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On November 18, HFTAG hosted an N4G side event titled Where is the anaemia target for young children? The missing WHA nutrition target. Perspectives on home fortification for children under five. The discussion focused on the need for the World Health Assembly to set anaemia targets for infants and young children, and the importance of promoting evidence-based interventions to improve the iron status of this demographic. Watch the full event and read our recap of key points below.

Why do we need targets? 

Globally, the prevalence of anaemia amongst children has remained significantly unchanged for nearly a decade, hovering around 40 percent since 2010. While we know that childhood anaemia is a serious issue, setting specific targets requires dedicated funding, resources, and investments in childhood anaemia, as well as an increased profile within the global health agenda.

Targets help to further the collection, use, and monitoring of data, which makes monitoring progress, tracking and evaluating programmatic impact easier. Targets contextualize the problem and support multiple approaches to interventions, an important consideration given the complex causes of anaemia.

Global targets also help influence national targets and lead to the development of costed scaling plans alongside global, national and subnational advocacy. Experiences with existing frameworks, like the global investment framework in nutrition, have shown that targets work to accelerate progress and investment, and make the issue a higher global priority.

What’s the problem? 

Infants and children have high daily iron requirements, with infants needing nine times as much iron as adults, yet evidence has shown that achieving adequate intake is a challenge. In many households, men consume most of the iron-rich foods, leaving not enough for the women and children in the family.

For infants, nearly all their required iron must come from complementary foods, yet these foods often contain little iron. Even in hypothetical best-case scenarios, infant diets are still far below the targets for adequate iron intake. In these cases, the diets that allocate enough iron are unlikely to be consumed by infants, either because the foods are not available or they include foods which an infant is unlikely to eat, such as liver.

Using home fortification as a pathway to success in tackling childhood anaemia 

While dietary diversification and the selection of iron-rich complementary foods may be optimal, cost, access, and other barriers prevent this from being a consistently accessible solution. While options like large-scale fortification or biofortification of staple foods broadly address anaemia in a population, they are unlikely to fill the gap in iron intake of infants under 12 months.

Foods specifically formulated for infants and young children allow for a level of iron fortification much higher than is possible for the general public and allow for greater scalability in the intervention as the child ages. Ongoing and recent evidence has shown that home, or point-of-use, fortification with multiple micronutrient powders (MNPs) is effective and supported by the WHO and UNICEF. A recent Cochrane review found that home fortification with MNPs resulted in an 18 percent reduction in anaemia and a 53 percent reduction in iron deficiency in children under two.

Successful implementation and scaling of home fortification to address childhood anaemia will require intentional thinking and should draw on experiences from other priority interventions in the nutrition sector. Global targets ultimately set the framework for the reduction of childhood anaemia, driving political and financing commitments, delivery platforms, and helping to accelerate demand driven scale-up. A global costed plan underwritten by clear targets and indicators will stimulate advocacy and investment in the scale-up of evidence-based interventions, like home fortification.

Continuing the momentum of N4G, we have a significant opportunity to invest and move on this under-resourced crisis and make smart, ambitious and targeted commitments towards childhood anaemia. Drawing on evidence and experience from across the nutrition spectrum, the setting of global targets in childhood anaemia is a necessary step in increasing child survival, reducing malnutrition globally, and unlocking progress for a better and brighter future for children.