Indicators/Laboratory Tests

Recommended cut-off values and definitions of a public health
problem, where applicable

Anemia/Hemoglobin

Children 6-59 mo: <11.0 g/dLa

Hemoglobin values was adjusted for altitude

Public health problem: Anemia prevalence:

<4.9% – normal

5.0  – 19.9 % – mild

20.0 – 39.9 % – moderate

>40 % – severe

Iron Deficiency/Ferritin

Children
<5 y: <12 ug/Lb

Iron Deficiency/sTfR

For all age groups:

>8.3 mg/L

Vitamin A deficiency/Retinol binding protein (RBP)

RBP should be calibrated to serum retinol to validate cut offs

Vitamin A deficiency/Serum retinol

For all age groups:

Mild <0.70 ^mol/L

Moderate 0.35 – 0.69 ^mol/L

Severe < 0.35 ^mol/Lc

Definition of a public health problem: prevalence of vitamin A deficiency (based on low serum retinol and unadjusted)

2-9% – mild

10-19% – moderate

>20% – severe

Vitamin A status/Modified relative dose response (MRDR)

For all age groups:

≥ 0.060 are indicative of insufficient vitamin A liver reserves’1^

Folic acid/ RBC folate

Children 6-59 mo:

<100 ng/mL
(<226.5 nmol/L)
f

Vitamin B12 /Serum
B
12

For all age groups:

<150 pmol/L (203 pg/mL)g

Zinc/Serum zinc

Children 6-59 mo.:

Morning, non-fasting: <65^g/dL

Afternoon, non-fasting: <57 ^g/dL

Morning is defined as sample collected before 1200 hours and afternoon as after 1200 hours.

To convert to ^mol/L divide by 6.54h

Zinc
deficiency is of public health concern when the prevalence of low serum zinc concentration is greater than 20%
i

Inflammation AGP (a1-acid glycoprotein) and CRP (C-reactive
protein)

For all age groups:

AGP >1.0 g/L

CRP >5.0 mg/L

Malaria/ First Response ® Malaria HRP2 Test kit

For all age groups:

Test provides a dichotomous result – positive or negative for malaria antibodies.
It distinguishes falciparum and vivax.


a
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information

System. Geneva, World Health Organization, 2011 (http://www.who.int/vmnis/indicators/haemoglobin. pdf, accessed October 11, 2011.)

b UNICEF, United Nations University, WHO. Iron deficiency anemia, assessment, prevention, and control: a guide for programme managers. WHO/NUT/96.10. 2001. Geneva, WHO.

c WHO. Indicators for assessing vitamin A deficiency and their application in monitoring and evaluating intervention programmes. 1996. Geneva, WHO.

d MRDR also provides value for serum retinol

e Tanumihardjo, S.A. Vitamin A: biomarkers of nutrition for development. Am J Clin Nutr 2011;94(suppl):658S-664S.

f Cut-offs for RBC folate among adults are based on homocysteine values or incidence of neural tube defects, which are not priority health events for children 6-59 months so cuts offs for children based on macrocytic anemia are suggested.

g WHO Technical Consultation. Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food and Nutrition Bulletin 2008; 29(2 (Supplement)):S238-S244.

h IZiNCG Technical Brief. No. 2, 2007. Assessing population zinc status with serum zinc concentration. Accessed at: http://www.izincg.org/pdf/English brief2.pdf.

1 deBenoist B, Darnton-Hill I, Davidsson L, Fonataine O, Hotz C. Conclusions of the Joint WHO/UNICEF/IAEA/IZiNCG intragency meeting on zinc status indicators. Food and Nutrition Bulletin 2007; 28(3):S480-S485.