Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries

Prevalence and risk factors of anemia among people living with HIV/AIDS in Southeast Asia: a systematic review and meta-analysis

BACKGROUND & OBJECTIVES

Anemia represents a critical hematological complication among people living with HIV/AIDS (PLHIV), significantly impacting morbidity and mortality. This systematic review and meta-analysis aimed to comprehensively evaluate anemia prevalence and identify key risk factors among PLHIV in Southeast Asia.

METHODS

We systematically searched PubMed, Scopus, Embase, and Web of Science (2000-2024) following PRISMA guidelines (PROSPERO: CRD42024610328). Random-effects meta-analysis was performed, with heterogeneity examined through meta-regression and subgroup analyses. Quality assessment utilized JBI critical appraisal tools.

RESULTS

Analysis of 39 studies (n = 21,427) revealed a striking pooled anemia prevalence of 50% (95% CI: 43-57%, I2 = 99.6%). Compelling disparities emerged across subgroups: ART-naïve individuals showed markedly higher prevalence (58%) versus those on ART (38%), children demonstrated elevated rates (52%) compared to adults (49%) and pregnant women (37%), and lower-middle-income countries exhibited greater burden (50%) versus upper-middle-income countries (39%). Meta-regression identified critical risk factors: CD4 count < 200 cells/mm3 (OR = 3.56, 95% CI: 2.59-4.90), underweight BMI (OR = 4.75, 95% CI: 3.57-6.33), female gender (OR = 3.06, 95% CI: 2.71-3.45), and notably, zidovudine use (OR = 9.28, 95% CI: 1.18-73.0).

CONCLUSIONS

Our findings reveal that anemia affects half of PLHIV in Southeast Asia, with vulnerable subgroups bearing a disproportionate burden. This evidence underscores the urgent need for enhanced screening protocols and targeted interventions, particularly among high-risk populations. Future research should prioritize intervention strategies for these vulnerable subgroups.

The prevalence of anemia, iron deficiency, and iron deficiency anemia in adult migrants in Nigde, Turkey

OBJECTIVES

Anemia is a significant public health concern, particularly among migrants. The aim of this study was to evaluate the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among adult migrants in Nigde.

METHODS

This retrospective study included a total of 2378 adult migrants who were admitted to Nigde Omer Halisdemir University Training and Research Hospital. The complete blood count, serum iron, unsaturated iron-binding capacity, transferrin saturation, and serum ferritin levels of all migrants were analyzed. The status and severity of anemia and ID were determined according to the definitions of the World Health Organization.

RESULTS

Out of the migrants, 77.2% were female. The migrants originated from 40 different countries, with the majority of them coming from Syria (41.4%), followed by Afghanistan (27.3%), Iraq (9.1%), Iran (9.1%), and other countries (13.1%). The prevalence of anemia, ID, and IDA among adult migrants was 20.8%, 23.8%, and 14%, respectively. In females, the prevalence of anemia, ID, and IDA in 25.5%, 29.9%, and 17.7%, respectively. In males, the prevalence of anemia, ID, and IDA was 4.8%, 3.1%, and 1.6%, respectively. 57.5% of the anemia cases were mild anemia and 57.9% were microcytic anemia. IDA accounted for 67.6% of total cases of anemia, 69.4% of females with anemia, and 34.6% of males with anemia. Serum iron, ferritin, and mean corpuscular volume (MCV) levels in Syrians were significantly lower than those in all other countries.

CONCLUSION

Anemia among adult migrants was a moderate public health concern. IDA is the most common cause of anemia in females, but not in males. The prevalence of anemia, ID and IDA varied significantly by geography and gender. Public awareness, screening and prevention programs on iron supplementation and food fortification should be implemented to reduce the prevalence of anemia in at-risk populations.

Factors affecting anemia among women of reproductive age in Mexico: a mixed-methods country case study

BACKGROUND

In Mexico, anemia prevalence among women of reproductive age (WRA) decreased from 16.4% in 2006 to 11.6% in 2012, only to increase to 18.3% in 2016. The factors associated with this fluctuation are uncertain.

OBJECTIVES

We conducted a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in Mexico between 2006 and 2018.

METHODS

Using multivariate stepwise linear regression, we analyzed Mexico's Encuesta Nacional de Salud y Nutrición surveys from 2006, 2012, and 2018 to identify determinants of WRA anemia. We also conducted a review of anemia-relevant programs and policies, including financing documents, and conducted in-depth interviews and focus group discussions with key stakeholders in Mexico.

RESULTS

Among nonpregnant women (NPW) 15-49 y, mean hemoglobin (Hb) increased from 13.8 g/dL in 2006 to 14.0 g/dL in 2012, decreasing to 13.2 g/dL in 2018 (P < 0.001). Inequities by geographical region and household wealth persisted throughout this period, with household wealth, urban residence and gravidity emerging as significant predictors of Hb among NPW. Qualitative analyses generally supported these findings. The most discussed program was Progresa-Oportunidades-Prospera, where most resources for health were invested and majority of participants acknowledged that its cancellation in 2019 would lead to worsening of health and nutrition outcomes among the poor. Financing analyses showed a drop in funding for nutrition-related programs between 2014 and 2018. Cultural norms around gender roles were still prevalent, along with increasing rates of teenage pregnancy.

CONCLUSIONS

Anemia prevention efforts need to refocus on poverty alleviation, continuity of adequate coverage and financing of nutrition programs, especially those with social safety nets, and increase in uptake of family planning, particularly among adolescent girls.

Drivers of anemia reduction among women of reproductive age in Pakistan: a mixed-methods country case study

BACKGROUND

In Pakistan, anemia prevalence among women of reproductive age (WRA) decreased from 50.5% in 2011 to 42.7% in 2018. The factors associated with this reduction are unclear.

OBJECTIVES

We conducted a systematic, in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in Pakistan between 2011 and 2018.

METHODS

Employing standard Exemplars mixed-methods methodology, we conducted quantitative analyses using Pakistan's National Nutrition Surveys. Qualitative analyses included a systematic literature review, program/policy analysis, key informant interviews, and focus group discussions with stakeholders to identify and understand country-level enablers and barriers to WRA anemia decline in Pakistan. A final Oaxaca-Blinder decomposition analysis (OBDA) evaluated the relative contribution of direct and indirect factors.

RESULTS

Among nonpregnant women, mean hemoglobin increased from 11.7 ± 1.8 g/dL in 2011 to 12.1 ± 1.6 g/dL in 2018 (P < 0.01), corresponding to an 11%-point decline in anemia prevalence during this time (51%-40%). However, inequities by geographical region, household wealth, and urban compared with rural residence persisted. From the policy and qualitative analyses, the Lady Healthcare Worker program was identified as being instrumental in improving women's health and nutrition, especially for antenatal care, including iron supplementation. However, at the community-level, government corruption was a perceived barrier to effective program implementation, especially the Benazir Income Support Program for women in poverty. OBDA explained 89% of the observed change in mean hemoglobin, with household enrollment in the Benazir Income Support Program (36%), household wealth (17%), and improvement in women's nutrition [body mass index (in kg/m2): 15%, serum retinol: 12%] emerging as the most critical drivers of anemia decline among nonpregnant women in Pakistan.

CONCLUSIONS

To protect these gains and continue improvements, anemia prevention efforts should continue to focus on improving healthcare access, women's economic empowerment, and poverty alleviation.

Drivers of anemia reduction among women of reproductive age in Senegal: a country case study

BACKGROUND

In Senegal, anemia prevalence among women of reproductive age (WRA) decreased from 59% in 2005 to 54% in 2017. However, determinants of reduction in disease burden under challenging public health conditions have not been studied.

OBJECTIVES

We aimed to conduct a systematic in-depth assessment of the quantitative and qualitative determinants of anemia reduction among WRA in Senegal between 2005 and 2017.

METHODS

Standard Exemplars in Global Health methodology was used for quantitative analyses using Senegal's Demographic and Health Surveys. Qualitative analyses included a systematic literature review, program/policy analysis, and interviews with key stakeholders. A final Oaxaca-Blinder decomposition analysis (OBDA) evaluated the relative contribution of direct and indirect factors.

RESULTS

Among non-pregnant women, mean hemoglobin (Hb) increased from 11.4 g/dL in 2005 to 11.7 g/dL in 2017 (P < 0.0001), corresponding to a 5%-point decrease in anemia prevalence (58% to 53%). However, inequities by geographical region, household wealth, women's educational attainment, urban compared to rural residence, and antenatal care during last pregnancy continue to persist. During this time period, several indirect nutrition programs were implemented, with stakeholders acknowledging the importance of these programs but agreeing there needs to be more consistency, evaluation, and oversight for them to be effective. Our OBDA explained 59% of the observed change in mean Hb, with family planning (25%), malaria prevention programs (17%), use of iron and folic acid (IFA) during last pregnancy (17%), and improvement in women's empowerment (12%) emerging as drivers of anemia decline, corroborating our qualitative and policy analyses.

