A systematic analysis of global anemia burden from 1990 to 2010

To what extent classic socio-economic determinants explain trends of anaemia in tribal and non-tribal women of reproductive age in India? Findings from four National Family Heath Surveys (1998-2021)

BACKGROUND

Despite unprecedented socio-economic growth experienced by Indians in the past few decades, and a long history of anti-anaemia public health measures, prevalence of anaemia in Indian non-pregnant women of reproductive age group (NPWRA) has not declined. This warrants a firm understanding of what explains the anaemia situation over time, preferably by sub-populations. Therefore, we aimed to examine the trends of anaemia in tribal NPWRA (least privileged) and compare with the trends in the NPWRA of general caste (most privileged) between 1998 to 2021. Additionally, the study also explored explanation of any decline and tribal/general narrowing of these trends.

METHODS

We studied four rounds of National Family Health Survey (1998-99, 2005-06, 2015-16, 2019-21). We examined the trend of anaemia (haemoglobin < 12 g/dl) and its possible determinants in tribal and general NPWRA and estimated the portion of "decline" and "narrowing" that could be explained by the underlying and intermediate determinants (wealth, education, residence, parity and food security) using multiple logistic regression.

RESULTS

The distribution of determinants improved over 23 years in both the groups but more in tribals. But anaemia either remained unchanged or increased in both except 7.1 points decline in tribals between 2006-2016, leading also to 7 points narrowing of tribal/general gap. The modest attenuation of beta coefficients representing the change of anaemia prevalence (log of odds) in tribals from -0.314(-0.377, -0.251) to -0.242(-0.308, -0.176) after adjustment with determinants could explain only 23% of the decline. Similarly, only 7% of the narrowing of the tribal/general anaemia gap could be explained.

CONCLUSIONS

The structural determinants wealth, education, food security, parity and urban amenities improved immensely in India but anaemia did not decline in this 23-year period. This implies that the "usual suspects" - the structural determinants are not the main drivers of anaemia in the country. The main driver may be absolute and/or functional deficiency status of micronutrients including iron attributable to inadequate uptake and absorption of these elements from Indian diets; and therefore, their effects are noticeable in every socio-economic stratum of India. Future research for aetiologies and new interventions for anaemia alleviation in India may focus on these factors.

Perceptions and practices of urban slum-dwelling women concerning soil-transmitted helminths infections in Bangladesh: A cross-sectional study

Introduction

Soil-transmitted helminths (STH) infections are still attributed to a significant part of mortality and disabilities in developing nations. This study aimed at exploring the perceptions and practices concerning STH and to assess the associated risk of infections among slum-dwelling women of Dhaka South City Corporations (DSCC), Bangladesh.

Materials and methods

A cross-sectional study was conducted in two selected slums (Malibagh and Lalbagh) of DSCC, Bangladesh, from September 2020 to February 2021. A total of 206 women participants were requested to provide stool samples, followed by a semi-structured questionnaire survey. Parasitological assessment was done by the formol-ether concentration (FEC) technique. Data were analyzed using descriptive statistics, and p-value < 0.05 was considered as statistically significant. An adjusted odds ratio (AOR) with a 95% confidence interval (95% CI) was estimated using logistic regression analysis to examine the association between explanatory and outcome factors.

Results

In total, 36 (17.5%) STH infections were observed out of 206 examined participants. Among the STH, Trichuris trichiura showed the highest prevalence (10.7%), followed by Ascaris lumbricoides (5.3%). Lack of formal education, overcrowded living, large family sizes, and using shared toilets were significantly associated with STH infections. Irregular nail cutting (AOR = 3.12), irregular soap usage after toilet (AOR = 2.98), wearing no shoes (AOR = 4.64), and failing to teach kids to wash their hands (AOR = 3.87) were revealed as practice concerns linked to high STH prevalence. Women, who had never heard about STH (AOR = 2.42) and had no misconceptions regarding STH (AOR = 1.94) were positively related to STH infection in this study.

Conclusion

Slum-dwelling women in Bangladesh still had a substantial infection of STH. Most of the communities under study were unaware of parasite infection and its negative effects on health. Revision of the policy of ongoing anthelmintic distribution programs and widespread health education programs are recommended aimed at controlling STH.

Erythrocyte pyruvate kinase activation in red cell disorders

PURPOSE OF REVIEW

In red cells, pyruvate kinase is a key enzyme in the final step of glycolytic degradative process, which generates a constant energy supply via ATP production. This commentary discusses recent findings on pyruvate kinase activators as new therapeutic option in hereditary red cell disorders such as thalassemic syndromes or sickle cell disease (SCD).

RECENT FINDINGS

Mitapivat and etavopivat are two oral pyruvate kinase activators. Studies in a mouse model for β thalassemia have shown beneficial effects of mitapivat on both red cell survival and ineffective erythropoiesis, with an amelioration of iron homeostasis. This was confirmed in a proof-of-concept study in patients with nontransfusion-dependent thalassemias. Both mitapivat and etavopivat have been evaluated in mouse models for SCD, showing an increased 2-3DPG/ATP ratio and a reduction in haemolysis as well as in sickling. These data were confirmed in proof-of-concept clinical studies with both molecules carried in patients with SCD.

SUMMARY

Preclinical and clinical evidence indicate that pyruvate kinase activators represent new therapeutic option in hemoglobinopathies or SCD. Other red cell disorders such as hereditary spherocytosis or hereditary anaemias characterized by defective erythropoiesis might represent additional areas to investigate the therapeutic impact of pyruvate kinase activators.

Peripapillary nerve fiber layer in patients with iron deficiency anemia: A cross-sectional study in a tertiary eye care center in Central India

AIMS

The aim of this study is to evaluate the effect of iron-deficiency anemia (IDA) on peripapillary retinal nerve fiber layer (RNFL) thickness using spectral-domain optical coherence tomography (SD-OCT).

SETTINGS

The study was conducted at tertiary eye care center in Central India.

DESIGN

This study was a prospective, cross-sectional, case-control, and observational study.

MATERIALS AND METHODS

In the present study, 58 eyes of patients with IDA were compared with 58 eyes of healthy individuals. All individuals underwent a thorough hematological, clinical, and ophthalmic examination, followed by peripapillary RNFL analysis using SD-OCT.

RESULTS

A total of 116 eyes were included in the study. The average RNFL thickness (RNFLT) in the cases was 97.26 ± 5.96, and 102.32 ± 6.26 (P = 0.005) in controls. There was a significant RNFL loss in the temporal (66.76 ± 6.1, P = 0.02), superior (119.66 ± 10.47, P = 0.01), nasal (73.59 ± 9.52, P = 0.003), and inferior (129.05 ± 10.96, P = 0.001) quadrants in the cases and controls. Serum hemoglobin, iron, ferritin, total iron-binding capacity, and transferrin saturation were lower in the cases (P < 0.05). A positive correlation was observed between average RNFLT and hemoglobin (r = 0.321), iron (r = 0.122), ferritin (r = 0.152), and transferrin (r = 0.190) levels.

CONCLUSIONS

In patients with IDA, RNFLT was decreased in all quadrants compared to normal healthy individuals. The inferior and nasal RNFL showed a significant decrease in thickness. The presence of myopia, glaucoma, and diabetic and hypertensive retinopathy can exert an additive effect in the thinning of RNFLs and cause significant visual loss; hence, the correction of anemia is essential. There is a pressing need to raise public and health professional awareness of these problems and their prevention, diagnosis, and management.

Comparison of Two Methods of Capillary Sampling in Blood Pre-Donation Anemia Screening in Brazil

BACKGROUND

The laboratory tests most used by blood banks to diagnose anemia are the hemoglobin (Hb) and microhematocrit (Hct) tests, measured from capillary samples.

OBJECTIVE

To analyze the two capillary screening methods for pre-donation anemia by comparing their agreement in diagnosing anemia.

METHOD

A cross-sectional study in a population of 15,521 blood donation candidates for whom information was available on Hb and Hct, performed from capillary blood samples. Hb was determined using the HemoCue^® test and Hct by the centrifugation method. The Kappa coefficient was calculated to assess the agreement between the methods. Pearson's correlation tests and gender-adjusted linear regression were used to assess the change in the response variable (Hb) as a function of the explanatory variable (Hct).

RESULTS

The majority of the study population were men (70.4%), aged between 18 and 44 years (72.1%), who declared themselves white or mixed skin color (85.6%), and had undergone at least 11 years of complete education (72.4%). The Kappa coefficient found was 92.7 and 99.2 for women and men, respectively. Pearson's correlation showed a correlation coefficient of 0.98 and the linear regression graph showed an adequate relationship between the tests with R² = 0.97.

CONCLUSIONS

Comparing the Hb and Hct capillary tests, it was found that Hct can be safely used to screen for anemia in pre-blood donation.

Applications of Artificial Intelligence in Thalassemia: A Comprehensive Review

Thalassemia is an autosomal recessive genetic disorder that affects the beta or alpha subunits of the hemoglobin structure. Thalassemia is classified as a hypochromic microcytic anemia and a definitive diagnosis of thalassemia is made by genetic testing of the alpha and beta genes. Thalassemia carries similar features to the other diseases that lead to microcytic hypochromic anemia, particularly iron deficiency anemia (IDA). Therefore, distinguishing between thalassemia and other causes of microcytic anemia is important to help in the treatment of the patients. Different indices and algorithms are used based on the complete blood count (CBC) parameters to diagnose thalassemia. In this article, we review how effective artificial intelligence is in aiding in the diagnosis and classification of thalassemia.

