Understanding the determinants of anemia reduction among women of reproductive age: Exemplar country case studies’ methodology

Background: Since 2000, only a few countries have substantially reduced the burden of anemia among women 15–49 y of age. The Exemplars in Anemia Reduction among Women of Reproductive Age (WRA) studied the determinants of success among these countries. Objectives: To describe the methodology used to determine the factors associated with anemia reduction in high-performing countries, with the aim to guide policy and programmatic decisions in other countries with similar sociodemographic and health indices. Methods: This article describes the process used to identify countries with exemplary reduction in WRA anemia burden, compared with their peers. We describe the Exemplars in Global Health methodology, the mixed-methods approach used to identify and quantify the macro- and microlevel characteristics associated with anemia burden decline among WRA. Quantitative analyses include descriptive and equity analyses, multivariate linear regression, and Oaxaca-Blinder decomposition analysis. Qualitative analyses include in-depth interviews and focus group discussions with national, subnational, and community stakeholders, as well as review of programs and policies with the potential to impact women's health and/or nutrition, enacted in the countries over the last 20 y. A technical advisory group oversaw all research activities. Results: We identified 5 countries, namely, Mexico, Pakistan, Philippines, Uganda, and Senegal, as anemia exemplars, after considering the magnitude of anemia decline between 2000 and 2018, availability of ≥2 nationally representative anemia surveys, geographical diversity to account for the complex etiology of anemia, regional representation, and logistics of in-country work. Conclusions: Exemplars in Anemia Reduction among WRA seeks to create awareness of how little anemia prevalence has changed globally and aims to inform and spur global efforts for improving women's health and nutrition.