Biology of Anemia: A Public Health Perspective

Qualitative evaluation of a package of implementation strategies codesigned to support the introduction of multiple micronutrient supplementation (MMS) for pregnant women in Bamako, Mali

Mali national policy recommends that women take iron and folic acid supplements (IFA) from the time of the first antenatal care (ANC) visit, throughout pregnancy and during the first 3 months after delivery. In 2020, the World Health Organization (WHO) updated their ANC guidelines to recommend the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) formulation of multiple micronutrient supplements (MMS) in the context of rigorous research, including implementation research. In Bamako, Mali, a codesign process was used to tailor antenatal care MMS packaging and counselling materials aimed at optimizing delivery and uptake of and adherence to MMS. This paper presents the codesign process along with the results of a post-intervention qualitative assessment to evaluate the behaviour change intervention. At the conclusion of the intervention, we conducted semistructured qualitative interviews with 24 women who had received the intervention and six pharmacy managers from the six health centres participating in the study. We conducted two focus groups with midwives who had delivered the intervention and two group discussions with family members of women who had received the intervention. Respondent perspectives reveal an easy experience transitioning from previously used IFA. Women and providers concur that the intervention counselling materials and visual aids were instrumental in influencing the perceived benefit and uptake of MMS. Family members play an influential role in pregnant women's decision-making regarding MMS uptake. MMS and the associated implementation strategies developed through the codesign process were found to be a highly acceptable intervention.

Impact of Vitamin A Deficiency on Iron Metabolism and Anemia: A Historical Perspective and Research Advances

Vitamin A deficiency (VAD) and iron deficiency anemia coexist around the world, particularly in children and women of reproductive age in low- and middle-income countries. Within this scenario, there is a known interaction between vitamin A and iron, and it has been postulated that lack of vitamin A impairs iron metabolism, leading to vitamin A deficiency anemia (VADA). Current animal, epidemiological, and clinical studies support this notion. The objective of this study was to review the current literature on proposed metabolic mechanisms regarding how VAD modulates iron metabolism leading to anemia. To attain this objective, a literature search was conducted of research publications in the related field, without date restriction, using PubMed, Scopus, Google Scholar, and the University of Illinois's reference system. The data support the essentiality of vitamin A for normal erythropoiesis. It indicates that, in VAD, iron mobilization is impaired, and that this mineral accumulates in the liver and spleen, making it less available for erythropoiesis. A triggering factor for the development of VADA seems to be inflammation and systemic infection, which release cytokines that upregulate the production of hepcidin by the liver. VAD may also increase hepcidin directly without the involvement of inflammation or infection. The elevated hepcidin, in turn, lowers circulating iron and sequesters iron in storage depots, downregulating erythropoietin, leading to inefficient erythropoiesis, decreased hemoglobin (Hb) production, and (subsequently) anemia. VAD may also impact the expression of iron regulatory protein 2 (IRP2), and thus affect intracellular iron metabolism gene expression. VADA is not due to iron deficiency, but to a redistribution of iron in the body. Understanding the mechanism of VADA will assist in designing more effective strategies for combating anemia worldwide.

A Review of Anemia Prevalence, and Prevention and Control Strategies, in the Eastern Europe and Central Asia Region

Anemia is a global public health and nutrition problem. However, data on its prevalence and potential causal factors in the 22 countries of the UNICEF Europe and Central Asia region are not systematically collected, analyzed, and reported, leading to challenges in formulating appropriate preventative strategies. We examined available anemia prevalence data among different population groups through reviewing survey reports from 2010 to 2022; conducted a literature review to explore underlying determinants of anemia including iron deficiency; and collated and reviewed program and policy documentation across the region. Anemia prevalence data for the period 1999-2009 were also researched to examine trends in anemia prevalence in the region over the past 23 y. Nationally representative data for anemia for ≥1 population group since 2010 were found for half the 22 countries, whereas less than a quarter of countries had recent data for iron deficiency. There was a lack of evidence for other factors potentially contributing to anemia in the region. Where information was available, our findings highlight that anemia remained a problem of public health significance among girls and women 15-49 y old and preschool children in all countries with data; anemia was highly associated with iron deficiency; large discrepancies in anemia prevalence existed between geographical regions and subpopulation groups within countries; and only a few countries were implementing the recommended WHO strategies to prevent and control anemia. The paucity of recent, representative, data on anemia in many countries and on the etiology of anemia in most countries remain obstacles to ensuring that effective anemia prevention strategies are placed high on national agendas in the region.

