Accelerating action to reduce anemia: Review of causes and risk factors and related data needs

Prevalence and correlates of childhood anemia in the MINA-Brazil birth cohort study

OBJECTIVE

This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study.

METHODS

Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]).

RESULTS

The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0-21.0%), 42.6% (38.0-47.2%), and 8.7% (6.3-11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7-45.8%) of the study children were anemic, 38.4% (34.6-42.3%) were iron-deficient, and 26.3 (23.0-29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6-15.2%), 18.1% (15.5-21.1%), and 4.1% (2.8-5.7%), respectively; at five years of age (n = 655), 5.2% (3.6-7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84-2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14-2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17-2.39), malaria since birth (2.25; 1.30-3.87), and iron deficiency (2.15; 1.47-3.15), after adjusting for children's age and household wealth index.

CONCLUSIONS

Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children.

Anemia, iron, and HIV: decoding the interconnected pathways: A review

This review delves into the intricate relationship between anemia, iron metabolism, and human immunodeficiency virus (HIV), aiming to unravel the interconnected pathways that contribute to the complex interplay between these 3 entities. A systematic exploration of relevant literature was conducted, encompassing studies examining the association between anemia, iron status, and HIV infection. Both clinical and preclinical investigations were analyzed to elucidate the underlying mechanisms linking these components. Chronic inflammation, a hallmark of HIV infection, disrupts iron homeostasis, impacting erythropoiesis and contributing to anemia. Direct viral effects on bone marrow function further compound red blood cell deficiencies. Antiretroviral therapy, while essential for managing HIV, introduces potential complications, including medication-induced anemia. Dysregulation of iron levels in different tissues adds complexity to the intricate network of interactions. Effective management of anemia in HIV necessitates a multifaceted approach. Optimization of antiretroviral therapy, treatment of opportunistic infections, and targeted nutritional interventions, including iron supplementation, are integral components. However, challenges persist in understanding the specific molecular mechanisms governing these interconnected pathways. Decoding the interconnected pathways of anemia, iron metabolism, and HIV is imperative for enhancing the holistic care of individuals with HIV/AIDS. A nuanced understanding of these relationships will inform the development of more precise interventions, optimizing the management of anemia in this population. Future research endeavors should focus on elucidating the intricate molecular mechanisms, paving the way for innovative therapeutic strategies in the context of HIV-associated anemia.

Risk factors for anaemia among women and their young children hospitalised with suspected thiamine deficiency in northern Lao PDR

Anaemia among women and young children remains a major public health concern. This secondary study describes the anaemia prevalence among young hospitalised children and their mothers in northern Lao People's Democratic Republic and explores possible nutritional causes and risk factors for anaemia. Hospitalised children (ages 21 days to <18 months) with clinical symptoms suggestive of thiamine deficiency disorders were eligible along with their mothers. Venous blood was collected for determination of haemoglobin, ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), erythrocyte glutathione reductase activation coefficient (EGRac), thiamine diphosphate (ThDP) and acute phase proteins. Risk factors for anaemia were modelled using minimally adjusted logistic regression controlling for age. Haemoglobin results were available for 436 women (mean ± SD age 24.7 ± 6.4 years; 1.6% pregnant) and 427 children (4.3 ± 3.5 months; 60.3% male). Anaemia prevalence (Hb < 120 g/L for nonpregnant women and <110 g/L for pregnant women and children) was 30.7% among women and 55.2% among children. In bivariate analyses, biomarkers significantly associated with anaemia in women were ferritin, sTfR, RBP, EGRac and ThDP. Other risk factors for women were lower BMI, mid-upper arm circumference < 23.5 cm, lower education, lower socioeconomic index, food insecurity, Hmong ethnicity, not/rarely having attended antenatal care, not having taken antenatal iron-containing supplements and not meeting minimum dietary diversity. Risk factors for anaemia among children were older age, male sex, stunting, sTfR, ThDP and alpha-1-acid-glycoprotein. Anaemia was common among women and their hospitalised children and was associated with micronutrient deficiencies and socioeconomic, dietary and health care-seeking risk factors, suggesting that multiple strategies are required to prevent anaemia among women and children.

Review of intervention products for use in the prevention and control of anemia

Anemia remains a major public health problem, especially in low- and middle-income countries. The World Health Organization recommends several interventions to prevent and manage anemia in vulnerable population groups, including young children, menstruating adolescent girls and women, and pregnant and postpartum women. Daily iron supplementation reduces the risk of anemia in infants, children, and pregnant women, and intermittent iron supplementation reduces anemia risk in menstruating girls and women. Micronutrient powders reduce the risk of anemia in children. Fortifying wheat flour with iron reduces the risk of anemia in the overall population, whereas the effect of fortifying maize flour and rice is still uncertain. Regarding non-nutrition-related interventions, malaria treatment and deworming have been reported to decrease anemia prevalence. Promising interventions to prevent anemia include vitamin A supplementation, multiple micronutrient supplementation for pregnant women, small-quantity lipid-based supplements, and fortification of salt with iodine and iron. Future research could address the efficacy and safety of different iron supplementation formulations, identify the most bioavailable form of iron for fortification, examine adherence to supplementation regimens and fortification standards, and investigate the effectiveness of integrating micronutrient, helminth, and malaria control programs.

