diff --git a/problem-packs/public-health/anemia-women-adolescents-global/datasets.md b/problem-packs/public-health/anemia-women-adolescents-global/datasets.md index fa4ee27..8caed77 100644 --- a/problem-packs/public-health/anemia-women-adolescents-global/datasets.md +++ b/problem-packs/public-health/anemia-women-adolescents-global/datasets.md @@ -1,15 +1,28 @@ # Dataset Inventory -| Source | Grain | Status | Use | -| ---------------------------- | ------------ | ------ | ------------- | -| Primary survey data | Sub-national | Usable | Core analysis | -| Satellite/environmental data | Variable | Usable | Risk context | -| Population data | 100m | Usable | Denominator | +Dated source inventory for anaemia prevalence and iron-folic-acid (IFA) supplementation coverage in women and adolescent girls in LMICs. Classification reflects fitness for a sub-national prevalence-and-coverage analysis. Inventory compiled 2026-06-18. + +## Sources + +| Source | Grain | Measure family | Status | Use | +| ---------------------------------------- | --------------------------------- | ---------------------------------- | -------- | ---------------------------------------------- | +| WHO Global Anaemia Estimates (GHO, 2023) | Global / national | Modeled prevalence benchmark | Usable | Global benchmark for women/children prevalence | +| WHO/Lancet GH pooled estimates (2022) | National, by severity | Measured-Hb pooled prevalence | Usable | Cross-country prevalence backbone | +| WHO VMNIS micronutrients database | National; survey-level entries | Measured haemoglobin distributions | Usable | Underlying measured-Hb source layer | +| GBD 2021 anaemia burden (IHME) | National + some subnational | Modeled prevalence/YLD by cause | Limited | Burden and cause context | +| DHS haemoglobin + iron supplementation | National + georeferenced clusters | Measured Hb (subset) + IFA recall | Limited | Sub-national prevalence and IFA coverage proxy | +| Clinical pallor / exam-only assessment | Varies | Visual clinical assessment | Rejected | Inaccurate and unreliable (see below) | + +## Classification Reasons + +- **Usable** sources rest on measured haemoglobin and provide prevalence at national or finer grain. +- **Limited** sources serve a narrower purpose: GBD outputs are modeled burden by cause rather than direct survey prevalence; DHS measures haemoglobin only in a subset of rounds and records IFA via recall (receipt, not confirmed consumption). +- **Rejected**: clinical pallor / examination-only assessment has wide, inconsistent diagnostic accuracy and poor inter-observer agreement, so it cannot anchor prevalence estimates in place of measured haemoglobin. ## Required Properties -Source methodology, data year, geographic grain, license. +Source methodology, data year, geographic grain, measure family (measured haemoglobin vs clinical vs recall), license, and prevalence/coverage coverage. ## Rejection Rule -Rejected if methodology, grain, date, or license unverifiable. +Rejected if methodology, grain, date, or license is unverifiable, or if anaemia status is from clinical assessment rather than measured haemoglobin. diff --git a/problem-packs/public-health/anemia-women-adolescents-global/evidence.json b/problem-packs/public-health/anemia-women-adolescents-global/evidence.json index bdb840a..e2dfcdf 100644 --- a/problem-packs/public-health/anemia-women-adolescents-global/evidence.json +++ b/problem-packs/public-health/anemia-women-adolescents-global/evidence.json @@ -9,12 +9,108 @@ "url": "https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children" }, "source_date": "2023-05-01", - "access_date": "2026-06-07", + "access_date": "2026-06-18", "method": "Reviewed WHO anemia database, prevalence estimates, and intervention coverage.", "limitations": [ "Anemia estimates modeled from surveys of variable recency.", "IFA coverage data is self-reported." ], "confidence": "high" + }, + { + "id": "who-lancet-gh-anaemia-estimates-2022", + "problem_id": "public-health/anemia-women-adolescents-global", + "claim": "A WHO-led pooled analysis of population-representative data estimates national, regional, and global anaemia prevalence by severity for women and children over 2000-2019, and is usable as the cross-country prevalence backbone for women of reproductive age.", + "evidence_type": "peer-reviewed-study", + "source": { + "title": "National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data", + "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9023869/" + }, + "source_date": "2022-05-01", + "access_date": "2026-06-18", + "method": "Read the open-access Lancet Global Health article and methods; confirmed it pools measured-haemoglobin survey data to produce severity-disaggregated anaemia prevalence for women aged 15-49 and children, by country and year.", + "limitations": [ + "Estimates are national, regional, and global; the analysis does not provide sub-national grain.", + "Values are modeled where survey data are sparse, widening uncertainty for some low-income countries.", + "Series ends in 2019 and covers women of reproductive age rather than adolescent girls specifically." + ], + "confidence": "high" + }, + { + "id": "who-vmnis-micronutrients-database", + "problem_id": "public-health/anemia-women-adolescents-global", + "claim": "The WHO Vitamin and Mineral Nutrition Information System (VMNIS) compiles haemoglobin-distribution data from hundreds of surveys across more than 130 countries, providing the measured-haemoglobin source layer underlying global anaemia estimates.", + "evidence_type": "dataset", + "source": { + "title": "WHO Vitamin and Mineral Nutrition Information System (VMNIS)", + "url": "https://www.who.int/teams/nutrition-and-food-safety/databases/vitamin-and-mineral-nutrition-information-system" + }, + "source_date": "2024-01-01", + "access_date": "2026-06-18", + "method": "Opened the VMNIS database page and confirmed it aggregates haemoglobin-distribution data from systematic literature search, collaborator