Abstract：
BACKGROUND: In Senegal, anemia prevalence among women of reproductive age (WRA) decreased from 59% in 2005 to 54% in 2017. However, determinants of reduction in disease burden under challenging public health conditions have not been studied.
OBJECTIVE: To conduct a systematic in-depth assessment of the quantitative and qualitative determinants of anemia reduction among WRA in Senegal between 2005 and 2017.
METHODS: Standard Exemplars in Global Health methodology was used for quantitative analyses using Senegal\'s Demographic and Health Surveys. Qualitative analyses included a systematic literature review, program/policy analysis, and interviews with key stakeholders. A final Oaxaca-Blinder decomposition analysis (OBDA) evaluated the relative contribution of direct and indirect factors.
RESULTS: Among non-pregnant women (NPW), mean hemoglobin (Hb) increased from 11.4 g/dL in 2005 to 11.7 g/dL in 2017 (p<0.0001), corresponding to a 5%-point decline in anemia prevalence (58% to 53%). However, inequities by geographical region, household wealth, women\'s educational attainment, urban compared to rural residence, and antenatal care (ANC) during last pregnancy continue to persist. During this time period, several indirect nutrition programs were implemented, with stakeholders acknowledging the importance of these programs, but agreeing there needs to be more consistency, evaluation, and oversight for them to be effective. Our OBDA explained 59% of the observed change in mean Hb, with family planning (25%), malaria prevention programs (17%), use of iron and folic acid (IFA) during last pregnancy (17%), and improvement in women\'s empowerment (12%) emerging as drivers of anemia decline, corroborating our qualitative and policy analyses.
CONCLUSIONS: Despite a reduction in anemia prevalence, anemia remains a severe public health problem in Senegal. To protect the gains achieved to date, as well as accelerate reduction in WRA anemia burden, focused efforts to reduce gender and social disparities, and improve coverage of health services, such as family planning, IFA, and antimalarial programs, are needed.
OBJECTIVE: To conduct a systematic in-depth assessment of the quantitative and qualitative determinants of anemia reduction among WRA in Senegal between 2005 and 2017.
METHODS: Standard Exemplars in Global Health methodology was used for quantitative analyses using Senegal\'s Demographic and Health Surveys. Qualitative analyses included a systematic literature review, program/policy analysis, and interviews with key stakeholders. A final Oaxaca-Blinder decomposition analysis (OBDA) evaluated the relative contribution of direct and indirect factors.
RESULTS: Among non-pregnant women (NPW), mean hemoglobin (Hb) increased from 11.4 g/dL in 2005 to 11.7 g/dL in 2017 (p<0.0001), corresponding to a 5%-point decline in anemia prevalence (58% to 53%). However, inequities by geographical region, household wealth, women\'s educational attainment, urban compared to rural residence, and antenatal care (ANC) during last pregnancy continue to persist. During this time period, several indirect nutrition programs were implemented, with stakeholders acknowledging the importance of these programs, but agreeing there needs to be more consistency, evaluation, and oversight for them to be effective. Our OBDA explained 59% of the observed change in mean Hb, with family planning (25%), malaria prevention programs (17%), use of iron and folic acid (IFA) during last pregnancy (17%), and improvement in women\'s empowerment (12%) emerging as drivers of anemia decline, corroborating our qualitative and policy analyses.
CONCLUSIONS: Despite a reduction in anemia prevalence, anemia remains a severe public health problem in Senegal. To protect the gains achieved to date, as well as accelerate reduction in WRA anemia burden, focused efforts to reduce gender and social disparities, and improve coverage of health services, such as family planning, IFA, and antimalarial programs, are needed.
摘要：
背景：在塞内加尔，育龄妇女贫血患病率从2005年的59%下降到2017年的54%.然而,在具有挑战性的公共卫生条件下降低疾病负担的决定因素尚未得到研究.
目的：对2005年至2017年塞内加尔WRA中减少贫血的定量和定性决定因素进行系统深入评估。
方法：全球卫生方法学标准范例用于塞内加尔人口与健康调查的定量分析。定性分析包括系统的文献综述，项目/政策分析，以及与主要利益相关者的访谈。最终的Oaxaca-Blinder分解分析（OBDA）评估了直接和间接因素的相对贡献。
结果：在非孕妇（NPW）中，平均血红蛋白（Hb）从2005年的11.4g/dL增加到2017年的11.7g/dL（p<0.0001），对应于贫血患病率下降5%(58%至53%)。然而,按地理区域划分的不平等，家庭财富,妇女的教育程度，城市与农村住宅相比，上次妊娠期间的产前护理（ANC）继续存在。在此期间,实施了几个间接营养计划，利益相关者承认这些项目的重要性，但是同意需要更多的一致性，评估，和监督他们是有效的。我们的OBDA解释了观察到的平均Hb变化的59%，计划生育（25%），疟疾预防计划（17％），上次怀孕期间使用铁和叶酸（IFA）（17％），随着贫血下降的驱动因素，女性赋权的改善(12%)，证实我们的定性和政策分析。
结论：尽管贫血患病率有所降低，贫血仍然是塞内加尔严重的公共卫生问题.为了保护迄今取得的成果，以及加速减少WRA贫血负担，集中努力减少性别和社会差距，提高卫生服务的覆盖面，比如计划生育,IFA,和抗疟药计划，是需要的。
目的：对2005年至2017年塞内加尔WRA中减少贫血的定量和定性决定因素进行系统深入评估。
方法：全球卫生方法学标准范例用于塞内加尔人口与健康调查的定量分析。定性分析包括系统的文献综述，项目/政策分析，以及与主要利益相关者的访谈。最终的Oaxaca-Blinder分解分析（OBDA）评估了直接和间接因素的相对贡献。
结果：在非孕妇（NPW）中，平均血红蛋白（Hb）从2005年的11.4g/dL增加到2017年的11.7g/dL（p<0.0001），对应于贫血患病率下降5%(58%至53%)。然而,按地理区域划分的不平等，家庭财富,妇女的教育程度，城市与农村住宅相比，上次妊娠期间的产前护理（ANC）继续存在。在此期间,实施了几个间接营养计划，利益相关者承认这些项目的重要性，但是同意需要更多的一致性，评估，和监督他们是有效的。我们的OBDA解释了观察到的平均Hb变化的59%，计划生育（25%），疟疾预防计划（17％），上次怀孕期间使用铁和叶酸（IFA）（17％），随着贫血下降的驱动因素，女性赋权的改善(12%)，证实我们的定性和政策分析。
结论：尽管贫血患病率有所降低，贫血仍然是塞内加尔严重的公共卫生问题.为了保护迄今取得的成果，以及加速减少WRA贫血负担，集中努力减少性别和社会差距，提高卫生服务的覆盖面，比如计划生育,IFA,和抗疟药计划，是需要的。