CONCLUSIONS

Despite a reduction in anemia prevalence, anemia remains a severe public health problem in Senegal. To protect the gains achieved to date, as well as accelerate reduction in WRA anemia burden, focused efforts to reduce gender and social disparities and improve coverage of health services, such as family planning, IFA, and antimalarial programs, are needed.

Drivers of anemia reduction among women of reproductive age in Uganda: a country case study

BACKGROUND

In Uganda, anemia prevalence among women of reproductive age (WRA) decreased from 41% in 2006 to 32% in 2016. The factors associated with this reduction are uncertain.

OBJECTIVES

We conducted a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in Uganda between 2006 and 2016.

METHODS

Employing standard Exemplars in Global Health methodology, quantitative analyses were conducted using Uganda's Demographic and Health Surveys. Qualitative analyses included a comprehensive literature review, program analysis, and stakeholder interviews to identify and understand country-level enablers and barriers to WRA anemia decline in Uganda over the past 2 decades. A final Oaxaca-Blinder decomposition analysis (OBDA) evaluated the relative contribution of direct and indirect factors.

RESULTS

Among nonpregnant women (NPW), mean hemoglobin (Hb) increased from 12.3 g/dL in 2006 to 12.6 g/dL in 2016 (P < 0.01), corresponding to a 9%-point decline in anemia prevalence during this time (from 40% to 31%). However, inequities by geographical region, household wealth, and women's educational attainment persisted. Key programs over the study period included food fortification, the Uganda Anemia Policy, and the Uganda Nutrition Action Plan (UNAP). Stakeholders also identified malaria control, family planning programs, and continued strengthening of Uganda's health care system as key enablers of anemia decline. Our OBDA explained 89% of the observed change in mean Hb, with family planning (27%), increased access to bednets (26%), household sociodemographics (17%), and improvement in women's overall nutrition (body mass index [BMI]: 15%) emerging as the most critical drivers of anemia decline among NPW in Uganda, corroborating our qualitative and policy analyses.

CONCLUSIONS

To protect the hard-fought gains and continue improvements, WRA anemia prevention efforts in Uganda should remain focused on improving health care access especially within antenatal care and malaria control programs. Additionally, multisectoral collaborations and investments to empower women and poverty alleviation strategies need to be enhanced.

Drivers of anemia reduction among women of reproductive age in the Philippines: a country case study

BACKGROUND

Anemia prevalence among women of reproductive age (WRA) in the Philippines was 25% in 2000, decreasing to 13% in 2018. To date, an in-depth assessment of the determinants associated with this decline has not been conducted.

OBJECTIVES

This study aimed to conduct a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in the Philippines between 2008 and 2018.

METHODS

Using standard Exemplars methodology, we conducted quantitative analyses using the Philippines' National Nutrition Survey, the Expanded National Nutrition Survey, and the Philippines National Demographic and Health Surveys. Qualitative analyses included a comprehensive literature review, program/policy analysis, and interviews with stakeholders to understand country-level enablers and barriers to WRA anemia decline in the Philippines. A final Oaxaca-Blinder decomposition analysis evaluated the relative contribution of direct and indirect factors.

RESULTS

Among nonpregnant women (NPW), mean hemoglobin (Hb) increased from 12.7 g/dL in 2008 to 13.1 g/dL in 2018 (P < 0.01), corresponding to an 11%-point decline in anemia prevalence (from 23% to 12%). Inequities by geographical region, household wealth, and women's educational attainment narrowed considerably during this time. Important direct and indirect nutrition programs were introduced during our study period, including universal health care and food fortification. Country experts interviewed credited programs focused on alleviating micronutrient deficiencies and poverty, and improvements in women's health and well-being, for the country's extraordinary success. Oaxaca-Blinder decomposition analysis explained ∼50% of the observed change in mean Hb among NPW, with family planning (35%), household sociodemographics (29%), and improvement in women's nutrition (23%) emerging as critical drivers of anemia decline, corroborating our qualitative and policy analyses.

CONCLUSIONS

To protect these gains, WRA anemia prevention efforts in the Philippines should continue to focus on universal health care access, women's empowerment, and poverty alleviation.

Association Between the Anemia During Pregnancy and Maternal Intensive Care Unit Admissions: A Systematic Review and Meta-Analysis

Anemia during pregnancy is one of the most common conditions that may have adverse consequences on maternal and fetal health. Current evidence is inconsistent with regards to the effects of anemia on maternal ICU admissions. This meta-analysis aimed to examine the overall effect of anemia during pregnancy on maternal ICU admissions. We searched PubMed, Embase, Cochrane Library, and Web of Science for observational studies that compared the risk of ICU admission between anemic and non-anemic pregnant women. We pooled the odds ratios (ORs) for ICU admission using a random-effects model. Heterogeneity among studies was assessed using prediction intervals (PIs), Tau2 and I2 statistics. Sensitivity analysis by excluding outlier studies, meta-regression by sample size and age, and publication bias detection by LFK index and Doi plot was undertaken. Eight studies with a total of 21,997,574 participants in both anemic and non-anemic groups were included. Of them, meta-analysis was conducted in seven studies which yielded a pooled OR for anemia and ICU admission as 1.32 (95% CI 0.62-2.81). There was also a very high level of heterogeneity among studies (PI: 0.10-18.16, I2 = 100%). When an influential study was omitted, the pooled OR 1.16 (95% CI - 1.13; 1.20) for ICU admission was significant. The LFK index was - 3.64, indicating publication bias. Anemia in pregnant women might be associated with a higher risk of ICU admission, but it is essential to interpret this cautiously due to significant heterogeneity and potential publication bias. Registration : PROSPERO database (CRD42023466529).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12288-024-01849-0.

Understanding the determinants of anemia reduction among women of reproductive age: Exemplar country case studies' methodology

BACKGROUND

Since 2000, only a few countries have substantially reduced the burden of anemia among women 15-49 y of age. The Exemplars in Anemia Reduction among Women of Reproductive Age (WRA) studied the determinants of success among these countries.

OBJECTIVES

To describe the methodology used to determine the factors associated with anemia reduction in high-performing countries, with the aim to guide policy and programmatic decisions in other countries with similar sociodemographic and health indices.

METHODS

This article describes the process used to identify countries with exemplary reduction in WRA anemia burden, compared with their peers. We describe the Exemplars in Global Health methodology, the mixed-methods approach used to identify and quantify the macro- and microlevel characteristics associated with anemia burden decline among WRA. Quantitative analyses include descriptive and equity analyses, multivariate linear regression, and Oaxaca-Blinder decomposition analysis. Qualitative analyses include in-depth interviews and focus group discussions with national, subnational, and community stakeholders, as well as review of programs and policies with the potential to impact women's health and/or nutrition, enacted in the countries over the last 20 y. A technical advisory group oversaw all research activities.

RESULTS

We identified 5 countries, namely, Mexico, Pakistan, Philippines, Uganda, and Senegal, as anemia exemplars, after considering the magnitude of anemia decline between 2000 and 2018, availability of ≥2 nationally representative anemia surveys, geographical diversity to account for the complex etiology of anemia, regional representation, and logistics of in-country work.

CONCLUSIONS

Exemplars in Anemia Reduction among WRA seeks to create awareness of how little anemia prevalence has changed globally and aims to inform and spur global efforts for improving women's health and nutrition.

The Interplay Between Iron Metabolism and Insulin Resistance: A Key Factor in Optimizing Obesity Management in Children and Adolescents

Iron plays a vital role in insulin signaling, regulating molecular mechanisms that influence cellular insulin responses. This review explores the link between iron metabolism and insulin resistance (IR) in children and adolescents with obesity. A connection between iron metabolism, iron deficiency (ID), and IR is well-documented, but further longitudinal studies are needed to better understand how iron metabolism influences insulin resistance during childhood and adolescence. This connection warrants attention due to its significant public health implications, as optimizing obesity management could help prevent both ID and metabolic complications in children. Current evidence does not suggest that dietary factors are primary contributors to ID in children. However, there is scientific evidence that weight reduction can restore iron homeostasis in people with obesity. Therefore, efforts should focus on improving dietary habits, increasing awareness of iron's importance, and implementing strategies to address both ID and obesity.

