evidence: source inventory for anemia-women-adolescents-global

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.

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"
   }
 ]

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.