Prevalence and types of anemia among people with tuberculosis in Africa: a systematic review and meta-analysis

Globally, tuberculosis (TB) and anemia are public health problems related with high morbidity and mortality. Furthermore, anemia is frequently manifested among people with TB in Africa, prevalence ranging from 25 to 99%. The presence of anemia is associated with an increase in individuals' susceptibility to TB and poor treatment outcomes. Studies have reported heterogeneous estimate of prevalence of anemia among people with TB in Africa. This review aimed to estimate the prevalence of anemia among newly diagnosed people with TB n Africa. We searched studies in Medline/PubMed, Cochrane library, ScienceDirect, JBI database, the Web of Science, Google Scholar, WorldCat, Open Grey, Scopus, Agency for Healthcare Research and Quality, ProQuest, and African Journals Online that reported the prevalence of anemia at TB diagnosis. Two reviewers performed data extraction with pre-defined inclusion criteria. A random-effects logistic regression model was used to pool the prevalence of anemia and levels of anemia with a 95% confidence interval (CI) in STATA version 14. Heterogeneity and publication biases were explored. A total of 1408 studies were initially identified, and seventeen studies with 4555 people with TB were included in the analysis. The prevalence of anemia among people with TB in Africa was 69% (95% CI 60.57-77.51). The pooled prevalence of anemia of chronic disease was 48% (95% CI 13.31-82.75) and normocytic normochromic anemia was 32% (95% CI 13.74-50.94) while mild anemia was 34% (95% CI 20.44-46.86). Females were more anemic than males at TB diagnosis in Africa (74% vs. 66%). The finding indicates that anemia is a common co-morbidity present among people with TB, especially among females. Mild anemia and normocytic normochromic anemia were more common at TB diagnosis. The finding indicates that anemia is a common co-morbidity present among people with TB in Africa region. Hence, it is recommended to instigate a routine anemia screening at TB diagnosis to improve treatment outcomes.

Haemoglobin levels and outcomes of subgroups of patients with pre-operative anaemia based on red cell size: A retrospective cohort study

BACKGROUND

Pre-operative anaemia is common and associated with adverse outcomes. We hypothesised that pre-operative anaemia would be evident more than 1 month pre-operatively, and that peri-operative changes in haemoglobin and post-operative outcomes differed between red cell size-based subsets of anaemia.

METHODS

A retrospective single-centre cohort study, including all patients 18 years and older undergoing their first surgery at Landspitali between January 2006 and December 2018 with available measurement of haemoglobin (Hb) within 30 days preceding surgery. Clinical data were compared between patients with subgroups of anaemia classified by mean corpuscular volume (MCV) into microcytic (MCV < 80 fl), normocytic (MCV 80-100 fl), and macrocytic (MCV > 100 fl) anaemia. The development of haemoglobin measurements from a nationwide database was plotted from 1 year pre-operatively to 2 years post-operatively.

RESULTS

Of 40,979 patients, 10,505 (25.6%) had pre-operative anaemia, of which 1089 (10.4%) had microcytic anaemia, 9243 (88.0%) had normocytic anaemia, and 173 (1.6%) had macrocytic anaemia. Patients within all subgroups of pre-operative anaemia had a higher degree of comorbidity and frailty burden and a low haemoglobin evident for more than 100 days pre-operatively and similar changes post-operatively. Post-operative prolonged recovery of haemoglobin was slower for macrocytic anaemia than other types of anaemia. All groups of patients with anaemia had a higher incidence of 30-day mortality, acute kidney injury, and rate of readmission compared with patients without anaemia.

CONCLUSIONS

Pre-operative anaemia is evident long prior to the procedure and its association with worse outcomes is similar regardless of red cell size.

Iron deficiency in sepsis patients managed with divided doses of iron dextran: a prospective cohort study

Iron deficiency (ID) impairs hemoglobin (Hb) synthesis and immune function, both crucial for sepsis patients. We assessed the impact of iron dextran on reticulocyte (Ret) Hb equivalent (Ret-He) and Ret subpopulations in iron-deficient sepsis patients. In this prospective clinical study we enrolled patients with sepsis or septic shock with procalcitonin concentration > 0.5 ng/mL, diagnosed with ID based on Ret-He. Study subjects received divided doses of iron dextran until normalization of Ret-He. The study population included 35 subjects. The median Ret-He increase after 2 doses of iron dextran was 3.0 (IQR 1.9-6.1) pg (p < 0.01) with median time to normalization 4 (IQR 3-5) days. Although no change in Ret percentage [Me 1.5 (IQR 1.1-2.1) vs. Me 1.4 (IQR 1.1-2.4) %, p = 0.39] and number [Me 0.05 (IQR 0.04-0.07) vs. Me 0.05 (IQR 0.03-0.06) 10⁶/µL, p = 0.88] was noted, Ret subpopulations changed significantly (p for all < 0.01). Divided doses of iron dextran relatively quickly normalize Ret-He in iron-deficient sepsis patients. Changes in Ret subpopulations suggest increased erythropoietic activity. Further research is needed to explore the role of intravenous iron in this clinical setting.

Determinants of anaemia among women of reproductive age in South Africa: A Healthy Life Trajectories Initiative (HeLTI)

Anaemia continues to be a persistent concern among South African women of reproductive age (WRA), yet population specific information on its determinants remains sparse. We used baseline data from the Healthy Lives Trajectory Initiative a randomised trial (n = 480) to quantify factors associated with anaemia in Soweto, South Africa aged 18-25 years. We used multivariable logistic regression to describe associations with anaemia and used structural equation modelling to assess a theoretical model, which tested three categories socioeconomic status (household asset score, education level), nutritional factors (food security, leafy green vegetable and chicken and beef consumption, iron status and vitamin A status) and biodemographic factors (parity, age at start of menarche, HIV status, contraception use, anthropometry, and inflammation status). The multiple logistic regression showed that ID (OR: 2.62, 95% CI: 1.72, 3.98), iron deficiency erythropoiesis (IDE) (OR: 1.62, 95% CI: 1.07, 2.46), and elevated CRP (OR: 1.69, 95% CI: 1.04, 2.76), increased the odds of being anaemic. SEM analysis revealed Hb was directly and positively associated with adjusted ferritin (0.0031 per mg/dL; p≤0.001), and CRP (0.015 per mg/dL; p≤0.05), and directly and negatively associated with soluble transferrin receptor sTfR (-0.042 per mg/dL; p≤0.001). While contraception use had both a direct (0.34; p≤0.05) and indirect (0.11; p≤0.01) positive association with Hb. Additionally, chicken and beef consumption had a positive indirect association with Hb concentrations (0.15; p≤0.05) through adjusted ferritin. Iron deficiency was the main anaemia risk factor in this low resource setting. However, anaemia of inflammation is present. Therefore, we suggest that in our setting, WRA anaemia control programs that include interventions to reduce ID and inflammation should be tested.

Prevalence and Risk Factors of Anaemia among Orang Asli Children in Malaysia: A Scoping Review

BACKGROUND

Anaemia continues to be a global public health burden affecting all age groups, particularly children. Indigenous people, including the Orang Asli (OA) population in Malaysia, are at risk of anaemia due to the vast disparities in social determinants of health in their population compared to the non-indigenous population.

OBJECTIVES

This review aimed to identify the prevalence and risk factors of anaemia among OA children in Malaysia and analyse the knowledge gaps.

METHODS

A systematic search was conducted in PubMed, Cochrane Library, Scopus and Google Scholar databases. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.

RESULTS

This review identified six studies involving the participation of OA children from eight subtribes residing in Peninsular Malaysia. The overall prevalence of anaemia among OA children ranged from 21.6 to 80.0%, with iron deficiency anaemia prevalence at 34.0%. The risk factors of anaemia among OA children reported from one study in this review were being younger than ten years old children (AOR 2.11 (95% CI 1.23, 3.63)) and moderate to heavy Ascaris infections (AOR 2.05 (95% CI 1.12, 3.76)). There was no data from OA children from certain age groups and subtribes. Additionally, there is a paucity of data on risk factors for anaemia among OA children from the currently available evidence.

CONCLUSION

The prevalence of anaemia among OA children poses a moderate to severe public health concern. Therefore, more comprehensive studies in the future are needed to address the gaps identified in this review, primarily regarding anaemia risk factors. This data would encourage policymakers in devising effective national prevention strategies to improve morbidity and mortality among OA children in the future.

Determinants of anemia severity levels among children aged 6-59 months in Ethiopia: Multilevel Bayesian statistical approach

Anemia is a widespread public health problem that affects all stages of life particularly preschool children and pregnant mothers. Anemia among children had significant impact on their growth, development, school performance and mortality. Different strategies like deworming of young children, vitamin A supplementation for children aged 6-59 months, and ferrous sulphate supplementation and provision of insecticide treated bed net for pregnant women were designed to control and prevent anemia. Also, previous studies on anemia factors were conducted but they were not considering the ordered nature of anemia. Therefore, this study aimed to identify the factors of anemia severity levels among children aged 6-59 months in Ethiopia by using ordinal analysis based on Bayesian hierarchical statistical approach. A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 8483 weighted children were included. Due to the ordered nature of the anemia and nested nature of DHS data, ordinal logistic regression model based on hierarchical Bayesian statistical approach was employed to identify the determinants of anemia severity levels. In this study, moderate anemia level was found to be the commonest type which accounts around 29.4%. Female children, poorer, middle, and richest wealth index, primary maternal education and having ANC visit had lower risk of having higher order of anemia. Moderate maternal anemia and stunted children had higher chance of having higher order of anemia. Children age had significant different effect on mild and moderate anemia. Meanwhile, multiple birth/s and deworming had effect on moderate anemia. In addition, normal birth weight had also significant and different effect on mild and severe anemia and history of feverlike illness on mild anemia. The prevalence of anemia among children aged 6-59 months anemia was found to be a severe public health problem. Children age, sex, maternal education, child stunting, history of fever, multiple birth, birth weight, provision of deworming and maternal anemia was found to be the most important factors for child anemia severity levels. Therefore, intervention efforts to control and prevent anemia in Ethiopia requires targeting of these hindering factors.

Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions

Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.

Magnetic resonance imaging of organ iron before and after correction of iron deficiency in patients with heart failure

AIMS

Intravenous iron therapy (IVIT) is known to improve functional status in chronic heart failure (CHF) patients. The exact mechanism is not completely understood. We correlated magnetic resonance imaging (MRI) patterns of T2* iron signal in various organs to systemic iron and exercise capacity (EC) in CHF before and after IVIT.

METHODS AND RESULTS

We prospectively analysed 24 patients with systolic CHF for T2* MRI pattern of the left ventricle (LV), small and large intestines, spleen, liver, skeletal muscle, and brain for iron. In 12 patients with iron deficiency (ID), we restored iron deficit by IVIT using ferric carboxymaltose. The effects after 3 months were analysed by spiroergometry and MRI. Patients with vs. without ID showed lower blood ferritin, haemoglobin (76 ± 63 vs. 196 ± 82 μg/L and 12.3 ± 1.1 vs. 14.2 ± 1.1 g/dL, all P < 0.002), and in trend a lower transferrin saturation (TSAT) (19.1 [13.1; 28.2] vs. 25.1 [21.3; 29.1] %, P = 0.05). Spleen and liver iron was lower as expressed by higher T2* value (71.8 [66.4; 93.1] vs. 36.9 [32.9; 51.7] ms, P < 0.002 and 33.5 ± 5.9 vs. 28.8 ± 3.9 ms, and P < 0.03). There was a strong trend for a lower cardiac septal iron content in ID (40.6 [33.0; 57.3] vs. 33.7 [31.3; 40.2] ms, P = 0.07). After IVIT, ferritin, TSAT, and haemoglobin increased (54 [30; 104] vs. 235 [185; 339] μg/L, 19.1 [13.1; 28.2] vs. 25.0 [21.0; 33.7] %, 12.3 ± 1.1 vs. 13.3 ± 1.3 g/L, all P < 0.04). Peak VO₂ improved (18.2 ± 4.2 vs. 20.9 ± 3.8 mL/min/kg^-1 , P = 0.05). Higher peak VO₂ at anaerobic threshold was associated with higher blood ferritin, reflecting higher metabolic exercise capacity after therapy (r = 0.9, P = 0.0009). Increase in EC was associated with haemoglobin increase (r = 0.7, P = 0.034). LV iron increased by 25.4% (48.5 [36.2; 64.8] vs. 36.2 [32.9; 41.9] ms, P < 0.04). Spleen and liver iron increased by 46.4 and 18.2%, respectively (71.8 [66.4; 93.1] vs. 38.5 [22.4; 76.9] ms, P < 0.04 and 33.5 ± 5.9 vs. 27.4 ± 8.6 ms, P < 0.007). Iron in skeletal muscle, brain, intestine, and bone marrow remained unchanged (29.6 [28.6; 31.2] vs. 30.4 [29.7; 30.7] ms, P = 0.7, 81.0 ± 6.3 vs. 82.9 ± 9.9 ms, P = 0.6, 34.3 ± 21.4 vs. 25.3 ± 14.1 ms, P = 0.2, 9.4 [7.5; 21.8] vs. 10.3 [6.7; 15.7] ms, P = 0.5 and 9.8 ± 1.5 vs. 13.7 ± 8.9 ms, P = 0.1).

CONCLUSIONS

CHF patients with ID showed lower spleen, liver, and in trend lower cardiac septal iron. After IVIT, iron signal of the left ventricle as well as spleen and liver increased. Improvement in EC was associated with increase in haemoglobin after IVIT. In ID, liver, spleen, and brain but not heart iron were associated with markers of systemic ID.

Using Capillary Whole Blood to Quantitatively Measure Ferritin: A Validation Trial of a Point-of-Care System

Iron deficiency is a public health problem with devastating health, developmental and behavioral effects which often exacerbated due to affordability and access to screening and diagnosis. Using IronScan™ a portable, point-of-care diagnostic system capable of quantitatively measuring ferritin in blood, we validated IronScan™ ferritin measurements using whole blood and serum with a lab-based, regulator-approved analytical device for measuring ferritin in venous serum. Capillary (finger stick) and venous whole blood samples were obtained from 44 male and female volunteers. Venous serum (vSer) ferritin concentrations were measured on Immulite 2000 Xpi (gold standard). Capillary whole blood (cWB), venous whole blood (vWB), and vSer ferritin levels were measured by IronScan™. cWB ferritin concentrations from IronScan™ were significantly correlated (R2 = 0.86) with vSer measured with the FDA-approved Immulite system. The results from the multiple regression analysis indicate that 10% of the variability was due to the method of blood collection (venous vs. capillary) and 6% was due to the form of blood analysis (whole blood vs. serum). The sensitivity of diagnosing iron deficiency using the WHO cutoff of <30 ng/mL is 90%, with a specificity of 96%. In conclusion, IronScan™ is a rapid viable option for measuring ferritin as a point-of-care system.

Tissue iron distribution in patients with anemia of inflammation: Results of a pilot study

Anemia of inflammation (AI) is frequently present in subjects with inflammatory disorders, primarily caused by inflammation-driven iron retention in macrophages. So far, only limited data on qualitative and quantitative estimates of tissue iron retention in AI patients exist. We performed a prospective cohort study analyzing splenic, hepatic, pancreatic, and cardiac iron content with MRI-based R2*-relaxometry in AI patients, including subjects with concomitant true iron deficiency (AI+IDA) hospitalized between 05/2020-01/2022. Control groups were individuals without inflammation. Spleen R2* values in AI patients with ferritin ≤200 μg/L (AI+IDA) were comparable with those found in controls. In AI patients with ferritin >200 μg/L, spleen (47.6 s^-1 vs. 19.3 s^-1 , p < .001) and pancreatic R2* values (32.5 s^-1 vs. 24.9 s^-1 , p = .011) were significantly higher compared with controls, while liver and heart R2*-values did not differ. Higher spleen R2* values were associated with higher ferritin, hepcidin, CRP, and IL-6 concentrations. Spleen R2* values normalized in AI patients after recovery (23.6 s^-1 vs. 47.6 s^-1 , p = .008), while no changes were found in patients with baseline AI+IDA. This is the first study investigating tissue iron distribution in patients with inflammatory anemia and AI with concomitant true iron deficiency. The results support the findings in animal models demonstrating iron retention in macrophages, which are primarily accumulating in the spleen under inflammatory conditions. MRI-related iron measurement may help to better characterize actual iron needs and to define better biomarker thresholds in the diagnosis of true ID in patients with AI. It may qualify as a useful diagnostic method to estimate the need for iron supplementation and to guide therapy.

Genetic and genomic interventions in crop biofortification: Examples in millets

Micronutrient malnutrition is a serious threat to the developing world's human population, which largely relies on a cereal-based diet that lacks diversity and micronutrients. Besides major cereals, millets represent the key sources of energy, protein, vitamins, and minerals for people residing in the dryland tropics and drought-prone areas of South Asia and sub-Saharan Africa. Millets serve as multi-purpose crops with several salient traits including tolerance to abiotic stresses, adaptation to diverse agro-ecologies, higher productivity in nutrient-poor soils, and rich nutritional characteristics. Considering the potential of millets in empowering smallholder farmers, adapting to changing climate, and transforming agrifood systems, the year 2023 has been declared by the United Nations as the International Year of Millets. In this review, we highlight recent genetic and genomic innovations that can be explored to enhance grain micronutrient density in millets. We summarize the advances made in high-throughput phenotyping to accurately measure grain micronutrient content in cereals. We shed light on genetic diversity in millet germplasm collections existing globally that can be exploited for developing nutrient-dense and high-yielding varieties to address food and nutritional security. Furthermore, we describe the progress made in the fields of genomics, proteomics, metabolomics, and phenomics with an emphasis on enhancing the grain nutritional content for designing competitive biofortified varieties for the future. Considering the close genetic-relatedness within cereals, upcoming research should focus on identifying the genetic and genomic basis of nutritional traits in millets and introgressing them into major cereals through integrated omics approaches. Recent breakthroughs in the genome editing toolbox would be crucial for mainstreaming biofortification in millets.

Predictors of Incidence and Remission of Anemia among Never-Married Adolescents Aged 10-19 Years: A Population-Based Prospective Longitudinal Study in India

Background

Dynamics of the anemia burden among Indian adolescents are poorly understood because of a lack of population-based longitudinal data.

Objectives

To examine the burden of anemia among never-married adolescents aged 10-19 y from the states of Bihar and Uttar Pradesh, India, and a wide range of predictors of its incidence and remission.

Methods

A sample of 3279 adolescents (male: 1787 and female: 1492) aged 10-19 y were included from baseline (2015-2016) and follow-up (2018-2019) surveys of the UDAYA (Understanding the Lives of Adolescents and Young Adults) project in India. In 2018-2019, all new cases of anemia were considered as incidence, whereas a return to the nonanemic status from being anemic in 2015-2016 was considered remission. Univariate and multivariable modified Poisson regression models with robust error variance were deployed to attain the study objective.

Results

The crude prevalence of anemia among males decreased from 33.9% (95% CI: 30.7%-37.3%) in 2015-2016 to 31.6% (95% CI: 28.6%-34.7%) in 2018-2019 but increased among females from 57.7% (95% CI: 53.5%-61.7%) in 2015-2016 to 63.8% (95% CI: 59.9%-67.5%) in 2018-2019. Anemia incidence was estimated to be 33.7% (95% CI: 30.3%-37.2%), whereas nearly 38.5% (95% CI: 35.1%-42.1%) of adolescents experienced remission of anemia. Older adolescents (aged 15-19 y) were less likely to experience anemia incidence. Consumption of eggs daily or weekly was negatively associated with anemia incidence compared with occasional or never consumption. Females had a higher risk of experiencing an incidence of anemia and decreased risk of experiencing anemia remission. The likelihood of adolescents experiencing anemia increased with an increased patient health questionnaire score. Household size was also associated with an increased risk of anemia incidence.