Global prevalence of anemia among women of reproductive age, 2000-2019

A common disease with significant impacts on health and quality of life, anemia is particularly prevalent in women of reproductive age due to blood losses during menstruation and pregnancy. Data from the World Health Organization (WHO) was analyzed to compare trends in prevalence of anemia in women aged 15-49 among countries and over time with the goal of identifying regions both successful and in need of assistance in combatting anemia. Worldwide from 2000 to 2013 the prevalence of anemia among women aged 15-49 decreased, and then increased from 2013 to 2019; severe anemia decreased throughout the world from 2000 to 2019. Throughout all years, African countries had the highest prevalence of anemia and severe anemia while American and European countries had the lowest. With each decrease in human development index (HDI) category (very high to high, etc.) there was a significant increase in prevalence of total anemia (P < 0.001 for all). This data suggests that although the prevalence of anemia among reproductive age women has decreased over time there is still much work remaining, particularly in low HDI countries. More effort is needed in preventing, recognizing and treating anemia.

Immunological Insights Into Nutritional Deficiency Disorders

Essential nutrients play a vital role in influencing immune cell development. This chapter explores the crucial relationship between nutrition and the immune system, delving into the profound impact of dietary choices on overall health. Research highlights the benefits of nutrient-rich foods in supporting optimal immune function, while deficiencies in key nutrients (vitamins A, D, zinc, and iron) compromise immune responses, increasing susceptibility to infections. The bidirectional nature of the relationship is emphasized, underscoring the critical role of a balanced diet in supporting immune cell development, activation, and function. Case studies illustrate immunological vulnerabilities linked to inadequate nutritional status, stressing the importance of maintaining optimal nutrient levels for a robust immune system. In summary, an individual's nutritional status significantly influences immune response effectiveness. Addressing deficiencies through supplementation, dietary interventions, and public health initiatives is crucial for improving immune function.

Host response during unresolved urinary tract infection alters female mammary tissue homeostasis through collagen deposition and TIMP1

Exposure to pathogens throughout a lifetime influences immunity and organ function. Here, we explore how the systemic host-response to bacterial urinary tract infection (UTI) induces tissue-specific alterations to the mammary gland. Utilizing a combination of histological tissue analysis, single cell transcriptomics, and flow cytometry, we identify that mammary tissue from UTI-bearing mice displays collagen deposition, enlarged ductal structures, ductal hyperplasia with atypical epithelial transcriptomes and altered immune composition. Bacterial cells are absent in the mammary tissue and blood of UTI-bearing mice, therefore, alterations to the distal mammary tissue are mediated by the systemic host response to local infection. Furthermore, broad spectrum antibiotic treatment resolves the infection and restores mammary cellular and tissue homeostasis. Systemically, unresolved UTI correlates with increased plasma levels of the metalloproteinase inhibitor, TIMP1, which controls extracellular matrix remodeling and neutrophil function. Treatment of nulliparous and post-lactation UTI-bearing female mice with a TIMP1 neutralizing antibody, restores mammary tissue normal homeostasis, thus providing evidence for a link between the systemic host response during UTI and mammary gland alterations.

Indian adolescents' perceptions of anaemia and its preventive measures: Aqualitative study

High prevalence of anaemia is a severe public health problem in several low- and middle-income countries like India. A qualitative inquiry was designed to understand the perceptions of adolescents regarding anaemia and anaemia prevention measures. Convenience sampling was employed to recruit 39 adolescents (19 girls; 20 boys) from Tikari, India. Interviews were carried out in the local language, audio-recorded and transcribed verbatim. Hemoglobin concentration was also assessed from a single drop of capillary blood using the HemoCue, and the participants were asked to share their Science/Biology and Home Science textbooks. Interview data was analysed thematically. Descriptive statistics were used to examine the distributions of the hemoglobin data while textbooks were analysed using content analysis to verify the coverage of anaemia and anaemia-related matter. Seven themes were identified: (i) Poor understanding of the term anaemia; (ii) Minimal discussion about anaemia in classroom; (iii) Limited knowledge about symptoms of anaemia; (iv) Limited awareness about prevention and cure of anaemia; (v) Perception of iron folic acid and deworming tablets among students; (vi) Lack of contribution of health workers in the prevention of anaemia; (vii) No knowledge of 'Anemia free India' programme. More than half of the sample had anaemia (16.7% mild anaemia, 33.3% moderate anaemia, 2.8% severe anaemia). Content analysis revealed that there was limited discussion about anaemia in both Home Science and Science textbooks. Behavioural interventions should focus on inculcating healthy culinary and dietary practices and addressing the gaps in knowledge and understanding of anaemia and its prevention among adolescents.