Hemoglobin as a mediator between air pollution and growth outcomes in children under 60 months: the moderating role of nutritional supplementation

BACKGROUND

Prior research has yielded incongruent results about the association between air pollutants and offspring hemoglobin levels, as well as between air pollutants and child development. This may be because previous studies have not taken both air pollution and nutrition into account. This study sought to examine the correlations between postnatal exposure to air pollution (PM2.5, PM10, SO2, and CO), offspring hemoglobin levels, stunting, and underweight. Furthermore, we investigated whether hemoglobin levels mediate these connections and assessed the moderating influence of dietary supplementation on hemoglobin levels and growth outcomes.

METHODS

A unified nutrition package intervention study was conducted in western, China between 2016 and 2023. In accordance with WHO guidelines, stunting, underweight, height-for-age z score (HFA), weight-for-age z score (WFA), and anemia status were all defined. A daily average of PM2.5, PM10, SO2, and CO levels was collected from the National Urban Air Quality Real-Time Dissemination Platform ( http://www.cnemc.cn/sssj/ ) of the China Environmental Monitoring General Station. Linear regression and logistic regression models were used to assess the correlation between air pollution and the above indicators. The mediating role of hemoglobin and the moderating effect of nutritional supplementation were also evaluated.

FINDINGS

This study examined the impact of postnatal air pollution exposure on child growth, mediated by hemoglobin levels and moderated by nutritional supplementation (YingYangBao, YYB). Our findings suggest that air pollution negatively affects growth via reduced hemoglobin levels, but extended nutritional supplementation mitigates this effect. A total of 10,766 children under 5 years of age participated in this study. All four air pollutants were associated with reduced hemoglobin levels, but their effects on growth and development were not uniform. Specifically, PM2.5 and PM10 showed stronger negative associations with HFA and WFA, while SO2 and CO had weaker effects. Air pollution had a greater impact on growth outcomes in anemic children compared to non-anemic children. Hemoglobin levels mediated 13.4% of the effect of air pollution on HFA (VAF = 13.4%, Cohen's f² = 0.15). Furthermore, the duration of YYB moderates the effects of air pollution on hemoglobin and HFA. The direct negative effect of air pollution on HFA was attenuated when the duration of use was > 10 months, whereas in the low use group the pollution effect was enhanced (β=-0.0444, 95%CI: -0.0613, -0.03).

CONCLUSION

Postnatal exposure to air pollution (PM2.5, PM10, SO2, CO) increases the risk of stunting, particularly during the critical developmental window of 6-23 months of age. This effect is partially mediated by hemoglobin levels, and YYB can moderate this relationship. These findings highlight the importance of prolonged nutritional interventions in mitigating the adverse effects of air pollution on child growth and development, with significant implications for public health policies targeting air quality and child nutrition in high-pollution regions.

Prevalence and risk factors of anemia in internationally adopted children: a cohort study

BACKGROUND

Adoptive children, who have often experienced inadequate healthcare, malnutrition, and exposure to infectious diseases in their countries of origin, are vulnerable to a range of health problems among which anemia is a major one, potentially leading to long term sequelae. We aimed to investigate the prevalence and risk factors associated with anemia in a cohort of internationally adopted children evaluated at the Pediatric Clinic of the Policlinico Universitario "A. Gemelli" in Rome. between 2007 and 2023.

METHODS

Retrospective cohort analysis. Demographic and hematological data were collected for each child. Associations between categorical variables was studied with Pearson's or Fisher's test and between quantitative and qualitative variables with Analysis of Variance (ANOVA) with Bonferroni correction. The occurrence of a Hb level inferior to -2SD and that of presenting together Hb Z score < -2SD for and low ferritin have been considered as a binary outcome and studied with multivariable logistic regression models.

RESULTS

Nine hundred and sixty-nine children have been enrolled. Weight and height were significantly lower in children from Asia and India compared to Africa and Latin America. Hb z-scores were significantly lower in the 11-18 age group compared to all other age groups. In univariate analysis, Hb z-scores were associated with black skin color and the presence of parasites in stool. Hemoglobin levels were not associated with patient BMI, creatinine levels, bilirubin, TSH, FT3, FT4, AST, or ALT. The mean corpuscular volume (MCV) was associated in univariate analysis with age at arrival, skin color, Macro-area of origin, duration of institutional stay, iron levels. At same MCV, Hb was higher in Asia compared to Africa (p < 0.001). 55 patients had both Hb and MCV values below two SD. These patients are predominantly characterized by black skin color and originating from Africa and India.

CONCLUSIONS

There is possibly a complex interplay between environmental exposures and genetic predispositions in shaping the health outcomes of adopted children. Healthcare providers who care for internationally adopted children should prioritize comprehensive health assessments that include screening for anemia, nutritional deficiencies, and parasitic infections.

Anemia in Young Children and the Association With Socioeconomic Deprivation Indices

BACKGROUND

Anemia is a global and local child health problem, with consequences that include long-term neurocognitive deficits. This study aimed to determine the prevalence of anemia in young children living in an urban environment and evaluate associations with indices of geospatial deprivation, as measured by the Community Material Deprivation Index (DI) and modified Retail Food Environment Index (mRFEI). The DI uses census variables to capture socioeconomic disadvantage. The mRFEI assesses the ratio of healthy food retailers to all food retailers in a geographic area.

PROCEDURE

This retrospective, cross-sectional study included a cohort of subjects aged 9 months to 6 years who had clinically indicated testing performed at Cincinnati Children's Hospital Medical Center's (CCHMC) clinical laboratories from 2017 to 2020. Residential addresses in the electronic health record were geocoded, geospatially joined to census tracts, and linked to DI and mRFEI values.

RESULTS

Data were available for 13,234 children, with 39% residing in Hamilton County, where CCHMC is located. The prevalence of anemia ranged from 1.0% to 1.6% per year in Hamilton County during the study years. Anemia was significantly associated with living in an area with a higher DI: A 1% increase in the DI corresponded to a 0.2% higher prevalence of anemia (p < 0.001). A 1% decrease in mRFEI was associated with a 0.1% higher prevalence of anemia (p = 0.027).

CONCLUSION

Socioeconomic conditions are associated with anemia prevalence at a population scale. Geospatial indices of deprivation can aid in the identification of children at increased risk for anemia.

The ABCDs of Nutritional Assessment in Infectious Diseases Research

Malnutrition is the most common acquired cause of immunodeficiency worldwide. Nutritional deficiencies can blunt both the innate and adaptive immune response to pathogens. Furthermore, malnutrition is both a cause and consequence of infectious diseases. The bidirectional relationship between infectious diseases and undernutrition, as well as the inflammatory milieu of infectious diseases, can complicate nutritional assessment. This article aims to provide clinicians and researchers with an overview of commonly used tools to assess nutritional status, with a particular emphasis on their use in the context of infectious diseases. These tools include anthropometric, biochemical, clinical/physical, and dietary assessments to screen and evaluate undernutrition, diet quality, and food insecurity effectively.

Childhood Anemia in Mozambique: A Multilevel Mixed-Effects Analysis of 2011-2022/23 Population-Based Surveys

Background/Objectives: Anemia adversely affects children's cognitive and motor development and remains a global public health problem. This study aimed to identify the individual, feeding, household, and community determinants of anemia among children in Mozambique. Methods: We used pooled datasets of two Mozambique representative population-based surveys: the 2011 and 2022-2023 Demographic and Health Surveys. A total sample of 8143 children aged 6-59 months with available hemoglobin testing was included. Multilevel mixed-effects analysis was performed using STATA (18.0). Results: Over a decade, the prevalence of anemia in children aged 6-59 months remained high, increasing slightly from 69.1% in 2011 to 72.9% in 2022. Children aged 6-11 months were less likely to have anemia than children from other age groups (aOR = 0.77, 95% CI = 0.62-0.96). Children who suffered from illnesses (aOR = 1.44, 95% CI = 1.18-1.75), received vitamin A supplements (aOR = 0.76, 95% CI = 0.63-0.93), lived in female-headed households (aOR = 1.16, 95% CI = 1.01-1.32), and who lived in households with unimproved drinking water sources (aOR = 1.40, 95% CI = 1.19-1.65) were more likely to have anemia than their peers. Overall, 16% of the variability in anemia prevalence was attributed to differences between clusters (ICC = 0.16). Conclusions: Childhood anemia remains a critical public health challenge in Mozambique, with prevalence rates exceeding the average for sub-Saharan Africa. Multisectoral approaches to enhance essential supplies' provision and the primary healthcare monitoring of children at risk favored more investments in rural development and sustainable agriculture, water sanitation, and social care and gender-sensitive work policies that can help tackle childhood anemia.

Lack of association between the TMPRSS6 gene polymorphism (rs855791) and anemia: a comprehensive meta-analysis

BACKGROUND

Anemia affects around 1.6 billion people worldwide and presents a significant challenge for healthcare providers. Despite the hemoglobin concentration being commonly used for diagnosis, identifying underlying causes remains challenging, particularly in vulnerable groups like children under five and pregnant women. Genetic factors, notably variations in the TMPRSS6 gene, are implicated in iron deficiency anemia, yet the precise relationship with anemia remains unclear.