Conclusions

Interventions that are sensitive to socio-demographic factors and encouraging access to mental health services and nutritious food consumption could be helpful in further anemia mitigation.

Importance of assessing biomarkers and physiological parameters of anemia-induced tissue hypoxia in the perioperative period

Anemia is associated with increased risk of Acute Kidney Injury (AKI), stroke and mortality in perioperative patients. We sought to understand the mechanism(s) by assessing the integrative physiological responses to anemia (kidney, brain), the degrees of anemia-induced tissue hypoxia, and associated biomarkers and physiological parameters. Experimental measurements demonstrate a linear relationship between blood Oxygen Content (C_aO₂) and renal microvascular PO₂ (y = 0.30x + 6.9, r² = 0.75), demonstrating that renal hypoxia is proportional to the degree of anemia. This defines the kidney as a potential oxygen sensor during anemia. Further evidence of renal oxygen sensing is demonstrated by proportional increase in serum Erythropoietin (EPO) during anemia (y = 93.806*10^-0.02, r² = 0.82). This data implicates systemic EPO levels as a biomarker of anemia-induced renal tissue hypoxia. By contrast, cerebral Oxygen Delivery (DO₂) is defended by a profound proportional increase in Cerebral Blood Flow (CBF), minimizing tissue hypoxia in the brain, until more severe levels of anemia occur. We hypothesize that the kidney experiences profound early anemia-induced tissue hypoxia which contributes to adaptive mechanisms to preserve cerebral perfusion. At severe levels of anemia, renal hypoxia intensifies, and cerebral hypoxia occurs, possibly contributing to the mechanism(s) of AKI and stroke when adaptive mechanisms to preserve organ perfusion are overwhelmed. Clinical methods to detect renal tissue hypoxia (an early warning signal) and cerebral hypoxia (a later consequence of severe anemia) may inform clinical practice and support the assessment of clinical biomarkers (i.e., EPO) and physiological parameters (i.e., urinary PO₂) of anemia-induced tissue hypoxia. This information may direct targeted treatment strategies to prevent adverse outcomes associated with anemia.

A Randomized Trial of Quadruple-Fortified Salt for Anemia and Birth Defects Prevention in Southern India: Protocol Design and Methods

Background

Women of reproductive age are at an increased risk of anemia and micronutrient deficiencies. Evidence supports the role of periconceptional nutrition in the development of neural tube defects (NTDs) and other pregnancy complications. Vitamin B12 deficiency is a risk factor for NTDs and may modify folate biomarkers that predict NTD risk at the population level. There is an interest in mandatory fortification with vitamin B12 and folic acid for anemia and birth defect prevention. However, there are limited population-representative data needed to inform policy and guidelines.

Objectives

This randomized trial will be conducted to evaluate the efficacy of quadruple-fortified salt (QFS; iron, iodine, folic acid, vitamin B12) in 1,000 households in Southern India.

Methods

Women 18 to 49 y who are not pregnant or lactating and reside within the catchment area of our community-based research site in Southern India will be screened and invited to participate in the trial. After informed consent, women and their households will be randomized to receive one of the following 4 interventions: 1) double-fortified salt (DFS; iron, iodine), 2) DFS + folic acid (iron, iodine, folic acid), 3) DFS + vitamin B12 (iron, iodine, vitamin B12), or 4) DFS + folic acid and vitamin B12 (QFS; iron, iodine, folic acid, vitamin B12) for 12 mo. Structured interviews will be conducted by trained nurse enumerators to collect sociodemographic, anthropometric, dietary, health, and reproductive history data. Biological samples will be collected at baseline, midpoint, and endpoint. Whole blood will be analyzed for hemoglobin using Coulter Counter. Total vitamin B12 will be measured by chemiluminescence; red blood cell folate and serum folate will be evaluated using the World Health Organization-recommended microbiologic assay.

Conclusions

The results of this randomized trial will help to evaluate the efficacy of QFS to prevent anemia and micronutrient deficiencies. Clinical trial registration numbers: NCT03853304 and Clinical Trial Registry of India REF/2019/03/024479.

Registration number

NCT03853304 and REF/2019/03/024479.

Evaluation of the use of non-invasive hemoglobin measurement in early childhood

BACKGROUND

Iron deficiency anemia in children affects psychomotor development. We compared the accuracy and trend of a non-invasive transcutaneous spectrophotometric estimation of arterial hemoglobin (Hb) concentration (SpHb) by rainbow pulse CO-oximetry technology to the invasive blood Hb concentration measured by an automated clinical analyzer (Hb-Lab).

METHODS

We measured the SpHb and Hb-Lab in 109 patients aged 1-5 years. Regression analysis was used to evaluate differences between the two methods. The bias, accuracy, precision, and limits of agreement of SpHb compared with Hb-Lab were calculated using the Bland-Altman method.

RESULTS

Of the 109 enrolled subjects, 102 pairs of the SpHb and Hb-Lab datasets were collected. The average value of measured Hb was 12.9 ± 1.03 (standard deviation [SD]) g/dL for Hb-Lab. A significant correlation was observed between SpHb and Hb-Lab measurements (SpHb = 7.002 + 0.4722 Hb-Lab, correlation coefficient r = 0.548, 95% confidence interval = 0.329-0.615). Bland-Altman analysis showed good visual agreement, with a mean bias between SpHb and Hb-Lab of 0.188 ± 0.919 g/dL (mean ± SD).

CONCLUSIONS

We concluded that non-invasive Hb measurement is useful for Hb estimation in children and provides new insights as a screening tool for anemia.

IMPACT

Our results indicated a good correlation between non-invasive transcutaneous spectrophotometric estimation of arterial hemoglobin (Hb) concentration using a finger probe sensor by rainbow pulse CO-oximetry technology and invasive blood Hb concentration. Although previous studies have indicated that in patients with a worse condition, the bias between the two methods was large, this study, which was conducted on children with stable disease, showed a relatively small bias. Further studies using this non-invasive device might help to understand the current status of anemia in Japan and promote iron intake and nutritional management in children.

Public health supply chain for iron and folic acid supplementation in India: Status, bottlenecks and an agenda for corrective action under Anemia Mukt Bharat strategy

PURPOSE

The IFA supplementation program under the Anemia Mukt Bharat (AMB) program is one of the most ambitious nutrient supplementation programs in India. The delivery of services often suffers due to frequent stock outs and shortages. It is critical to understand the bottleneck in the supply chain adversely affecting the performance and coverage of the program. The paper attempts to identify the bottlenecks of the IFA supply chain in key areas of supply chain i.e., forecasting, procurement, warehousing and inventory management, transportation, distribution, logistic information system and suggests a plan of action aimed at ensuring uninterrupted supplies to the end beneficiaries.

DESIGN/METHODOLOGY/APPROACH

The data source for the present paper is the nationwide IFA Supply Chain Assessment (2018-19) conducted across 29 Indian states with a total of 58 districts, 116 blocks, 232 Sub-Centres, 232 Anganwadi centres and 232 schools covered under the assessment as a multi-partner collaborative initiative. Field insights from supply chain strengthening interventions under different public health programs in India and other developing countries were taken to arrive at corrective actions and recommendations. Findings were disseminated to government and an action plan was suggested for connecting service delivery points through an app-based system, developing a micro plan for ensuring fixed distribution schedule, followed by continuous monitoring and review meetings identified for follow up.

FINDINGS

The average lead time across states was 35 weeks with top three performing states being Goa, Sikkim, and Telangana. The average per unit cost of procurement was Rs 0.35 for IFA Red, Rs 0.25 for IFA Blue, Rs 0.31 for IFA Pink and Rs 7.30 for IFA syrup. Out of the 704 districts in India, only 213 has IFA Red, only 140 had IFA Blue, 152 had IFA Pink and 163 had IFA Syrup available in four quarters of 2018-19. The key issues identified in the assessment were-a lack of standardized forecasting process, absence of inventory management techniques, no fixed distribution schedule, inadequate availability of transport vehicles and an absence of an integrated MIS.

ORIGINALITY/VALUE

The identification of bottlenecks in the IFA supply chain and its impact on the performance of the supply chain would provide policy guidelines for the government as well as development partner agencies to design an effective and efficient supply chain. It would also enable the policy planners to understand the challenges associated with managing different components of a supply chain, their interrelation and impact on the overall performance of the supply chain. The suggested recommendations would equip program managers with the tool to devise and implement field level solutions.

Arsenite Methyltransferase Is an Important Mediator of Hematotoxicity Induced by Arsenic in Drinking Water

Chronic arsenic exposures via the consumption of contaminated drinking water are clearly associated with many deleterious health outcomes, including anemia. Following exposure, trivalent inorganic arsenic (As^III) is methylated through a series of arsenic (+III oxidation state) methyltransferase (As3MT)-dependent reactions, resulting in the production of several intermediates with greater toxicity than the parent inorganic arsenicals. The extent to which inorganic vs. methylated arsenicals contribute to As^III-induced hematotoxicity remains unknown. In this study, the contribution of As3MT-dependent biotransformation to the development of anemia was evaluated in male As3mt-knockout (KO) and wild-type, C57BL/6J, mice following 60-day drinking water exposures to 1 mg/L (ppm) As^III. The evaluation of hematological indicators of anemia revealed significant reductions in red blood cell counts, hemoglobin levels, and hematocrit in As^III-exposed wild-type mice as compared to unexposed controls. No such changes in the blood of As3mt-KO mice were detected. Compared with unexposed controls, the percentages of mature RBCs in the bone marrow and spleen (measured by flow cytometry) were significantly reduced in the bone marrow of As^III-exposed wild-type, but not As3mt-KO mice. This was accompanied by increased levels of mature RBCS in the spleen and elevated levels of circulating erythropoietin in the serum of As^III-exposed wild-type, but not As3mt-KO mice. Taken together, the findings from the present study suggest that As3MT-dependent biotransformation has an essential role in mediating the hematotoxicity of As^III following drinking water exposures.

