Anemia testing included as component of basic antenatal care package

Anemia testing included as component of basic antenatal care package

Anemia testing included as component of basic antenatal care package

The number or percent of facilities that provide anemia testing for pregnant women as part of a basic antenatal care (ANC) package.

This indicator is calculated as:

(# of facilities that provide anemia testing as part of basic ANC/Total # of facilities providing basic ANC) x 100

Evaluators may weight results by client volume.

Anemia is tested by measuring blood hemoglobin concentration.  The gold standard for assessing hemoglobin is the direct cyanomethhemoglobin method, which requires access to a laboratory. However, indirect methods using a finger-prick blood sample can be administered as a low technology alternative.  In areas where resources are lacking for the test kits, ANC clinics can screen for anemia by clinical examination using a WHO developed color scale comparing the shade or color shade of blood with defined hues of red (WHO, 2006).

Data Requirement(s):

Total number of ANC clinics in a specified area and number of ANC clinics that provide anemia testing as part of basic ANC package; optional review of local and national policies on guidelines for basic ANC package and inclusion of anemia testing.

Health facility and ANC clinic records; staff and exit interviews and observations; local and national policies for basic ANC care best practices.

This indicator measures the extent to which ANC clinics include testing for anemia in basic ANC care for all clients.  The level of screening for anemia can serve as a proxy for the quality of ANC services. Testing for anemia, provision of iron/folate supplements during pregnancy, and treatment for moderate to severe anemia are standard best practices in ANC (USAID/CORE, 2004; CARE/CDC, 2003). This indicator relates to two of the Millennium Development Goals: #4. Reduce child mortality; and #5. Improve maternal health.

Anemia is a condition in which an inadequate number of red blood cells or an inadequate amount of hemoglobin impairs blood oxygen transport resulting in reduced physical and mental capacity. Among women of reproductive age, adolescent girls and pregnant women are at most risk for anemia: adolescents because of the onset of menstruation and pregnant women because of the increased blood volume associated with pregnancy.  Anemia in pregnant women is defined as a hemoglobin concentration <11 g/dl.  Based on a WHO review of nationally representative samples from 1993 to 2005, 42 percent of pregnant women have anemia, and 60 percent of this anemia is assumed to be due to iron deficiency in non-malarial areas and 50 percent in malarial areas (WHO/CDC, 2008).  In industrialized countries anemia also affects women, especially those of lower socioeconomic status. Iron deficiency is the primary cause of most anemia in low-income environments. Severe anemia among pregnant women resulting from iron deficiency is associated with an increased risk of maternal and fetal mortality and morbidity and of intrauterine growth retardation (WHO, 2000; WHO/CDC, 2008).

Ideally, all ANC services in a specified area would be included in a survey.  However, for a large catchment area, this may not be practical and sampling can be adopted. Screening for anemia does not indicate if pregnant women are given the universally recommended doses of iron/folate supplements during their ANC visit and more specialized counseling and treatment for cases of moderate to severe anemia.

nutrition, malaria, quality, safe motherhood (SM), policy, newborn (NB)

CARE/CDC, 2003, The Healthy Newborn: A reference manual for program managers, J. Lawn, B. McCarthy, S.R. Ross. Atlanta, Georgia: CARE/CDC Health Initiative.

USAID/CORE, 2004, Maternal and newborn standards and indicators compendium,

WHO, 2006, Reproductive health indicators; guidelines for their generation, interpretation, and analysis, Geneva: WHO.

WHO/CDC. 2008. Worldwide prevalence of anaemia 1993–2005 : WHO global database on anaemia. De Benoist B, McLean E, Egli I, Cogswell M Eds. World Health Organization, Geneva. Available at

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