METHODS

A thorough literature search was conducted across databases, including Embase, Google Scholar, and PubMed, focusing on studies investigating TMPRSS6 gene polymorphisms and anemia. Thirteen eligible studies, comprising 2082 cases and 2684 controls, underwent meta-analysis using Review Manager 5.4 software. Various genetic models were assessed, including allelic, homozygous, heterozygous, dominant, and recessive, with no significant relationship found between the TMPRSS6 rs855791 polymorphism and anemia.

CONCLUSION

This meta-analysis provides robust evidence suggesting no significant association between the TMPRSS6 rs855791gene polymorphism and anemia. These findings underscore the complexity of genetic factors contributing to anemia and emphasize the importance of the further investigation to unravel the mechanisms underlying this relationship for improved diagnostic and therapeutic approaches.

KDM4B modulates autocrine IL6 in erythroblasts to prevent ineffective erythropoiesis

Ineffective erythropoiesis (IE) commonly underlies anemia in congenital disorders. However, the causes of IE remain largely unknown. Recently, attention has been drawn to the involvement of nucleated erythrocytes in immune responses, providing a new perspective for exploring the etiology of IE. In this study, we found that the kdm4b-/- mutant zebrafish developed an IE-like defect, including impaired terminal maturation and apoptosis of erythroblasts, as confirmed by observations in Kdm4b-/- mutant mice. Thus, the Kdm4b mutant serves as an appropriate model for studying IE. Mechanistically, kdm4b primarily targets interleukin 6 (il6) to regulate the previously underrated immune activity of embryonic erythroblasts. The erythroblast-secreted Il6, in the absence of kdm4b, increased pro-inflammatory activities of myeloid cells and elevated T cell counts. Meanwhile, the activated Il6-pStat3 signaling elevated mitochondrial oxidative stress, leading to the maturation arrest of erythroblasts. Collectively, we demonstrate an important role for kdm4b in coordinating terminal maturation and immune function in erythroblasts. These findings might shed light on our understanding of the etiology of IE and the discovery of new effective compounds.

Anaemia, overweight and abdominal obesity in mothers and children are associated with the food environment in socially vulnerable areas of a northeastern Brazilian capital

This study aimed to assess the association between community and consumer food environment (FE) measures and anaemia, overweight and abdominal obesity in mother-child dyads living in situations of social vulnerability. A cross-sectional study was carried out in 40 favelas in a capital city in the northeast of Brazil. The sample consisted of 1882 women and 665 children aged under 5 years. The community FE was assessed using a scale of perception of the availability of healthy food in the neighbourhood. Consumer FE was assessed by auditing 624 retail food stores using the AUDITNOVA instrument. This investigated various aspects of the food environment and evaluated the availability of 18 ultra-processed foods (UPF) most consumed by the Brazilian population available in these stores. The presence of overweight was assessed by measuring the weight and height of the mother and the child, and abdominal obesity was assessed by measuring the mother's waist circumference. The presence of anaemia in the mother and the child was assessed by measuring haemoglobin. Adjusted multilevel regression models were used to verify associations between the FE and malnutrition in mother-child dyads. Low perception of community FE was associated with higher risk of women being overweight (OR: 1.35; 95% CI: 1.05-1.73) and abdominally obese (OR: 1.38; 95% CI: 1.04-1.84); low health scores in food shops were associated with higher risk of abdominal obesity (OR: 1.35; 95% CI: 1.01-1.79) and anaemia (OR: 1.16; 95% CI: 1.02-1.98) in women and overweight in children (OR: 1.69; 95% CI: 1.05-2.73); and the high availability of UPF in retail shops was associated with increased odds of overweight (OR: 2.64; 95% CI: 1.61-4.33) and anaemia (OR: 2.11; 95% CI: 1.38-3.02) in children by 164% and 111%, respectively. It was observed that less healthy food environments are associated with greater chances of anaemia, overweight and abdominal obesity in mothers and children under 5 years in situations of social vulnerability in Brazil.

Association between hemoglobin level and clinical outcomes in ischemic stroke patients with high-grade carotid artery stenosis

OBJECTIVE

Abnormal hemoglobin levels may influence stroke outcome, while high-grade carotid artery stenosis (CAS) is linked to distal hemodynamic compromise. The relationship between hemoglobin and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate this association in acute IS patients with high-grade CAS.

METHODS

To compare the characteristics and outcome in acute IS patients with high-grade CAS across different hemoglobin levels, we conducted an observational cohort study from January 2007 to April 2012 and followed for 5 years.

RESULTS

Among 372 enrolled patients, 75 had hemoglobin < 12 g/dL, 153 had 12-14 g/dL, and 144 had > 14 g/dL. Hemoglobin < 12 g/dL was associated with higher rates of congestive heart failure, gout, and chronic kidney disease, but lower rate of hyperlipidemia. Hemoglobin< 12 g/dL had lower levels of white blood cells, total cholesterol, and estimated glomerular filtration rate, but higher levels of high-sensitivity C-reactive protein and potassium. The Cox proportional hazards model revealed that hemoglobin< 12 g/dL was associated with higher risk of all-cause mortality (hazard ratio (HR) 1.99, 95 % confidence interval (CI) 1.20-3.32, P = 0.008) and lower risk of stroke recurrence over 5 years in IS patients with high-grade CAS (HR 0.50, 95 % CI 0.26-0.95; P = 0.033).

CONCLUSIONS

Hemoglobin< 12 g/dL was associated with higher mortality and lower stroke recurrence risk over 5 years in IS patients with high-grade CAS. Further studies are warranted to determine the optimal hemoglobin level for improving outcomes in these patients.

The Association Between Ambient Particulate Matter Exposure and Anemia in HIV/AIDS Patients

BACKGROUND

Anemia is common among HIV/AIDS patients, impacting prognosis. Particulate matter (PM) exposure is an understudied, potentially modifiable risk factor in this group.

METHODS

We gathered 36,266 hemoglobin (Hb) measurements from 6808 HIV/AIDS patients from the HIV/AIDS Comprehensive Response Information Management System from 1 January 2004 to 31 December 2021. We evaluated the relationship between Hb levels and short-term PM exposure using linear mixed-effects models. We used logistic regression to estimate the association of long-term PM exposure with baseline anemia prevalence and time-varying Cox models to estimate the association of long-term PM exposure with follow-up incidence of anemia. Mediation analysis explored the role of chronic kidney disease (CKD) in the association between PM exposure and anemia.

RESULTS

For every 5 µg/m³ increase in 28-day average PM 1 , Hb levels decreased by 0.43 g/l. For a 10 µg/m³ increase in PM 2.5 , Hb decreased by 0.55 g/l; for the same increase in PM 10, Hb decreased by 0.35 g/l. A 5 µg/m³ increase in 1-year average PM 1 corresponded to a 7% higher prevalence of anemia at baseline, a 10 µg/m³ increase in PM 2.5 to 8% higher prevalence, and a 10 µg/m³ increase in PM 10 to 6% higher prevalence. These rises in average PM concentrations during follow-up were associated with increased incident anemia by 54% (PM 1 ), 72% (PM 2.5 ), and 51% (PM 10 ). CKD partially mediated the positive associations between PM exposure and the incidence of anemia.

CONCLUSION

PM exposure was associated with lower Hb levels and higher incidence of anemia in HIV/AIDS patients and CKD with mediating estimated effects in PM-induced anemia.

Building capacity for pediatric hematological diseases in Sub-Saharan Africa

ABSTRACT

The spectrum of hematological diseases in African children includes anemias, bleeding disorders, thromboses, and oncological diseases such as leukemias. Although data are limited, outcomes for these diseases are poorer in Africa. The dearth of specialists, and lack of infrastructure that supports diagnosis and management, have been identified as key barriers to improving outcomes for childhood hematological disorders in Sub-Saharan Africa (SSA). To address these, intentional capacity building efforts addressing education and training, diagnostic capacity, and access to blood products and medicines are needed. This article explores some ongoing efforts in the region aimed at fostering the capacity to identify and treat childhood hematological disorders across a breadth of initiatives targeting the critical themes of education, diagnostic support, and treatment. We also identify existing opportunities through international partnerships, to build sustainable programs that can support children with hematological diseases in SSA.

Role of hepcidin on benefits and risks of supplementation with iron syrup and multiple micronutrient powders in Bangladeshi children: a substudy to a randomized controlled trial

BACKGROUND

Hepcidin can determine individuals' responses to iron supplementation, but limited evidence exists from pediatric trials.