Association between Anemia Severity and Ischemic Stroke Incidence: A Retrospective Cohort Study

Stroke patients presenting with anemia at the time of stroke onset had a higher risk of mortality and development of other cardiovascular diseases and comorbidities. The association between the severity of anemia and the risk of developing a stroke is still uncertain. This retrospective study aimed to evaluate the association between stroke incidence and anemia severity (by WHO criteria). A total of 71,787 patients were included, of whom 16,708 (23.27%) were identified as anemic and 55,079 patients were anemia-free. Female patients (62.98%) were more likely to have anemia than males (37.02%). The likelihood of having a stroke within eight years after anemia diagnosis was calculated using Cox proportional hazard regression. Patients with moderate anemia had a significant increase in stroke risk compared to the non-anemia group in univariate analyses (hazard ratios [HR] = 2.31, 95% confidence interval [CI], 1.97-2.71, p < 0.001) and in adjusted HRs (adj-HR = 1.20, 95% CI, 1.02-1.43, p = 0.032). The data reveal that patients with severe anemia received more anemia treatment, such as blood transfusion and nutritional supplementation, and maintaining blood homeostasis may be important to preventing stroke. Anemia is an important risk factor, but other risk factors, including diabetes and hyperlipidemia, also affect stroke development. There is a heightened awareness of anemia's severity and the increasing risk of stroke development.

Green synthesis of CQDs for determination of iron and isoniazid in pharmaceutical formulations

Camphor leaves were used as the precursor for the hydrothermal synthesis of carbon quantum dots. The preparation method is simple and rapid, and the raw material is environmentally friendly and easy to obtain. Without additional modification, the carbon quantum dots were used as fluorescent probes for the sensitive and selective detection of Fe³⁺ and isoniazid at different excitation wavelengths. For Fe³⁺, at the excitation wavelength of 320 nm, the ratio of fluorescence intensity of CQD solution after adding Fe³⁺ to CQD solution without Fe³⁺ addition, F/F₀, and Fe³⁺ concentration showed a good linear relationship in the range of 2.72 × 10^-5 to 1.00 × 10^-4 mol L^-1 (R² = 0.9912), and the limit of detection was 8.16 μmol L^-1. For isoniazid, at the excitation wavelength of 270 nm, the ratio of fluorescence intensity of CQDs solution with isoniazid to CQDs solution without isoniazid, F/F₀, and isoniazid concentration showed good linear relationships in the range of 3.81 × 10^-6 to 1.00 × 10^-5 mol L^-1 (R² = 0.9941) and 1.00 × 10^-5 to 2.10 × 10^-4 mol L^-1 (R² = 0.9910) respectively, and the limit of detection was 1.14 μmol L^-1. A fluorescence method for the determination of Fe and isoniazid content was proposed. The method has been used to detect iron in iron supplement tablets and isoniazid in isoniazid tablets with satisfactory results.

Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis

BACKGROUND

South and Southeast Asian countries (SSEA) account for the highest burden of anemia globally, nonetheless, progress towards the decline of anemia has almost been stalled. This study aimed to explore the individual and community- level factors associated with childhood anemia across the six selected SSEA countries.

METHODS

Demographic and Health Surveys of SSEA countries (Bangladesh, Cambodia, India, Maldives, Myanmar, and Nepal) conducted between 2011 and 2016 were analyzed. A total of 167,017 children aged 6-59 months were included in the analysis. Multivariable multilevel logistic regression analysis was used to identify independent predictors of anemia.

RESULTS

The combined prevalence of childhood anemia across six SSEA countries was 57.3% (95% CI: 56.9-57.7%). At the individual level, childhood anemia was significantly higher among (1) mothers with anemia compared to non-anemic mothers (Bangladesh: aOR = 1.66, Cambodia: aOR = 1.56, India: aOR = 1.62, Maldives: aOR = 1.44, Myanmar: aOR = 1.59, and Nepal: aOR = 1.71); (2) children with a history of fever in the last two weeks compared to those without a history of fever (Cambodia: aOR = 1.29, India: aOR = 1.03, Myanmar: aOR = 1.08), and; (3) stunted children compared to those who were not (Bangladesh: aOR = 1.33, Cambodia: aOR = 1.42, India: aOR = 1.29, and Nepal: aOR = 1.27). In terms of community-level factors, children with mothers in communities with a high percentage of community maternal anemia had higher odds of childhood anemia in all countries (Bangladesh: aOR = 1.21, Cambodia: aOR = 1.31, India: aOR = 1.72, Maldives: aOR = 1.35, Myanmar: aOR = 1.33, and Nepal: aOR = 1.72).

CONCLUSION

Children with anemic mothers and stunted growth were found vulnerable to developing childhood anemia. Individual and community-level factors identified in this study can be considered to develop effective anemia control and prevention strategies.

Ready-to-Use Therapeutic Foods Fail to Improve Vitamin A and Iron Status Meaningfully during Treatment for Severe Acute Malnutrition in 6-59-Month-old Cambodian Children

Severe acute malnutrition (SAM) remains a global health concern. Studies on the impact of ready-to-use therapeutic foods (RUTFs) on micronutrient status during SAM treatment are almost nonexistent. The objective was to investigate the impact of RUTFs on the iron and vitamin A status of 6-59-month-old children receiving SAM treatment. Biomarkers of vitamin A status (retinol-binding protein, RBP), iron status (ferritin and soluble transferrin receptor, sTfR), and inflammation (C-reactive protein, CRP, and alpha-1 acid glycoprotein, AGP) were collected at admission and discharge (week 8) during an RUTF effectiveness trial. Vitamin A deficiency was defined as RBP <0.70 µmol/L, low body iron as body iron (BI) <0 mg/kg and deficient iron stores as ferritin <12 µg/L. Data were available for 110 and 75 children at admission and discharge, respectively. There was no significant difference in haemoglobin, ferritin, sTfR, BI or RBP concentrations between admission and discharge. At discharge, BI was 0.2 mg/kg lower, and there was a tendency towards a slightly lower RBP concentration, but the prevalence of vitamin A deficiency was low at admission and discharge (6% and 3%, respectively). The small impact of both RUTFs on improving vitamin A and iron status during SAM treatment calls for further research on the bioavailability of micronutrients to enhance the effectiveness of SAM treatment on micronutrient status.

Anemia Among Women Using Family Planning at Public Health Facilities in Ambo Town, Central Ethiopia: Multi-Center Cross-Sectional Study

Background

Anemia affects more than a quarter of non-pregnant women over the globe, with Sub-Saharan Africa bearing a disproportionate share. Although the use of family planning is beneficial in reducing anemia, lack of scientific study on anemia among family planning users of reproductive-age women is notable, particularly in the study setting. The purpose of this study was to determine the extent of anemia and associated factors in women who used family planning.

Methods

A cross-sectional multi-centered study was conducted from March 3 to 29, 2019, among 443 non-pregnant reproductive age (15 to 49 years) women receiving family planning services in Ambo town. Sample size was calculated using Epi-info version 7 software. Participants were selected by systematic random sampling technique. Trained data collectors collected data using a structured pretested questionnaire, as well as venous blood and stool samples. Epi-Data and SPSS were used to enter and analyze data. The effect of independent variables on the outcome variable was determined by binary logistic regression analysis with adjusted odds ratio at 95% confidence interval and 5% margin of error. P-value <0.05 was used to declare statistical significance.

Results

This study revealed 28% (95% CI:23.9%, 32.3%) magnitude of anemia. Age of 25-35 years [AOR:2.84, 95% CI:1.74, 4.64], implantable family planning method [AOR: 0.34, 95% CI: 0.12, 0.96], no previous use of family planning [AOR:2.62, 95% CI: 1.62, 4.24], household food insecurity [AOR: 2.04, 95% CI: 1.06, 3.93], parasite infestations [AOR:2.01, 95% CI: 1.12, 3.63], and regular intake of coffee/tea within 30 minutes post meal [AOR:3.85, 95% CI:1.24, 11.92] were independently associated with anemia.

Conclusion

Anemia is a moderate public health concern among reproductive-age women receiving family planning services in the study area. There are missed opportunities to address the anemia burden during family planning services. This study emphasizes the importance of nutritional screening for early detection and targeted interventions for healthcare workers in reducing missed opportunities to prevent and control anemia in vulnerable populations.

Chronic anemia complicated by cardiac failure, pulmonary hypertension, and pericardial effusion: a case report

BACKGROUND

Worldwide, iron deficiency anaemia (IDA) is the most common cause of anaemia. Iron deficiency alone has an association with heart failure and pulmonary hypertension. Chronic iron deficiency anemia triggers various physiologic adjustments, leading to hyperdynamic circulation and enhanced hypoxic pulmonary vasoconstriction. Those mechanisms may result in the development of high output cardiac failure and pulmonary hypertension; however, pericardial effusion remains a rare association.

CASE PRESENTATION

A 44-year-old Nepalese man presented with fatigability and swollen ankles. Except for a hemorrhoidectomy 4 years ago, he had no comorbidities. Labs confirmed severe iron deficiency anemia (hemoglobin 1.8 grams per deciliter) likely secondary to hemorrhoids. An echocardiogram revealed high output cardiac failure, pericardial effusion, and severe pulmonary hypertension. He responded well to the correction of anemia and diuretics with the resolution of vascular complications.

