Reducing Iron-Deficiency Anemia Among Adolescent Girls in Kazakhstan: A Multi-Criteria Decision Analysis of Intervention Strategies

Iron-deficiency anemia (IDA) remains a significant public health concern among adolescent girls in Kazakhstan, driven by increased physiological iron demands during puberty, menstrual iron losses, and unequal access to nutritious food. While national anemia rates have declined over the past decade, the burden remains elevated among specific subgroups, including rural adolescents and those from households with lower food expenditure and maternal education. Existing research on adolescent anemia in Kazakhstan has largely documented prevalence and its correlates rather than evaluating which interventions are best suited to the country's existing healthcare and educational infrastructure. This literature review addresses that gap by examining the causes of adolescent IDA, reviewing international guidelines, and evaluating the evidence for four interventions, iron supplementation, food fortification, nutrition education, and a combined approach, using a Multi-Criteria Decision Analysis (MCDA) weighted across six criteria: clinical effectiveness, feasibility, cost, scalability, sustainability, and acceptability. The analysis finds that iron supplementation has the strongest direct clinical evidence, but food fortification and nutrition education score highest overall once feasibility, cost, and sustainability are considered, largely because Kazakhstan already has mandatory wheat flour fortification (since 2004) and an established school health network. The findings support a layered strategy: fortification as a population-wide foundation, nutrition education to reinforce dietary practices and supplementation adherence, and targeted iron supplementation reserved for high-risk subgroups, such as girls with heavy menstrual losses or limited access to fortified foods. Rather than proposing new delivery systems, this approach builds on infrastructure Kazakhstan already operates, offering a realistic, actionable framework for policymakers.