OBJECTIVES

We aimed to examine the influence of hepcidin on the effects of supplementation with iron syrup and multiple micronutrient powders (MNPs) on hemoglobin and ferritin concentrations and the incidence of diarrhea in young children.

METHODS

Participants included a subsample of 1281 8-mo-old children enrolled in a 3-arm, double-blind, double-dummy, individually randomized controlled trial examining the efficacy of 3 mo of universal supplementation with daily iron syrup (12.5 mg iron), MNPs (containing 12.5 mg iron), or placebo in children living in Bangladesh. In all participants at baseline, immediately postintervention (month 3), and after a further 9 mo of follow-up (month 12), serum hepcidin concentrations were measured by enzyme-linked immunosorbent assay, venous hemoglobin by HemoCue 301, and incidence of diarrhea by caregiver report. We used a likelihood-based longitudinal data analysis model to examine effect modification from baseline hepcidin on the effects of iron syrup or MNPs on hemoglobin and ferritin concentrations and a log-binomial model on the incidence of diarrhea at months 3 and 12.

RESULTS

Hepcidin modified the effect of MNPs, but not iron syrup, compared with placebo on hemoglobin and ferritin concentrations immediately postintervention. The treatment effect of MNPs compared with placebo in the change from baseline to month 3 was larger among children with low compared with not-low baseline hepcidin [hemoglobin: mean difference 11.6 g/L (7.2, 15.9) compared with 4.3 (3.09, 5.7), P-interaction = 0.002; ferritin: geometric mean ratio 2.4 (1.6, 3.6) compared with 1.5 (1.3, 1.7), P-interaction = 0.024]. This effect modification was not sustained at month 12. Hepcidin did not modify the effects of either intervention on the incidence of diarrhea.

CONCLUSIONS

Immediate effects of MNPs on child hemoglobin and iron status are larger among those with low compared with not-low hepcidin, indicating that preintervention screening could help identify those who would benefit most from MNPs. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12617000660381.

The association between dietary inflammatory index and anemia in individuals with diabetes mellitus

Background

Diabetes mellitus (DM) has emerged as a significant component of the global health crisis, closely linked with anemia. Studies have demonstrated a connection between anemia and inflammation. The Dietary Inflammatory Index (DII) is a novel metric for evaluating the overall inflammatory or anti-inflammatory impact of dietary intake. While risk factors for DM are linked to an unhealthy diet, there is currently insufficient research regarding the correlation between DII and anemia among individuals with DM. This study aims to investigate the correlation between DII and anemia among American individuals with DM.

Methods

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) database, encompassing 4,435 participants recorded between 2007 and 2016. We conducted a weighted multivariable logistic regression analysis to investigate the correlation between the DII and anemia of individuals with DM. Furthermore, we explored their relationship through subgroup analysis and smooth curve fitting techniques.

Results

This study comprised 726 participants with DM who were anemic and 3,709 who were non-anemic; notably, anemic participants exhibited elevated DII scores (2.05 ± 1.50 vs. 1.70 ± 1.59). In the fully adjusted model, we noted a positive correlation between the DII and anemia (Odds Ratio [OR] = 1.09, 95% Confidence Interval [CI] =1.03 to 1.16, p = 0.004). Participants in the fully adjusted model had a 9% higher prevalence of anemia for each unit increase in DII. The significant association between anemia and DII persisted even after subgroup analysis. Smooth curve fitting analysis revealed a positive correlation between DII and anemia.

Conclusion

There is a positive correlation between DII and anemia in individuals with DM in the United States. It provides important insights into dietary management strategies for diabetic patients with anemia.

Postmortem point-of care hemoglobin testing is feasible and potentially accurate among children in South Africa

Anemia is an important cause of child morbidity and mortality. Postmortem point-of-care hemoglobin testing is a potential method for assessing anemia at death, but its reliability has not been extensively studied. We aimed to assess the feasibility and validity of postmortem point-of-care hemoglobin assessment using HemoCue in the setting of a child mortality surveillance program in South Africa.In a pilot cohort study, 44 children under five years of age who died in an academic hospital in South Africa were enrolled. Hemoglobin levels were measured from venous blood antemortem using standard hematology analyzers and postmortem using the HemoCue 201 from blood collected within 72 hours of death (either by needle aspiration or from whole blood collected in an EDTA tube). Updated World Health Organization hemoglobin cutoffs to define anemia were used. Wilcoxon signed-rank tests, equivalence tests, and regression models assessed the concordance between antemortem and postmortem hemoglobin concentrations. Postmortem testing showed a significant decrease in hemoglobin concentrations compared to antemortem levels. However, no significant differences were found between hemoglobin measurements from needle aspiration and those from EDTA tubes postmortem. The prevalence of anemia increased from 52% antemortem to 73-77% postmortem, with the most notable rises in moderate and severe anemia. Bland-Altman analysis confirmed a systematic, not random, decrease in postmortem hemoglobin measurements. Upon applying a fixed adjustment of 2.5 g/dL, the sensitivity and specificity of postmortem hemoglobin testing to diagnose anemia were 69.6% and 61.9%, respectively. Postmortem point-of-care hemoglobin testing using HemoCue is feasible and offers a potentially valid reflection of antemortem anemia status in deceased children, despite consistently lower measured values postmortem. These findings support the utility of postmortem hemoglobin assessments in determining the presence and severity of anemia at the time of death.

Predictors of Anaemia Among Young Children Receiving Daily Micronutrient Powders (MNPs) for 24 Weeks in Bangladesh: A Secondary Analysis of the Zinc in Powders Trial

In Bangladesh, anaemia is estimated to affect 52% of children 6-59 months, with the youngest children (6-23 months) experiencing the highest levels of anaemia (71%). Micronutrient powders (MNPs) are designed to increase micronutrient intake in young children; however, in some settings, the prevalence of anaemia may remain elevated despite the high coverage of MNPs. In a secondary analysis of the Zinc in Powders trial (ZiPT), we identified risk factors that were associated with anaemia among Bangladeshi children 9-11 months of age who received standard 15-component MNPs, including 10 mg of iron, daily for 24 weeks. At enrolment, socio-demographic characteristics were collected. Morbidity symptoms were assessed on a semi-weekly basis. Haemoglobin (measured via single-drop capillary blood using Hemocue 301+) and child anthropometry were assessed at enrolment and endline (24 weeks). Risk factors for anaemia at endline (24 weeks) were identified using minimally adjusted (age and sex) logistic regression models. Multivariate models were subsequently constructed, controlling for age, sex and significant risk factors. Of the 481 children randomized to the MNP arm, 442 completed the trial and had haemoglobin data available at endline. Anaemia (haemoglobin < 10.5 g/dL) prevalence declined from 54.1% at baseline to 32.6% at endline. In minimally adjusted models, season of enrolment, underweight at enrolment, asset score, hygiene score and frequent morbidity symptoms were associated with the odds of anaemia at endline. However, some factors lost statistical significance in multivariate models. MNPs are an important tool for anaemia prevention; however, they should be part of an integrated approach for anaemia control.

Effect of nutrition education on hemoglobin level of pregnant women in Southeast Ethiopia: a cluster randomized controlled trial

BACKGROUND

Maternal hemoglobin (Hgb) is considered an essential, modifiable risk factor for adverse pregnancy outcomes (APOs). Evidence for the effect of nutrition education on the Hgb levels of pregnant women in low-income countries, including Ethiopia, is inconclusive. This study aimed to assess the effect of nutrition education on the Hgb levels of pregnant women in urban settings in the Bale Zone, Southeast Ethiopia.

METHODS

A community-based two-arm parallel cluster randomized controlled trial was carried out among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control groups) at health facilities from February to December 2021. A multistage cluster sampling technique followed by systematic sampling was used to select the pregnant women. Pregnant women who took part in the intervention arm received six nutrition education sessions, whereas pregnant women in the control group received routine standard care. We used a pretested, interviewer-administered, structured questionnaire to collect the data. The Hgb level of pregnant women was measured by collecting a finger-prick blood sample using a HemoCue Hb 301. A generalized estimating equation (GEE) model was used to isolate the net effect of the intervention on Hgb, accounting for the clustering. Beta coefficients (β) along with a 95% confidence interval (CI) were used for interpretations.

RESULTS

The mean difference in Hgb levels between the intervention and control groups was 0.12 ± 0.04 (P value < 0.002). The multivariable GEE linear model revealed that nutrition education significantly improved the Hgb levels of pregnant women [β = 0.36, 95% CI: (0.30, 0.43)]. An increase in the consumption of a cup of coffee or tea decreased Hgb levels by 0.14 g/dL [β = -0.14, 95% CI: (-0.23, -0.06)].

