Iron deficiency anaemia—an ongoing challenge

Iron deficiency anaemia—an ongoing challenge

Iron Deficiency Day Iron deficiency and iron deficiency anaemia are major global health problems and contribute substantially to the global burden of disease. To help raise awareness of iron deficiency, November 26 is Iron Deficiency Day , with this year's theme being “Listen to your body”. One of the goals of Iron Deficiency Day is to educate people about the importance of healthy iron levels and to encourage people to seek help from health-care providers if needed. Symptoms of iron deficiency are not always obvious, and the goal of the campaign is to provide people with the tools to listen to their bodies—whether they are feeling tired, or breathless, or in a mental fog. The consequences of iron deficiency can be severe, even in the absence of anaemia; underlying health conditions can be exacerbated, and individuals often see an overall decline in general health and wellbeing.

iron deficiencydecreased Although any individual can be affected by iron deficiency , it particularly affects children, premenopausal women, and people in low-income and middle-income countries (LMICs). The WHO estimates that that 42% of children younger than 5 years of age and 40% of pregnant women worldwide are anaemic. In most LMICs, anaemia is a major cause of child and maternal mortality. It is also linked with an increased risk of low birth weight, cognitive impairment, delayed mental and physical development, and increased susceptibility to infection. Therefore, reducing anaemia in LMICs is an important goal for health outcomes in these areas. In 2012, a 50% reduction in the prevalence of anaemia in women of reproductive age was a target of the WHO maternal, infant, and young child nutrition targets. In 2019, the target date to achieve this goal was extended to 2030, when it was clear that anaemia prevalence had not decreased globally as quickly as required.

Many factors can contribute to iron deficiency and anaemia for women of reproductive age, from dietary practices, infectious diseases, menstrual history, gastrointestinal symptoms, medications, and blood donation. Identifying which factors are most important to target in a population would help in the implementation of effective interventions to address these causes. The most common causes of anaemia include nutritional deficiencies, particularly iron deficiency, but also deficiencies in folate and vitamins B12 and A. Therefore, programmes are needed that include interventions such as daily and intermittent iron supplementation, and home fortification with micronutrient powders for specific groups. Regular deworming for soil-transmitted helminths and schistosomiasis in high-risk communities are an important intervention, and larger community-wide interventions, such as the fortification of staple foods and condiments and activities to improve food security and dietary diversity, can have benefits beyond reducing anaemia.

common misperceptionunderestimate the effect Further challenges in the treatment of iron deficiency anaemia lie in the use of standardised haemoglobin cutoffs to define anaemia (12 g/dL for women and 13 g/dL for men). These cutoffs are not always reflective of an appropriate concentration for different populations, but they are used in clinical trials and studies to prompt intervention. To address this issue, in 2016, the WHO began a 5-year project to review these haemoglobin cutoffs with the aim of providing evidence-informed recommendations on assessing anaemia for individuals and wider populations. There have been arguments that these cutoffs should be tailored towards specific populations, accounting for factors such as habitat, altitude, and race. However, having separate thresholds of baseline values that vary by race could validate the common misperception that there are physiological differences between racial groups. Even the differences in the current haemoglobin cutoffs between sexes might underestimate the effect of anaemia in women. Equalisation of male and female laboratory variable thresholds for anaemia and iron deficiency would result in a higher proportion of women diagnosed and appropriately treated.

As 2030 draws closer, it is clear that much work still remains. The basic act of defining anaemia remains under debate, and current interventions are not making enough progress. Given that iron deficiency anaemia disproportionally affects LMICs, anaemia reduction can help drive progress towards the other global nutrition targets, which in turn help to improve breastfeeding rates, reduce low birthweight for newborns, and help guard against stunting and wasting in children. Although the original 2012 plans laid out a multisectoral approach to the reduction of anaemia, involving strengthening health systems and community support, substantial challenges remain to alleviate this burden.

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