Indicators/Laboratory Tests

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


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

<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)

Vitamin B12 /Serum

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

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

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

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.

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

System. Geneva, World Health Organization, 2011 ( 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: 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.