CONCLUSION

The findings showed that a comprehensive nutrition education intervention using the health belief model (HBM) and theory of planned behaviour (TPB) designed to improve dietary diversity substantially improved hemoglobin (Hgb) levels among pregnant women. While we found no single dietary factor to be significant, in this group of pregnant women in Ethiopia, an increase in the daily consumption of a cup of coffee or tea decreased Hgb levels. As a consequence, pregnant women should be advised to limit their coffee or tea consumption. The study was registered on Clinicaltrials.gov retrospectively with the registration number PACTR202201731802989 on 24/01/2022.

The impact of anemia on left ventricular function and deformation in patients with essential hypertension: a cardiac magnetic resonance study

Background

Hypertension (HTN) and anemia contribute to left ventricular (LV) hypertrophy and are associated with adverse outcomes. Anemia is often overlooked in patients with HTN, and its combined impact on the heart may be underestimated. The study aims to investigate the additive effects of anemia on LV function and global strains in individuals with essential HTN, utilizing cardiac magnetic resonance (CMR) imaging.

Methods

A total of 238 patients diagnosed with HTN and 67 sex- and age-matched controls who underwent CMR examination were retrospectively included. All HTN patients were divided into two groups: 88 with anemia and 150 without anemia. LV performance was evaluated using CMR including LV function parameters, LV global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS). Comparisons among the three groups were conducted using one-way analysis of variance (ANOVA), the Kruskal-Wallis test, or the Chi-squared test. Additionally, multivariable linear regression analysis was performed to investigate factors associated with LV global strains.

Results

The HTN patients with anemia were older and had lower hemoglobin concentration and estimated glomerular filtration rate, and higher indices for LV end-diastolic volume, end-systolic volume, mass index, and mass/volume ratio compared with the control group and HTN without anemia group (all P<0.001). Additionally, the GLPS and GCPS deteriorated progressively from the HTN without anemia group to the HTN with anemia group when compared with the control group (all P<0.001). After adjusting for age, GLPS (-10.40%±0.46% vs. -11.95%±0.35%, P=0.008), GCPS (-16.60%±0.52% vs. -18.08%±0.39%, P=0.025), and GRPS (28.95%±1.49% vs. 32.72%±1.14%, P=0.048) were significantly poorer in HTN patients with anemia compared with those without anemia. Furthermore, multivariate analysis revealed significant independent associations between anemia and GLPS (β =0.308, P=0.002), GCPS (β =0.273, P=0.004), and GRPS (β =-0.142, P=0.021).

Conclusions

Anemia has additive deleterious effects on LV function and global strains in patients with HTN. Regular monitoring and early intervention of anemia might be beneficial for patients with HTN.

[Comparison of a portable hemoglobinometer (Verio Q Red) with clinical laboratory results in routine clinical practice]

OBJECTIVE

To analyze the concordance between a hemoglobinometer with capillary blood sample and the clinical laboratory with a venous blood sample.

DESIGN

Cross-sectional concordance study.

LOCATION

Care Centre Primary Bufalà-Canyet Primary and Care Centre Primary Dalt la Vila Primary Care Center, Badalona, Barcelona.

PARTICIPANTS

Random selection of participants who attended routine blood tests. Over 18years old. No abandonment or loss was obtained.

MAIN INTERVENTIONS AND MEASUREMENTS

Sex, age, and reason for the blood test were collected from the medical history. Venous blood is drawn, and simultaneously, capillary blood is collected.

RESULTS

120 individuals are included, with an average age of 58.9years. The Bland-Almant graph showed differences within the confidence intervals for hemoglobin and hematocrit. The mean differences between the values of the Verio Q Red hemoglobinometer and those of the clinical laboratory were -0.42mg/dl for hemoglobin and -1.25% for hematocrit. The intraclass correlation coefficient showed excellent correlation for hemoglobin and hematocrit between the Verio Q Red hemoglobinometer and the clinical laboratory. Pearson's correlation for hemoglobin was 0.737 and for hematocrit 0.787.

CONCLUSIONS

The Verio Q hemoglobinometer is a valid tool for the early diagnosis of anemias and can be very useful in primary care consultations.

An approach to Hemequity: Identifying the barriers and facilitators of iron deficiency reduction strategies in low- to middle-income countries

Approximately 1.92 billion people worldwide are anaemic, and iron deficiency is the most common cause. Iron deficiency anaemia (IDA) disproportionately affects women of reproductive age and remains under-addressed in low- to middle-income countries (LMICs). The primary objective of our scoping review is to evaluate the barriers and facilitators to IDA management in LMICs by using an intersectionality-enhanced implementation science lens adapted from the consolidated framework for implementation research and the theoretical domains framework. A total of 53 studies were identified. Contextual barriers included the deprioritization of IDA risk, unequal gender norms and stigma from the HIV/AIDS epidemic. Regional poverty, conflict and natural disasters led to supply chain barriers. Individual-level facilitators included partner support and antenatal care access while barriers included forgetfulness and having medical comorbidities. Successful interventions also utilized education initiatives to empower women in community decision-making. Moreover, community mobilization and the degree of community ownership determined the sustainability of IDA reduction strategies. IDA is not only a medical problem, but one that is rooted in the sociocultural and political context. Future approaches must recognize the resilience of LMIC communities and acknowledge the importance of knowledge translation rooted in community ownership and empowerment.

Deciphering the role of hepcidin in iron metabolism and anemia management

One of the most common diseases worldwide is anemia, which is characterized by insufficient erythrocyte production. Numerous complex factors, such as chronic diseases, genetic mutations, and nutritional inadequacies, contribute to this widespread syndrome. This review focuses specifically on anemias caused by defective hepcidin production. Hepcidin, a peptide hormone produced primarily by liver cells, plays a crucial role in regulating iron levels by controlling its absorption. Hepcidin's mechanism of action involves binding to the ferroportin iron transporter, causing its internalization. Disturbances in iron metabolism can have far-reaching consequences, affecting not only the blood but also organs like the liver, kidneys, and brain. Iron homeostasis is crucial for maintaining optimal physiological function. Several blood-based markers are employed to assess iron stores. However, these markers have inherent limitations. Hepcidin, a key regulator of iron metabolism, plays a pivotal role in preventing iron release into the plasma from absorptive enterocytes and macrophages. Elucidating the structure and function of hepcidin is essential for understanding its role in iron homeostasis, which has significant implications for the diagnosis and management of various anemia subtypes. A well-established correlation exists between hepcidin dysregulation and iron deficiency. Despite its potential as a biomarker, the clinical application of hepcidin is hindered by the lack of a commercially available, clinically validated assay. This review aims to provide a comprehensive overview of hepcidin's role in regulating blood iron concentrations and elucidate its implications in the pathogenesis of various anemia subtypes, paving the way for its future applications in research and clinical practice.

From the marrow to the blood: optimising the diagnosis of iron deficiency in the setting of inflammation

Iron deficiency (ID) is a common condition with readily available treatment but can be challenging to diagnose. Traditional biomarkers of ID are acute-phase reactants, which complicate diagnosis in patients with co-existent inflammation. This study aimed to establish optimal biomarker diagnostic thresholds for ID diagnosis using bone marrow (BM) iron stores as the gold standard and the C-reactive protein (CRP) as an inflammatory marker. A cross-sectional study was carried out in the haematology department of a tertiary academic hospital. Patients undergoing BM biopsies for any reason were recruited for inclusion. Retrospective case finding was used to enrich the data for cases with confirmed BM ID. Laboratory markers including red cell indices, reticulocyte haemoglobin and iron studies were evaluated to establish optimal cut-offs for ID diagnosis. A CRP of >5 mg/L was used as a marker of inflammation. The study included 139 patients. Forty-two had BM ID, with a median serum ferritin (SF) of 48.5 μg/L. Ninety-six of 134 (72%) had inflammation with a CRP >5 mg/L. An SF of <80 μg/L had optimal sensitivity (69%) and specificity (94%) for ID diagnosis in the whole group (odds ratio 23.5; 95% confidence interval 4.3-129). In patients without inflammation, an SF cut-off of 80 μg/L had high sensitivity (93%) and specificity (96%). An SF <200 μg/L indicated ID in those with inflammation (sensitivity 78%, specificity 74%). A transferrin saturation of <13% in those with inflammation increased the diagnostic specificity (92%). The reticulocyte haemoglobin was unhelpful in diagnosing ID in this setting. In this hospital population, SF was the best parameter to diagnose ID, even in the presence of inflammation. The CRP was useful to identify populations with inflammation in whom higher SF thresholds could be used together with the transferrin saturation to accurately diagnose ID.