CONCLUSION

We report a unique presentation of chronic severe iron deficiency anemia complicated by heart failure, pulmonary hypertension, and pericardial effusion. We believe it to be the first-ever such case reported in the literature. These cardiovascular complications seem to result from internal homeostatic mechanisms against the chronic tissue hypoxemia observed in severe anemia. Furthermore, iron deficiency alone has an association with heart failure and pulmonary hypertension. After excluding other potential causes, we confirmed iron deficiency anaemia as the cause of those complications. The correction of anemia led to an excellent recovery without any sequelae. Our case report highlights the fact that management of such a case should be focused on underlying etiology rather than the complications.

Combination of ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry and network pharmacology to reveal the mechanism of Shengyu Decoction for treating anemia

Anemia is a common clinical hematological disease with a high incidence, which seriously affects human health. Shengyu Decoction is often used in the treatment of anemia. However, the pharmacodynamic substance basis and therapeutic mechanism are still unclear, which hinders the comprehensive development and utilization of Shengyu Decoction. In this study, 143 compounds were identified in Shengyu Decoction using high-throughput ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry, 24 of which were absorbed into the blood. Taking these blood-entering ingredients as the research object, we found through network pharmacology research that ferulic acid, calycosin, and astragaloside A can act on AKT1, MAPK1, and MAPK14, and play a role in treating anemia through PI3K-Akt signaling pathway and Pathways in anemia. Finally, it was demonstrated that the active compound could bind to the core target with good affinity by molecular docking. The research shows that Shengyu Decoction has multi-component, multi-target, and multi-channel effects in the treatment of anemia, which provides a basis for the development and clinical application of Shengyu Decoction.

Oral iron supplementation and anaemia in children according to schedule, duration, dose and cosupplementation: a systematic review and meta-analysis of 129 randomised trials

INTRODUCTION

WHO guidelines on iron supplementation among children call for further research to identify the optimal schedule, duration, dose and cosupplementation regimen.

METHODS

A systematic review and meta-analysis of randomised controlled trials was undertaken. Randomised controlled trials providing ≥30 days of oral iron supplementation versus placebo or control to children and adolescents aged <20 years were eligible. Random-effects meta-analysis was used to summarise the potential benefits and harms of iron supplementation. Meta-regression was used to estimate iron effect heterogeneity.

RESULTS

129 trials with 201 intervention arms randomised 34 564 children. Frequent (3-7/week) and intermittent (1-2/week) iron regimens were similarly effective at decreasing anaemia, iron deficiency and iron deficiency anaemia (p heterogeneity >0.05), although serum ferritin levels and (after adjustment for baseline anaemia) haemoglobin levels increased more with frequent supplementation. Shorter (1-3 months) versus longer (7+ months) durations of supplementation generally showed similar benefits after controlling for baseline anaemia status, except for ferritin which increased more with longer duration of supplementation (p=0.04). Moderate-dose and high-dose supplements were more effective than low-dose supplements at improving haemoglobin (p=0.004), ferritin (p=0.008) and iron deficiency anaemia (p=0.02), but had similar effects to low-dose supplements for overall anaemia. Iron supplementation provided similar benefits when administered alone or in combination with zinc or vitamin A, except for an attenuated effect on overall anaemia when iron was cosupplemented with zinc (p=0.048).

CONCLUSIONS

Weekly and shorter duration iron supplementation at moderate or high doses might be optimal approaches for children and adolescents at risk of deficiency.

TRIAL REGISTRATION NUMBER

CRD42016039948.

Gastrointestinal parasites in Africa: A review

Data on human gastrointestinal parasites (GIP) infections in the african sub-regions and countries are mainly lacking in terms of prevalence and population stratification by afflicted age group, symptomatology, multi-parasitism, and diagnostic methods. This study aims to describe the GIP reported in african countries and discuss the extent of the burden in the african context. Only 68.42% (39/57) of african countries reported human cases of GIP with helminths (45%, CI: 40-50%, I²: 99.79%) as the predominant parasitic group infecting the african population. On a regional scale, Central Africa had the highest pooled prevalence for GIP (43%, CI: 32-54%, I²: 99.74%), while the Central African Republic led all countries with a pooled prevalence of 90% (CI: 89-92%, I²: 99.96%). The vulnerable population (patients who are minorities, children, old, poor, underfunded, or have particular medical conditions) was the most affected (50%, CI: 37-62%, I²: 99.33%), with the predominance of GIP in the 6 to <20 years age group (48%, CI: 43-54%, I²: 99.68%). Reports on multi-parasitism (44%, CI: 40-48%, I²: 99.73%) were almost double the reports of single infections (43%, CI: 27-59%, I²: 99.77%) with combined molecular and non-molecular techniques demonstrating the best performance for GIP identification. The current review spans more than 40 years of GIP reports from the african continent. Geographical characteristics, environmental factors, habits of its inhabitants, and their health status play a crucial role in GIP modulation and behaviour in its captive hosts. Strategies for regular and enhanced surveillance, policy formation, and high-level community awareness are necessary to identify the true incidence in Africa and the transmission of the pathogens via water and food.

Ferumoxytol: an emerging therapeutic for iron deficiency anemia

INTRODUCTION

Iron deficiency anemia (IDA) is common worldwide, and various iron replacement therapies are available. Ferumoxytol is an injectable, high-dose iron formulation (510 mg) that can be administered over a short period (15 min) without test administration. The drug was approved by the Food and Drug Administration in 2009 for the treatment of IDA in patients with chronic kidney disease (CKD), and in 2018, the indication was expanded to include patients without CKD.

AREAS COVERED

This paper reviews studies testing the efficacy and safety of ferumoxytol in treating IDA compared with other iron formulations.

EXPERT OPINION

There is substantial evidence that ferumoxytol is effective for the treatment of IDA. The efficacy of ferumoxytol in improving anemia is comparable to that of iron sucrose and ferric carboxymaltose (FCM) and superior to that of oral iron or a placebo in replenishing iron stores. Treatment with ferumoxytol, although more expensive, is cost-effective for outpatients requiring parenteral administration because it requires fewer doses and shorter dosing times per dose. Ferumoxytol also causes less frequent hypophosphatemia than FCM. Currently, its use in children and pregnant women is under consideration, which may provide important information for the future applications of ferumoxytol in larger numbers of patients.

Lack of Evidence on Association between Iron Deficiency and COVID-19 Vaccine-Induced Neutralizing Humoral Immunity

Iron is a crucial micronutrient for immunity induction in response to infections and vaccinations. This study aimed to investigate the effect of iron deficiency on COVID-19-vaccine-induced humoral immunity. We investigated the effectiveness of COVID-19 vaccines (BNT162b2, mRNA-1273, and ChAdOx nCov-2019) in iron-deficient individuals (n = 63) and provide a side-by-side comparison to healthy controls (n = 67). The presence of anti-SARS-CoV-2 spike (S) and anti-nucleocapsid (NP) IgG were assessed using in-house S- and NP-based ELISA followed by serum neutralization test (SNT). High concordance between S-based ELISA and SNT results was observed. The prevalence of neutralizing antibodies was 95.24% (60/63) in the study group and 95.52% (64/67) in the controls with no significant difference. The presence/absence of past infection, period since vaccination, vaccine type, and being iron-deficient or having iron-deficiency anemia did not exert any significant effect on the prevalence or titer of anti-SARS-CoV-2 neutralizing antibodies. NP-based ELISA identified individuals unaware of exposure to SARS-CoV-2. Moreover, absence of anti-NP IgG was noted in participants who were previously diagnosed with COVID-19 suggesting the unpredictability of after-infection immunity. To sum up, this study demonstrated an initial lack of evidence on the association between iron deficiency and the effectiveness of COVID-19-vaccine-induced neutralizing humoral immunity. Similar studies with larger sample size remain necessary to obtain comprehensive conclusions about the effect or lack of effect of iron on COVID-19-vaccine effectiveness.

Early adaptive responses in the skeletal muscle of young mice with hereditary hemochromatosis

BACKGROUND

Hereditary hemochromatosis (HH) is characterized by iron overload that can cause multiple organ dysfunction primarily due to uncontrolled iron-mediated oxidative stress. Although HH leads to muscular weakness, disorder, and fatigue, the mechanism by which HH affects skeletal muscle physiology is largely unknown.

METHODS

Using Hfe knockout mice (6-7 months old), a well-defined mouse model of HH, we examined iron status in the skeletal muscle, as well as other organs. As mitochondria are key organelle for muscular function, this study also explored how molecular markers for mitochondrial function and related systems are regulated in the HH skeletal muscle using western blots.

RESULTS

Although iron overload was evident at the systemic level, only mild iron overload was observed in the skeletal muscle of HH. Of note, mitochondrial electron transport chain complex I was upregulated in the HH skeletal muscle, which was accompanied by enhanced autophagy. However, these molecular changes were not associated with oxidative stress, suggesting altered mitochondrial metabolism in the muscle in response to iron overload.

CONCLUSIONS

These early adaptive responses may be important for supporting mitochondrial health before fully developing skeletal muscle dysfunction in HH. More studies are needed to determine the role of autophagy in the HH-related muscle mitochondrial dysfunction.

Iron supplementation and deworming during pregnancy reduces the risk of anemia and stunting in infants less than 2 years of age: a study from Sub-Saharan Africa

BACKGROUND

In sub-Saharan Africa, infant anemia, stunting and low birth weight remains major public health problems. It is unclear whether prenatal iron supplementation and/or deworming can reduce the risk of infant stunting, anemia and low birth weight. The aim of this study was to investigate the relationship between iron supplementation and/or deworming and stunting, anemia, and low birth weight in infants under two years of age in sub-Saharan Africa.

