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

Abstract

Anemia is a major public health concern. Young children, menstruating adolescent girls and women, and pregnant women are among the most vulnerable. Anemia is the consequence of a wide range of causes, including biological, socioeconomic, and ecological risk factors. Primary causes include: iron deficiency; inherited red blood cell disorders; infections, such as soil‐transmitted helminthiasis, schistosomiasis, and malaria; gynecological and obstetric conditions; and other chronic diseases that lead to blood loss, decreased erythropoiesis, or destruction of erythrocytes. The most vulnerable population groups in low‐ and middle‐income countries are often at the greatest risk to suffer from several of these causes simultaneously as low socioeconomic status is linked with an increased risk of anemia through multiple pathways. Targeted and effective action is needed to prevent anemia. Understanding the causes and risk factors of anemia for different population subgroups within a country guides the design and implementation of effective strategies to prevent and treat anemia. A coordinated approach across various expert groups and programs could make the best use of existing data or could help to determine when newer and more relevant data may need to be collected, especially in countries with a high anemia burden and limited information on the etiology of anemia.

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

“…10,[28][29][30] These issues and the associated data gaps are discussed in detail in the input paper on anemia determinants. 11 Tools and guidelines have been developed to support national and district-level landscape analysis and the development of contextualized, multisectoral anemia control strategies, although some tools were developed more than a decade ago and may require updating. 5,31,32 Experiences using these tools in several countries with support from SPRING showed the value of the anemia landscaping process as a means to increase engagement and communication across sectors, contributing to the formation of coordination mechanisms as well as the development of national anemia strategies.…”

“…(i) nutritional factors, notably iron deficiency as well as deficiencies in folate, vitamin A, and other micronutrients; (ii) inflammation and infection, including malaria, intestinal parasites, HIV, and tuberculosis; (iii) inherited blood disorders, such as hemoglobinopathies, sickle cell trait, and glucose-6-phosphate dehydrogenase (G6PD) deficiency; and (iv) women's reproductive biology, including menstruation, hemodilution during pregnancy, and postpartum hemorrhage. 2,10 Current knowledge and issues regarding the causes and contributing factors of anemia are discussed in detail in a separate paper in this series of input papers, 11 which have been developed in support of the Comprehensive framework for integrated action on the prevention, diagnosis and management of anemia led by the World Health Organization (WHO). The aim of the present paper is to provide a broad overview of the state of country programs to address the burden of anemia across the life course, as well as common challenges and opportunities to strengthen integration and coordination for improved outcomes.…”

Comprehensive framework for integrated action on the prevention, diagnosis, and management of anemia: An introduction

“…Background papers were developed on four priority topics to help inform the framework: causes and risk factors of anemia; diagnosis of anemia and its underlying causes; preventive and therapeutic interventions; and the integrated management of anemia. The four papers are published in a special virtual issue of Annals of the New York Academy of Sciences 1,5–8 . Each paper summarizes the existing literature on the topic and contains perspectives that will be essential for driving country impact and activities that are actionable for reducing anemia within a multisectoral approach.…”

“…The first paper of the special issue 5 reviews the main determinants of anemia. Anemia has complex etiology and is the consequence of a wide range of causes and biological, socioeconomic, and ecological risk factors.…”

“…The third paper 7 examines the preventive and therapeutic interventions for impact. As the causes and risk factors for anemia are complex and diverse, interventions to address anemia will need to be equally diverse and based on the specific underlying disease and its pathophysiology at individual and population levels 5,7 . A range of interventions have been shown to be effective for improving hemoglobin and reducing anemia by addressing determinants related to nutrition, infection, and reproductive health (Table 1).…”