were moderately and severely anemic. On the other hand, 20.6% of Cambodian and 24.5% of Kenyan women were found anemic, with 7.7% and 0.2% as well as 10.2% and 2.0% respectively falling into the moderate and severe anemia categories. From mid‐term reviews, the capacity of the rural health system to effectively address severe anemia in the Kenyan site seems to be limited. Secondly, the intensity of the Timed and Targeted Counseling (ttC) methodology, although effective for certain outcomes, may not be enough to meet goals. Lastly, access to and consumption of diverse diets, rich in micronutrients is affected by the availability of food security programs in study sites.

Conclusion

These findings provide valuable evidence of the use and limitations of multi‐platform interventions via community oriented and health facility focused strategies to enhance service delivery and outcomes for addressing anemia in rural communities with minimal access to care.

Support or Funding Information

This study was funded by World Vision International