Predictors of Stunting and Pathway Analysis for Linear Growth among Children Aged Two to Three Years after a Trial of Small-Quantity Lipid-Based Nutrient Supplements and Home-Installed Growth Charts in Three Districts in Zambia

BACKGROUND

Globally, 148 million children aged <5 y are stunted, with risk factors varying by context. Our "Impact of Growth Charts and Nutritional Supplements on Child Growth in Zambia" (ZamCharts) trial observed persistently high rates of stunting in all treatment groups after 18-mo of intervention with monthly distributions of small-quantity lipid-based nutrient supplements (SQ-LNS) and/or installation of a wall-mounted growth chart in children's homes.

OBJECTIVES

We sought to identify determinants of stunting and height-for-age z-score in children aged 27-36 mo who participated in the ZamCharts endline survey (n = 1911).

METHODS

Multilevel, log-binomial models were used to estimate univariable and multivariable prevalence ratios for predictors of stunting. Multilevel models were also used to predict height-for-age z-score (HAZ) with and without baseline HAZ (assessed at ages 211 mo). We also conducted a path analysis using covariance analysis of linear structural equations to assess underlying and modifiable risk factors for impaired linear growth.

RESULTS

Significant predictors of stunting in the multivariable model included low asset ownership, being male, using biomass as cooking fuel, lower maternal height, a mother with ≤ primary education, lower baseline HAZ, and not being randomly assigned to SQ-LNS. Significant predictors of a lower mean HAZ in the full multivariable models included all the same risk factors that predicted stunting but also living in an urban area, having ≥1 child aged <5 y in the household, and diarrhea in the previous 2 wk. The multivariable model explained 48% of variability in endline HAZ; the strongest predictor was baseline HAZ, which explained 29% of endline HAZ variability in the univariable model.

CONCLUSIONS

Preventing stunting in Zambia will require investments in early life (pre- and postnatal) determinants of growth trajectory as well as improving complementary feeding practices and addressing risk factors for infectious diseases; SQ-LNS can also improve linear growth and reduce stunting.

Red Blood Cell-Related Phenotype-Genotype Correlations in Chronic and Acute Critical Illnesses (Traumatic Brain Injury Cohort and COVID-19 Cohort)

Changes in red blood cell (RBC)-related parameters and anemia are common in both severe chronic and acute diseases. RBC-related phenotypes have a heritable component. However, it is unclear whether the contribution of genetic variability is pronounced when hematological parameters are affected by physiological stress. In this study, we analyzed RBC-related phenotypes and phenotype-genotype correlations in two exome-sequenced patient cohorts with or at a high risk for a critical illness: chronic TBI patients admitted for rehabilitation and patients with acute COVID-19. In the analysis of exome data, we focused on the cumulative effects of rare high-impact variants (qualifying variants, QVs) in specific gene sets, represented by Notch signaling pathway genes, based on the results of enrichment analysis in anemic TBI patients and three predefined gene sets for phenotypes of interest derived from GO, GWAS, and HPO resources. In both patient cohorts, anemia was associated with the cumulative effects of QVs in the GO (TBI: p = 0.0003, OR = 2.47 (1.54-4.88); COVID-19: p = 0.0004, OR = 2.12 (1.39-3.25)) and Notch pathway-derived (TBI: p = 0.0017, OR = 2.33 (1.35-4.02); COVID-19: p = 0.0012, OR =8.00 (1.79-35.74)) gene sets. In the multiple linear regression analysis, genetic variables contributed to RBC indices in patients with TBI. In COVID-19 patients, QVs in Notch pathway genes influenced RBC, HGB, and HCT levels, whereas genes from other sets influenced MCHC levels. Thus, in this exploratory study, exome data analysis yielded similar and different results in the two patient cohorts, supporting the view that genetic factors may contribute to RBC-related phenotypic performance in both severe chronic and acute health conditions.

Association between occupational exposure to gasoline and anemia: a retrospective cohort study in China

BACKGROUND

Anemia is a major global burden, and occupational gasoline exposure is a common occupational hazard factor. Although previous studies have shown that there is a potential relationship between occupational gasoline exposure and the increase of anemia prevalence, this relationship has not been fully explored. The current cohort study aimed to investigate the association between occupational exposure to gasoline and anemia, and the effect of gasoline concentration on hemoglobin (Hb) levels.

METHODS

This retrospective cohort study collected baseline data from 1451 workers, including 605 exposed to gasoline and 846 not exposed to gasoline. Participants were enrolled in 2013-2015, and follow-up in 2019. Anemia was diagnosed according to WHO guidelines on hemoglobin cutoffs to define anemia in individuals and populations. Occupational exposure concentration of gasoline was measured based on the Chinese national standard (GBZ-T300.62-2017). Logistic regression was conducted to analyze the associations of occupational exposure to gasoline and anemia.

RESULTS

The incidence of anemia among workers exposed to gasoline was significantly higher than that among non-exposed workers (relative risk [RR] = 11.03, 95% confidence interval [CI]: 9.45-12.53). The risks of anemia were significantly higher among participants exposed to gasoline concentrations ≥ 43.20 mg/m³ (RR = 13.92, 95%CI: 12.25-15.28), 18.01-43.19 mg/m³ (RR = 12.93, 95%CI: 11.07-14.51), and 0.01-18.00 mg/m³ (RR = 5.49, 95%CI: 3.96-7.32) compared with the control non-exposed group. The risk of anemia was significantly higher among exposed workers, after adjusting for all confounding factors. There was also a significant negative correlation between gasoline exposure concentration and hemoglobin level.

CONCLUSIONS

Occupational exposure to gasoline is associated with an increased incidence of anemia, with a positive correlation between occupational gasoline exposure levels and the severity of anemia. The incidence and severity of anemia increase while hemoglobin levels decrease in line with increasing gasoline exposure concentrations. These findings emphasize the importance of assessing anemia in workers exposed to gasoline.

Harnessing the power of proteins in modulation of miRNAs for targeting Iron deficiency Anemia: Opinion for future implications and strategies

Iron Deficiency Anemia (IDA) remains a pervasive global health challenge, disproportionately affecting vulnerable populations such as women and children. This review explores the cutting-edge interplay between microRNAs (miRNAs) and proteins in erythropoiesis, highlighting novel therapeutic strategies for IDA. Emerging evidence underscores the pivotal role of miRNAs-such as miR-15a, miR-24, miR-150, and miR-223-in regulating erythropoiesis, with dysregulation linked to hematologic and systemic diseases. Proteins, acting as modulators of miRNA activity, present innovative pathways for intervention by influencing erythropoiesis at multiple stages, from stem cell proliferation to red blood cell maturation. Our synthesis highlights key molecular mechanisms: miR-15a suppresses erythropoiesis by inhibiting c-Myb, miR-24 impairs heme biosynthesis through ALK4 regulation, while miR-150 and miR-223 modulate critical hematopoietic pathways affecting cell differentiation and apoptosis. These miRNA-protein interactions suggest targeted therapies such as protein-based miRNA modulators could optimize erythropoiesis, advancing IDA management. Additionally, the review emphasizes the potential of leveraging protein-miRNA interactions for precision medicine, especially in resource-limited settings where anemia's burden is profound. By bridging current knowledge gaps, our proposed strategies offer personalized and scalable therapeutic solutions. This comprehensive perspective lays the groundwork for future interventions addressing one of the world's most widespread public health crises.

Metal Ion Signaling in Biomedicine

Complex multicellular organisms are composed of distinct tissues involving specialized cells that can perform specific functions, making such life forms possible. Species are defined by their genomes, and differences between individuals within a given species directly result from variations in their genetic codes. While genetic alterations can give rise to disease-causing acquisitions of distinct cell identities, it is now well-established that biochemical imbalances within a cell can also lead to cellular dysfunction and diseases. Specifically, nongenetic chemical events orchestrate cell metabolism and transcriptional programs that govern functional cell identity. Thus, imbalances in cell signaling, which broadly defines the conversion of extracellular signals into intracellular biochemical changes, can also contribute to the acquisition of diseased cell states. Metal ions exhibit unique chemical properties that can be exploited by the cell. For instance, metal ions maintain the ionic balance within the cell, coordinate amino acid residues or nucleobases altering folding and function of biomolecules, or directly catalyze specific chemical reactions. Thus, metals are essential cell signaling effectors in normal physiology and disease. Deciphering metal ion signaling is a challenging endeavor that can illuminate pathways to be targeted for therapeutic intervention. Here, we review key cellular processes where metal ions play essential roles and describe how targeting metal ion signaling pathways has been instrumental to dissecting the biochemistry of the cell and how this has led to the development of effective therapeutic strategies.