Association between anemia and grip strength indices combined with anthropometry in the Korean population

Anemia is common in older people and is associated with low hand grip strength (HGS). However, there is no study of the association of anemia with both absolute and various relative HGS indices. Therefore, the objectives of this study are to examine the association of anemia with absolute and relative HGS indices and to evaluate whether the relative HGS indices are useful as risk indices of anemia. In this large-scale cross-sectional study, we analyzed the association of anemia with anthropometric indices, absolute HGS indices, and relative HGS indices using both crude and adjusted binary logistic regression models. A total of 24,022 participants were included in the final analysis. Anemia was defined as a blood hemoglobin concentration of less than 13.0 g/dL for men, less than 11.0 g/dL for pregnant women, and less than 12.0 g/dL for nonpregnant women. We considered covariates such as residential area, marital status, education level, occupation, household income, alcohol consumption, smoking status, muscular exercise, walking exercise, blood pressure, and age for men, while for women, we also included menopause. The mean ages of the subjects in this study were 51.89 ± 0.19 years in the nonanemic group and 66.56 ± 0.61 in the anemic group in men and 52.55 ± 0.19 in the nonanemic group and 51.85 ± 0.44 in the anemic group in women. The number of anemic patients was 570 (5.5%) in men and 1638 (12%) in women. The mean HGS value in the dominant hand was 38.97 ± 0.11 in the nonanemic group and 30.84 ± 0.38 in the anemic group in men and 22.64 ± 0.07 in the nonanemic group and 21.85 ± 0.16 in the anemic group in women. Age was highly associated with anemia in men but not in women. Absolute HGS indices, such as the dominant HGS index and both HGS indices, were negatively associated with anemia in both sexes in all crude and adjusted models. All relative HGS indices were associated with anemia in men, but in women, only dominant HGS divided by height and both HGS divided by height were related to anemia status in all models. The associations between anemia and absolute and relative HGS indices were significantly high in men, while in women, these associations were of moderate strength. Anemia was negatively associated with HGS in the Korean population. The strengths of the associations of anemia with the absolute and relative HGS indices showing the highest association with anemia were similar. Therefore, there is no need to use relative HGS indices as risk factors for anemia, and absolute HGS indices, as easily obtained and cost-effective measurement, are suitable.

Global warming may significantly increase childhood anemia burden in sub-Saharan Africa

Childhood anemia constitutes a global public health problem, especially in low- and middle-income countries (LMICs). However, it remains unknown whether global warming has an impact on childhood anemia. Here, we examined the association between annual temperatures and childhood anemia prevalence in sub-Saharan Africa and then projected childhood anemia burden attributable to climate change. Each 1°C increment in annual temperature was associated with increased odds of childhood anemia (odd ratio = 1.138, 95% confidence interval: 1.134-1.142). Compared with the baseline period (1985-2014), the attributable childhood anemia cases would increase by 7,597 per 100,000 person-years under a high-emission scenario in the 2090s, which would be almost 2-fold and over 3-fold more than those projected in moderate- and low-emission scenarios. Our results reveal the vulnerabilities and inequalities of children for the excess burden of anemia due to climate warming and highlight the importance of climate mitigation and adaptation strategies in LMICs.

Integrating and coordinating programs for the management of anemia across the life course

Anemia is a major global public health concern with a complex etiology. The main determinants are nutritional factors, infection and inflammation, inherited blood disorders, and women's reproductive biology, but the relative role of each varies between settings. Effective anemia programming, therefore, requires evidence-based, data-driven, contextualized multisectoral strategies, with coordinated implementation. Priority population groups are preschool children, adolescent girls, and pregnant and nonpregnant women of reproductive age. Opportunities for comprehensive anemia programming include: (i) bundling interventions through shared delivery platforms, including antenatal care, community-based platforms, schools, and workplaces; (ii) integrating delivery platforms to extend reach; (iii) integrating anemia and malaria programs in endemic areas; and (iv) integrating anemia programming across the life course. Major barriers to effective anemia programming include weak delivery systems, lack of data or poor use of data, lack of financial and human resources, and poor coordination. Systems strengthening and implementation research approaches are needed to address critical gaps, explore promising platforms, and identify solutions to persistent barriers to high intervention coverage. Immediate priorities are to close the gap between access to service delivery platforms and coverage of anemia interventions, reduce subnational coverage disparities, and improve the collection and use of data to inform anemia strategies and programming.

Factors Related to Anemia Prevalence Among Women of Childbearing Age in the Period of Global Pandemic

Background Health authorities in Pakistan in collaboration with local and foreign non-government organizations are working hard to achieve the targets set by World Health Organization in 2012, that is, to reduce anemia prevalence and its related factors. However, due to the prevailing COVID-19 crisis, all resources and attention were diverted toward it, which led to ignorance of existing basic health issues. Objective This study assesses anemia prevalence and its related factors among women of childbearing age in the period of global pandemic. Methods A time-lagged, cross-sectional survey was conducted using a self-administered questionnaire among 1,702 volunteer women aged between 15 and 49 years across five major cities of Pakistan from January 2021 to December 2021 using the non-probability consecutive sampling technique. Blood sample results were analyzed to determine prevalence and anemia severity. The chi-squared test and multiple logistic regression were performed to examine the relationship and effect of related factors with hemoglobin levels using SPSS version 26. Results Among the 1,702 respondents, 788 (46.3%) were non-anemic and 914 (53.7%) were anemic. Anemia prevalence in Karachi was slightly greater (n=294, 55.48%) compared to other cities, and the mean hemoglobin level was 11.98 ± 0.92 g/dL. The chi-square test and multiple logistic regression indicated that the respondents' employment status, mother's profession, family income, living conditions, chronic health conditions, use of iron and folic acid supplements, junk food, source of drinking water, and knowledge about anemia and its preventive measures were associated significantly with anemia during the pandemic. Conclusion Results confirmed that anemia is a multi-factor health problem and that it was totally ignored during the COVID-19 pandemic, as the prevalence increased during the pandemic. Therefore, more attention should be paid to anemia surveillance, anemia awareness programs, and mobilization of community health workers and volunteers to reach a wide range of the population, including women of childbearing age even during the pandemic.