Blog post

From the VLAG community for the VLAG community

Published on
October 26, 2022

Contribution by PhD candidate Kesso Gabrielle van Zütphen – Global Nutrition

A few days ago, as I was clearing up my desk, I came across a one-pager feedback that I had received from my supervisor a while ago regarding my PhD research proposal. I jokingly said to my husband I was totally going to frame it and hang it above my desk. That one-pager marked an important crossroad in my PhD journey and determined its course. [PV1]As I picked up the piece of paper, I remember how this comment had struck me: “Your key research question concerns the identification of etiological factors of anemia in adolescents but, surprisingly, no data is foreseen to be collected on what is likely to be the primary cause of anemia in this risk group, namely menstruation!”

How on earth did I miss this!? Of course… menses. That one thing that just “happens” monthly and that I do not look forward to. Not sure how I managed to forget this integral part of my life as I was writing up my research proposal!

Did you know that the average woman will experience 500 menstrual cycles, spending approximately 10 years of her life menstruating? I did not. Did you know that 40% of adolescent girls suffer from dysmenorrhea and that up to one-third of women of reproductive age experience heavy menstrual bleeding? I did not. Although women have had periods since the dawn of time, the lack of knowledge on menstrual blood loss volume and the contribution of heavy menstrual bleeding to iron deficiency and anemia is striking…

Globally, iron-deficiency anemia is recognized as the number one cause of disability adjusted life years in adolescent girls aged 10 to 19. Yet, the most recent assessment of progress indicates that out of 133 countries, only two are on track to reach the global target of a 50% reduction of anemia by 2025. The message is clear: We need alternative approaches to a lingering problem. The reality, however, is that interventions to reduce menstrual blood loss are non-existent in policies, completely overlooked by the World Health Organization, and the lack of research in this area is astounding! This gap may well represent a major underestimated solution in our fight against anemia and it deserves widespread attention.

It is against this backdrop that I feel both compelled and fortunate to dedicate 4 years of my life to shed light on the contribution of heavy menstrual bleeding to iron deficiency and anemia among adolescent girls in Malawi. The ultimate goal is to improve the quality of life of thousands of adolescent girls and to safeguard their health as much as possible before their first pregnancy. Technically, I will conduct a 2x2 factorial, double-blind, randomized placebo-controlled trial. The objective is to demonstrate the effects of multiple micronutrient supplementation and/or ibuprofen during menstruation on menstrual blood and iron loss, as well as iron status.

Finally, the timing could not have been any better. It’s a very exciting time to be involved in anemia. The nutrition community is renewing efforts (at long last!) to address anemia more holistically with a more pronounced multi-sectoral lens, and my research topic is a perfect example of such an integrated approach. I’ve had countless discussions with nutritionists, gynecologists, sexual and reproductive health experts, microbiologists, infectious diseases experts, gender experts, water sanitation & hygiene, mental health experts, education experts and many more experts! All of them appreciate the multi-faceted nature of anemia and have demonstrated much enthusiasm in contributing their expertise whilst learning from us nutrition folks. More than ever, am I convinced that these exchanges and integrated systems are what will help us accelerate efforts to wipe out anemia globally.