network, and country consultation for women and children.", + "limitations": [ + "It is a compilation of heterogeneous surveys; methods, recency, and representativeness vary by entry.", + "Coverage is country-level; it is not a ready-made sub-national dataset.", + "Source date is approximate — the database is continuously updated rather than published once." + ], + "confidence": "medium" + }, + { + "id": "gbd-2021-anaemia-burden", + "problem_id": "public-health/anemia-women-adolescents-global", + "claim": "GBD 2021 estimates anaemia prevalence and years lived with disability by severity and cause for 204 countries over 1990-2021, reporting global all-age prevalence of 24.3 percent in 2021 and much slower progress in women and girls than in men and boys.", + "evidence_type": "peer-reviewed-study", + "source": { + "title": "Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021", + "url": "https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(23)00160-6/fulltext" + }, + "source_date": "2023-09-01", + "access_date": "2026-06-18", + "method": "Reviewed the published GBD 2021 anaemia findings to confirm severity- and cause-disaggregated prevalence and YLD estimates and the women-versus-men progress gap.", + "limitations": [ + "Outputs are modeled burden estimates with uncertainty intervals, not direct survey observations.", + "Headline figures are all-age; women-of-reproductive-age and adolescent breakdowns require the underlying results tool.", + "Cause attribution depends on modeling assumptions that vary across settings." + ], + "confidence": "medium" + }, + { + "id": "dhs-haemoglobin-and-iron-supplementation", + "problem_id": "public-health/anemia-women-adolescents-global", + "claim": "DHS surveys measure haemoglobin for women and men aged 15 and over in selected rounds and record antenatal iron-supplementation receipt, providing georeferenced measured-anaemia prevalence and survey-based IFA coverage in many LMICs.", + "evidence_type": "dataset", + "source": { + "title": "The DHS Program — Biomarkers", + "url": "https://www.dhsprogram.com/What-We-Do/Biomarkers.cfm" + }, + "source_date": "2024-01-01", + "access_date": "2026-06-18", + "method": "Reviewed the DHS biomarkers page and confirmed haemoglobin is collected for ages 15+ in selected surveys; cross-checked that DHS questionnaires also capture iron supplementation during pregnancy, the standard LMIC IFA-coverage measure.", + "limitations": [ + "Haemoglobin is measured only in a subset of DHS surveys and countries, not all rounds.", + "IFA coverage is recall-based and records receipt or number of days, not confirmed consumption.", + "Field capillary haemoglobin measurement is less precise than venous laboratory assay.", + "Source date is approximate — this is a continuously maintained program page, not a dated publication." + ], + "confidence": "medium" + }, + { + "id": "clinical-pallor-anaemia-rejected", + "problem_id": "public-health/anemia-women-adolescents-global", + "claim": "A meta-analysis of clinical pallor for diagnosing anaemia finds wide and inconsistent diagnostic accuracy with poor inter-observer agreement, which is the documented basis for rejecting pallor-based or clinical-examination-only assessment as an anaemia prevalence source in place of measured haemoglobin.", + "evidence_type": "peer-reviewed-study", + "source": { + "title": "Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis", + "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC1325025/" + }, + "source_date": "2005-12-16", + "access_date": "2026-06-18", + "method": "Read the open-access meta-analysis to confirm the reported sensitivity and specificity ranges and inter-observer reliability for pallor, then applied it as the rejection rule for clinical-assessment-only anaemia data.", + "limitations": [ + "The meta-analysis is in children, so the precise accuracy figures may differ for adolescent girls and adult women.", + "It establishes the rejection rationale; it is not itself a usable prevalence data source.", + "It does not address iron-supplementation coverage measurement." + ], + "confidence": "high" } ] diff --git a/problem-packs/public-health/anemia-women-adolescents-global/evidence.md b/problem-packs/public-health/anemia-women-adolescents-global/evidence.md index 6c9ec12..ee47f32 100644 --- a/problem-packs/public-health/anemia-women-adolescents-global/evidence.md +++ b/problem-packs/public-health/anemia-women-adolescents-global/evidence.md @@ -6,6 +6,26 @@ WHO estimates 30 percent of women aged 15-49 have anemia, with prevalence exceeding 50 percent in several Sub-Saharan African and South Asian countries. +### who-lancet-gh-anaemia-estimates-2022 + +WHO-led pooled analysis of measured-haemoglobin surveys gives national/regional/global anaemia prevalence by severity for women and children, 2000-2019. Usable backbone; national grain only and ends in 2019. + +### who-vmnis-micronutrients-database + +VMNIS compiles haemoglobin-distribution data from hundreds of surveys across 130+ countries — the measured-Hb source layer beneath global estimates. Usable; heterogeneous entries, country-level. + +### gbd-2021-anaemia-burden + +GBD 2021 (IHME) supplies modeled anaemia prevalence and YLDs by severity and cause for 204 countries, 1990-2021 (24.3% global all-age in 2021). Limited: modeled burden, all-age headline figures. + +### dhs-haemoglobin-and-iron-supplementation + +DHS measures haemoglobin for ages 15+ in selected rounds and records antenatal iron-supplementation receipt, with georeferenced clusters. Limited: Hb in a subset of surveys; IFA is recall-based. + +### clinical-pallor-anaemia-rejected + +A meta-analysis finds clinical pallor has wide, inconsistent accuracy and poor inter-observer agreement. Basis for rejecting clinical-assessment-only anaemia data in place of measured haemoglobin. + ## Evidence Quality Rule Evidence accepted only when source, method, limitations, and confidence are explicit enough for a reviewer to attack.