METHODS

Our studies examined pooled data from Demographic and Health Surveys (DHS) in twenty-three African countries collected between 2014 and 2020. childhood anemia and stunting in infants under the age of two were the primary outcomes. Iron supplementation and deworming during prenatal visits were the main exposure variables. A multivariate logistic regression model was used to investigate these relationships.

RESULTS

The prevalence of stunting was 29.9%, severe stunting was 10.6%, childhood anemia was 74.3%, childhood severe anemia was 3.2%, and low birth weight was 16.4%, respectively. The use of prenatal iron supplementation alone was associated with a significant reduction of childhood anemia [aOR (95% CI) = 0.9 (0.8-1.0)]. Prenatal deworming alone was associated with a significantly reduced risk of stunting [aOR (95% CI) = 0.7 (0.8-1.0)], childhood anemia [aOR (95% CI) = 0.7 (0.8-0.9)], and low birth weight [aOR (95% CI) = 0.7 (0.8-1.0)]. Prenatal iron supplementation plus deworming or iron supplementation (with or without deworming) were not associated with childhood anemia, infant stunting and low birth weight.

CONCLUSIONS

In Sub-Saharan Africa, prenatal deworming alone has the potential to improve infants' outcomes. Childhood anemia was improved with prenatal iron supplementation alone. Our recent findings indicate the necessity for prospective studies on the association between prenatal iron supplementation plus deworming and childhood anemia, stunting and low birth weight.

Determinants of anemia among women of childbearing age: analysis of the 2018 Mali demographic and health survey

BACKGROUND

Anemia occurs at all stages of life and it is of public health concern as it serves as an indicator of quality nutrition and health of a society. Almost one third of the global prevalence of anemia occur among reproductive aged women and almost 40% of these women reside in sub-Saharan Africa including Mali. This study, therefore, sought to assess the determinants of anemia among women of childbearing age in Mali.

METHODS

Secondary data analysis of the 2018 Mali Demographic and health Survey (MDHS). Anemia in women was the outcome variable for the study. Data of 5,048 women aged 15-49 was used for the study. Using binary and multivariate logistic regression models, factors associated with anemia among women were identified. The analysis was conducted using Stata version 14.2 software and adjusted Odds Ratio (aOR) with a 95% Confidence Interval (CI) and p-value < 0.05 were used to see the significant association.

RESULTS

The prevalence of anemia among women of childbearing age in Mali is 63.5%. Of these, 4.3% and 24.9% were severely and mildly anemic respectively, and the rest 34.3% were moderately anemic. Women who had secondary education (aOR = 0.70, 95% CI: 0.58-0.84), overweight (aOR = 0.63, 95% CI: 0.50-0.81), exposure to mass media (aOR = 0.90, 95% CI = 0.76-1.49) and women with two births (aOR = 0.86, 95% CI = 0.71-1.05) were less likely to be anemic. Likely, richest wealth quintile (aOR = 0.73, 95% CI = 0.51-1.05), living in urban setting (aOR = 0.85, 95% CI = 0.70-1.03) and women in Kidal Region (aOR = 0.42, 95% CI = 0.27-0.65) were less likely to be anemic. However, pregnant women, women covered by health insurance, women with unimproved drinking water, women in communities with low literacy and low socioeconomic status had higher odds of anemia.

CONCLUSION

These findings point to the need for community and household level public health sensitization interventions to highlight the pro-anemic factors and mitigating strategies. More especially, women with no education, pregnant women, women covered by health insurance, women from communities with low literacy and socioeconomic status ought to be the focus of such interventions.

Visualizing changes of metabolites during iron deficiency chlorosis in field-grown pear leaves using micro-Raman spectral imaging

Owing to iron chlorosis, pear trees are some of the most severely impacted by iron deficiency, and they suffer significant losses every year. While it is possible to determine the iron content of leaves using laboratory-standard analytical techniques, the sampling and analysis process is time-consuming and labor-intensive, and it does not quickly and accurately identify the physiological state of iron-deficient leaves. Therefore, it is crucial to find a precise and quick visualization approach for metabolites linked to leaf iron to comprehend the mechanism of iron deficiency and create management strategies for pear-tree planting. In this paper, we propose a micro-Raman spectral imaging method for non-destructive, rapid, and precise visual characterization of iron-deficiency-related metabolites in pear leaves. According to our findings, iron deficiency significantly decreased the Raman peak intensities of chlorophylls and lipids in leaves. The spatial distributions of chlorophylls and lipids in the leaves changed significantly as the symptoms of iron insufficiency worsened. The technique offers a new, prospective tool for rapid recognition of iron deficiency in pear trees because it is capable of visual detection of plant physiological metabolites induced by iron deficiency.

Infant and young child feeding practices are associated with childhood anaemia and stunting in sub-Saharan Africa

BACKGROUND

The co-occurrence of anaemia and stunting (CAS) presents acute development and morbidity challenges to children particularly in sub-Saharan Africa (SSA). Evidence on the effect of child feeding recommendations on CAS is scarce.

METHODS

We used data from 22 recent Demographic and Health Surveys in SSA countries to examine the association between caregivers' implementation of recommendations on infant and young child feeding and the CAS in their 6- to 23-mo-old children.

RESULTS

Overall, in multiple logistic regression models, child feed index score, high wealth of household, increasing household size, household head with at least secondary school education, improved sanitation of household, an increase in caregiver's age and caregiver's with at least secondary education were associated with lower odds of CAS (i.e.

, AOR

0.86; 95% CI; 0.84 - 0.88: 0.75; 0.69 - 0.82: 0.98, 0.98 - 0.99: 0.76, 0.70 - 0.83: 0.81, 0.74 - 0.87: 0.87, 0.81 - 0.94: 0.69, 0.62 - 0.77 respectively). Having a diarrhoea in the past 2 weeks and having fever in the past month were associated with higher odds of CAS (AOR:1.1, 95% CI; 1.0 - 1.2: 1.1, 1.0 - 1.2, respectively). Results from the decision tree analysis showed that the educational level of women was the most important predictor of CAS, followed by child feeding score, the level of education of the family head and state of drinking water.

CONCLUSION

The results buttress the importance of interventions aimed at improving feeding practices and parental educational as a vehicle to improve children's nutritional status.

Iron in infectious diseases friend or foe?: The role of gut microbiota

Iron is a trace element involved in metabolic functions for all organisms, from microorganisms to mammalians. Iron deficiency is a prevalent health problem that affects billions of people worldwide, and iron overload could have some hazardous effect. The complex microbial community in the human body, also called microbiota, influences the host immune defence against infections. An imbalance in gut microbiota, dysbiosis, changes the host's susceptibility to infections by regulating the immune system. In recent years, the number of studies on the relationship between infectious diseases and microbiota has increased. Gut microbiota is affected by different parameters, including mode of delivery, hygiene habits, diet, drugs, and plasma iron levels during the lifetime. Gut microbiota may influence iron levels in the body, and iron overload and deficiency can also affect gut microbiota composition. Novel researches on microbiota shed light on the fact that the bidirectional interactions between gut microbiota and iron play a role in the pathogenesis of many diseases, especially infections. A better understanding of these interactions may help us to comprehend the pathogenesis of many infectious and metabolic diseases affecting people worldwide and following the development of more effective preventive and/or therapeutic strategies. In this review, we aimed to present the iron-mediated host-gut microbiota interactions, susceptibility to bacterial infections, and iron-targeted therapy approaches for infections.

Temporal evolution of anemia in children aged six to 59 months in the state of Pernambuco, Brazil, 1997 to 2016

OBJECTIVE

To analyze the temporal evolution of anemia in children aged six to 59 months in Pernambuco, based on population surveys from 1997, 2006, and 2016 and the factors associated with the situation in 2016.

METHODS

The field studies took place in the participants' households, in the Recife Metropolitan Area, as well as in the urban and rural inland. The trend study of anemia in children used data from the State Health and Nutrition Survey (Pesquisa Estadual de Saúde e Nutrição - PESN) II (40.9%) and III (32.8%). Data from PESN IV were collected using questionnaires administered to families to verify socioeconomic and individual conditions, as well as anthropometric - weight and height - and biochemical - hemoglobin - records. We adopted the test for trend in proportion for the time trend study and Poisson regression for hypothesis tests for the associated factors. Statistically significance was set at a p-value<0.05.

RESULTS

In 2016, the prevalence of anemia was 24.2%, indicating a significant reduction in disease incidence. In children aged 6-23 months, this number decreased from PENS II and III to PENS IV - 63 and 55.6 to 37.7% (p<0.001), respectively. In 2016, the statistically significant variables for anemia in children were maternal hemoglobin, child's age, current or recent case of diarrhea, and weight-for-age index.

CONCLUSION

Between 1997 and 2016, anemia rates decreased, showing an epidemiological trend that can contribute to continuously improve the health of children under five years of age in Pernambuco.

Anemia of inflammatory: does eiderr knowledge mean better diagnosis and treatment?

Anemia, which is a manifestation of the deterioration of patients' health and performance, is a common concomitant condition in diseases with signs of inflammation activation. This anemia - anemia of inflammation, is caused by disturbances of iron metabolism that lead to iron retention within macrophages, cytokine mediated inhibition of erythropoietin function and erythroid progenitor cell differentiation, and a reduced erytrocyte half-life. Anemia is usually mild to moderate, normocytic and normochromic. It is characterized by low iron circulation, but normal to increased levels of stored ferritin and the hormone hepcidin. The primary therapeutic approach is the treatment of the underlying inflammatory disease. In case of failure, iron supplementation and / or treatment with erythropoietin stimulating agents may be used. Blood transfusions are just an emergency treatment for life-threatening anemia. A new treatment modalities with hepcidin-modifying strategies and stabilizers of hypoxia inducible factors is emerging. However, their therapeutic efficacy needs to be verified and evaluated in clinical trials.

Postpartum anemia and its determinant factors among postnatal women in two selected health institutes in Gondar, Northwest Ethiopia: A facility-based, cross-sectional study

Background

Anemia is highly prevalent globally and disproportionately affects postnatal women. It is a significant cause of maternal mortality and morbidity globally.

Objective

The main aim of this study was to determine the extent of postpartum anemia and associated factors among postnatal women in two selected health facilities in Gondar, Northwest Ethiopia.

Methods

A facility-based, cross-sectional study was conducted among 282 postnatal women from March to May 2021. A systematic sampling technique was used to recruit study participants from each institute. Sociodemographic, obstetric, and clinical data were collected through a semi-structured questionnaire. A venous blood sample was collected to determine the red blood cell parameters. A thin blood smear preparation was performed to examine blood morphology. In addition, direct wet mount and formalin-ether sedimentation techniques were used for stool examination to identify intestinal parasites. Data were entered into EpiData and exported to Stata 14 for statistical analysis. Descriptive statistics were presented in text, tables, and figures. A binary logistic regression model was used to identify factors associated with postpartum anemia. A p-value <0.05 was considered statistically significant.

Results

The proportion of postpartum anemia was 47.16%; 95% CI; 41.30-53.03 with moderate, mild, and severe anemia accounting for 45.11, 42.86, and 12.03%, respectively. The majority of the anemia (94%) was of the normocytic normochromic type. It was associated with postpartum hemorrhage (AOR = 2.23; 95% CI: 1.24-4.01), cesarean section (AOR = 4.10; 95% CI: 2.11-7.78), lack of iron and folate supplementation during pregnancy (AOR = 2.12; 95% CI: 1.17-4.02), and low diet diversity level (AOR = 1.83; 95% CI: 1.05-3.18).

Conclusion

The prevalence of anemia was found to be a major public health concern. Iron and folate supplementation during pregnancy, improved management of PPH, an effective cesarean section with post-operative care, and taking a diversified diet will reduce the burden. Therefore, identified factors should be considered to prevent and control postpartum anemia.

Interplay between systemic inflammation, anemia, and mycobacterial dissemination and its impact on mortality in TB-associated HIV: a prospective cohort study

Introduction

Anemia frequently affects people living with HIV (PLHIV). Nevertheless, the impact of anemia on treatment outcomes of patients with HIV-associated tuberculosis (TB) and the underlying molecular profiles are not fully characterized. The aim of this study was to investigate the interplay between anemia, the systemic inflammatory profile, dissemination of TB and death in HIV-TB patients in an ad hoc analysis of results from a prospective cohort study.

Methods

496 hospitalized PLHIV ≥18 years old, with CD4 count <350 cells/μL and high clinical suspicion of new TB infection were enrolled in Cape Town between 2014-2016. Patients were classified according to anemia severity in non-anemic, mild, moderate, or severe anemia. Clinical, microbiologic, and immunologic data were collected at baseline. Hierarchical cluster analysis, degree of inflammatory perturbation, survival curves and C-statistics analyses were performed.

Results

Through the analysis of several clinical and laboratory parameters, we observed that those with severe anemia exhibited greater systemic inflammation, characterized by high concentrations of IL-8, IL-1RA and IL-6. Furthermore, severe anemia was associated with a higher Mtb dissemination score and a higher risk of death, particularly within 7 days of admission. Most of the patients who died had severe anemia and had a more pronounced systemic inflammatory profile.

Discussion

Therefore, the results presented here reveal that severe anemia is associated with greater TB dissemination and increased risk of death in PLHIV. Early identification of such patients through measurement of Hb levels may drive closer monitoring to reduce mortality. Future investigations are warranted to test whether early interventions impact survival of this vulnerable population.

SIMULTANEOUS INTAKE OF LIQUID L-T4 FORMULATION AND IRON SALT: FACT OR FICTION?

Context

Hypothyroidism and iron deficiency are among the most common pathologies in population. Therefore, there are a lot of patients assuming both iron salt supplements and levothyroxine therapy.

Objective

To evaluate the effect of iron salt intake on L-T4 absorption among different L-T4 formulations.

Materials and methods

A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Original studies and reviews written in English and published online up to 21 December 2022 were selected and reviewed. The final reference list was defined based on the relevance of each paper to the scope of this review.

Results

The data show an impaired absorption of L-T4 in tablets formulation when taken concomitantly with iron salt supplements. These phenomena seem to be circumvented by new L-T4 formulations.

Conclusion

Liquid L-T4 formulations can be ingested with iron salts, with no impairment of absorption. More studies are necessary to confirm these data for soft-gel capsules L-T4.

Magnitude of Anemia and Undernutrition Among Primary School Children in a Setting of Mass Deworming in Central Ethiopia

Background

Undernutrition and anemia in children continue to be a public health problem in developing countries. Besides, intestinal parasitic infection among school children is common in developing countries. World Health Organization (WHO) recommends periodic deworming of children who live in endemic areas. The aim of this study was to determine the magnitude of anemia and undernutrition among school children in a setting of mass deworming.

Methods

A cross-sectional study was conducted among 510 school children aged 5-14 years from three randomly selected governmental schools in Sululta town, central Ethiopia. Socio-demographic variables were assessed using interviewer administered structured questionnaire. Anthropometric data were obtained and analyzed using WHO Anthroplusv1.0.4. Venous blood samples were collected using EDTA vacutainers. Hemoglobin level was determined by Sysmex KX-21N automated hematology analyzer and stool samples were processed using direct wet mount, formol-ether concentration and Kato-Katz methods. Data were entered and analyzed using SPSS version 21. Logistic regression analysis was performed to determine the association of anemia and undernutrition with the independent variables.

Results

The overall magnitude of anemia was 3.7%. Among anemic individuals, 84.2% and 15.8% of participants had mild and moderate anemia, respectively. The magnitude of stunting and thinness was 16.9% and 10.8%, respectively. Of them, 18.6% of stunting and 14.5% of thinness were severe. Of factors related to undernutrition, children from large families (≥5) were less likely to be stunted (AOR=0.38, 95% CI=0.2-0.7, P=0.002) compared to small families.

Conclusion

The magnitude of anemia in the study area was considered as an insignificant public health problem and none of the socio-demographic variables of participants were significantly associated with anemia and likewise with undernutrition except for family size. Further studies are required to clearly understand the impact of mass deworming on the magnitude of anemia and undernutrition.

Ferric Carboxymaltose Versus Ferrous Glycine Sulfate For Treatment of Iron Deficiency Anemia and Their Effect On Vitamin B12 And Folic Acid: A Retrospective Study

Aim Anemia is a major public health problem, affecting about one-third of the world's population, and is most commonly caused by iron deficiency. Iron deficiency anemia requires oral or intravenous iron replacement therapy. The purpose of this study was to assess the change in several hematological parameters, vitamin B12, and folic acid from baseline to the first month of follow-up following therapy with oral ferrous glycine sulfate or intravenous ferric carboxymaltose. Methods: All patients who received oral ferrous glycine sulfate or intravenous ferric carboxymaltose for the treatment of iron deficiency anemia between January 1, 2016, and December 31, 2018, were included in the trial. Along with age and gender information, values of hemoglobin, ferritin, transferrin saturation, mean corpuscular volume, vitamin B12, and folic acid were derived from patients’ records at the beginning of treatment and first month follow-up. Results: Laboratory values obtained after treatment showed statistically significant improvement in both groups (intra group, p&lt;0.001). When the percentage of change between groups was compared: Percentage-based increases in hemoglobin, mean corpuscular volume, transferrin saturation and ferritin values were significantly higher in the ferric carboxymaltose group (p&lt;0.001). The percentage decrease in vitamin B12 and folic acid values was higher in the ferric carboxymaltose group (p=0.005 and p=0.01, respectively) when compared with oral ferrous glycine sulfate group. Conclusions: According to the findings of our study, iron deficiency anemia can be treated very successfully using ferric carboxymaltose; however, it should be remembered that concurrent supplementation of elements such vitamin B12 and folic acid is necessary for the appropriate progression of erythropoiesis.

Declining trend in anemia prevalence among non-pregnant women of reproductive age in Vietnam over two decades: A systematic review and meta-analysis of population studies

Background: Anaemia is a public health concern in developing nations, particularly among women of reproductive age. However, the present prevalence and recent trend in anaemia among this population are unclear. This systematic review aimed to evaluate the prevalence of anaemia among non-pregnant women in Vietnam. Methods: We systematically searched databases such as PubMed, Scopus, and reference lists of earlier prevalence studies from their inception until July 2022. For statistical analysis to check for heterogeneity, random or fixed effects models were employed to summarize the prevalence of anaemia. Visual examination of a funnel plot was used to determine the presence of publication bias, which was then verified using the Egger regression test. Subgroup analyses were also undertaken to evaluate how the proportion of anaemia differs across various study groups. Results: A total of 188 studies were found as a result of the bibliographical search. Finally, of the 12 included studies, anaemia affected 5089 non-pregnant women out of a total of 19744, making the prevalence of this condition 23.2% (95% CI: 16.1-32.2). From 1995 to 2013, the prevalence of anaemia in this population declined significantly, from 42.6% to 16.9%. Notably, the prevalence of anaemia among non-pregnant women differed by geography and increased by mountains, Northern Vietnam, rural areas, and ethnic minority groups. Furthermore, no publication bias was found in this meta-analysis. Conclusion: To enhance the health of women and meet global objectives for eliminating anaemia, more efforts are required in specific regions and ethnic minority groups in Vietnam.