Citric acid vapor-assisted crosslinking of zein/PEG composite nanofiber membrane embedded with nisin by electrospinning for the cooled goose meat preservation

This study demonstrated the fabrication of zein/polyethylene glycol/nisin (zein/PEG/nisin) nanofiber membrane and cross-linked by citric acid vapor (zein/PEG/nisin/C). The distribution within the whole nanofiber membranes was monitored by scanning electron microscopy (SEM). Studies using thermogravimetric analysis (TGA) and Fourier transform infrared spectroscopy (FTIR) validated the effectiveness nisin encapsulation and molecular interactions. The water vapor permeability (WVP) and oxygen permeability (OP) of zein/PEG/nisin/C are 150.47 ± 7.14 (g m-2 24h) and 59.74 ± 3.10 (cm3 m-2 24h), respectively. Antibacterial experiments have shown that the antibacterial effect of zein/PEG/nisin/C on Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) and the diameters of the bacteriostatic circle were 11.52 ± 0.44 mm and 10.67 ± 0.46 mm, respectively. During 10 days of the storage of the cooled fresh goose meat, compared with the control group, the pH of zein/PEG/nisin/C nanofiber membrane was 5.7, the concentration of the total volatile basic nitrogen (TVB-N) and the value of total viable count (TVC) and thiobarbituric acids (TBARS) are 11.28 mg/100g, 5.01 ± 0.69 log (CFU g-1), and 0.83 mg kg-1, respectively. These results point to the possibility of using functionalized nanofiber membranes for the cold fresh goose meat preservation facilitated by vaporized citric acid cross-linking.

Comparison of a non-invasive point-of-care measurement of anemia to conventionally used HemoCue devices in Gambella refugee camp, Ethiopia, 2022

Annual surveys of refugees in Gambella, Ethiopia suggest that anemia is a persistent public health problem among non-pregnant women of reproductive age (NP-WRA, 15-49 years). Measurement of anemia in most refugee camp settings is conducted using an invasive HemoCue 301. We assessed the accuracy and precision of a non-invasive, pulse CO-oximeter in measuring anemia among NP-WRA in four Gambella refugee camps. We conducted a population-representative household survey between November 7 and December 4, 2022. Hemoglobin (Hb) concentration was measured by HemoCue 301, using capillary blood, and Rad-67, a novel non-invasive device. We collected four measurements per participant: two per device. We calculated Rad-67 bias and precision of Hb measurements and sensitivity and specificity of detecting anemia. Of the 812 NP-WRAs selected, 807 (99%) participated in the study. Anemia was detected in 39% of NP-WRA as classified by the Rad-67 compared with 47% of NP-WRA as classified by the HemoCue 301. Average bias of Rad-67 measurements was 1.1 ± 1.0 SD g/dL, using HemoCue 301 as a comparator. Absolute mean difference between the first and second measurements was 0.9 g/dL (95% CI 0.8, 0.9) using the Rad-67, compared with 0.6 g/dL (95% CI 0.5, 0.6) using the HemoCue 301. The Rad-67 had 49% sensitivity and 70% specificity for detecting anemia, compared with the HemoCue 301. The Rad-67 can be a useful tool for anemia screening; however, lower accuracy and precision, and poor sensitivity suggest it cannot immediately replace the HemoCue 301 in the study area.

The correlation and predictive value of Hb, RDW and their association for short-term and long-term mortality in patients with acute aortic dissection

Background

This study examines the relationship between Hb, RDW and their association and both short-term and long-term mortality in patients with acute aortic dissection (AAD), aiming to establish combined effect between Hb and RDW as a potential prognostic biomarker for AAD outcomes.

Methods

We extracted clinical data from the Medical Information Mart for Intensive Care (MIMIC) databases for this analysis. Using adjusted Cox regression and Kaplan-Meier survival curve analyses, we assessed the relationship between Hb, RDW and their association at admission and mortality at multiple post-discharge intervals (30 days, 90 days, 1 year, and 5 years) among patients with AAD. Additionally, subgroup analyses and receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive accuracy of Hb, RDW and their association for mortality in this patient population.

Results

High RDW combined with low Hb (RDW ≥ 13.60 and Hb < 7.9) significantly predicted increased mortality at 30 days, 90 days, 1 year, and 5 years post-diagnosis, with hazard ratios (HRs) as follows: 4.33 (95% CI: 1.82-10.33, P < 0.001), 4.48 (95% CI: 2.06-9.77, P < 0.001), 3.38 (95% CI: 1.70-6.70, P < 0.001), and 3.07 (95% CI: 1.66-5.66, P < 0.001), respectively.

Conclusion

Hb and RDW are both abnormal (Hb with low level, RDW with high level) is positively correlated with 30 days, 90 days, 1 year, and 5 years mortality risk in patients with AAD. This suggests that combined effect between Hb and RDW is a significant predictor of short-term to long-term mortality risk in this patient population, highlighting its potential utility as a prognostic marker in clinical settings.

Impact of Severity of Sickle Cell Anemia on Auditory Discrimination Ability and Speech Perception in Noise

Introduction  Sickle cell anemia (SCA) is a genetic disorder with clinical manifestations due to circulatory changes, leading to adverse effects on the auditory system that might impact auditory processing, such as auditory discrimination and speech perception ability. This condition is associated with the severity level of anemia. Objective  The purpose of the present study was to investigate the influence of anemia severity on auditory discrimination ability and speech perception in noise among SCA patients with normal hearing sensitivity. Methods  A total of 52 normal-hearing adults diagnosed with SCA in the age range of 15 to 40 were grouped into mild, moderate, and severe, based on anemia severity. Auditory discrimination tests for frequency, intensity, and duration were evaluated at 500 and 4,000 Hz along with speech perception in noise (SPIN) at 0 dB SNR using the mlp toolbox in the MATLAB software, version 2014a (MathWorks, Natick, MA, USA). The IBM Statistical Package for Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. Results  The results revealed an increase in median and interquartile range among anemia groups with increasing severity. Additionally, the median scores were found to be poorer for the higher frequency in all auditory discrimination tests than for the lower one. A regression in performance with an increase in severity for the SPIN test was observed. Conclusion  The severity of anemia plays an important role in functional auditory processing deterioration. Circulatory changes secondary to SCA affected auditory discrimination processing and speech perception in noise. However, all auditory discrimination abilities are not necessarily affected equally.

Incidence and influencing factors for surgical site infections after cesarean section in China: A systematic review and meta-analysis

OBJECTIVE

This study aims to estimate the overall incidence of surgical site infections (SSIs) after cesarean section (CS) and the influencing factors in the Chinese population.

MATERIALS AND METHODS

The study searched all relevant literature in English and Chinese search databases (English search bases: PubMed, Embase, Cochrane Library, Web of Science; Chinese search bases: China National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database) up to March 19, 2024, according to the search strategy. A random/fixed effects model was decided on the basis of the I2 statistic assessing the magnitude of study heterogeneity, and publication bias was assessed using the Begg's test.

RESULTS

After the selection, a final selection of 25 articles was involved. The estimate of post-CS SSIs in China was 2.4% (95%CI: 0.019, 0.029). Age ≥30 years (WMD: 3.8), pre-pregnancy body mass index (BMI) ≥25 kg/m2 (WMD: 1.8), obesity (odds ratio [OR]: 3.0), vaginal cleanliness 3-4 (OR: 4.2), anemia (OR: 1.4), premature rupture of membranes (OR: 2.6), diabetes mellitus (OR: 2.7), National Nosocomial Infections Surveillance System 1-3 (OR: 5.6), emergency surgery (OR: 2.3), trial of labor (OR: 2.9), duration of surgery ≥60 min (OR: 2.0), and intraoperative blood loss >500 mL (OR: 3.5) were the risk factors for post-CS SSIs.

CONCLUSIONS

The rate of post-CS SSIs estimated was 2.4% in China. Both maternal conditions and surgical factors can potentially increase the risk of post-CS SSIs.

Deep Learning Model-Based Detection of Anemia from Conjunctiva Images

OBJECTIVES

Anemia is characterized by a reduction in red blood cells, leading to insufficient levels of hemoglobin, the molecule responsible for carrying oxygen. The current standard method for diagnosing anemia involves analyzing blood samples, a process that is time-consuming and can cause discomfort to participants. This study offers a comprehensive analysis of non-invasive anemia detection using conjunctiva images processed through various machine learning and deep learning models. The focus is on the palpebral conjunctiva, which is highly vascular and unaffected by melanin content.

METHODS

Conjunctiva images from both anemic and non-anemic participants were captured using a smartphone. A total of 764 conjunctiva images were augmented to 4,315 images using the deep convolutional generative adversarial network model to prevent overfitting and enhance model robustness. These processed and augmented images were then utilized to train and test multiple models, including statistical regression, machine learning algorithms, and deep learning frameworks.

RESULTS

The stacking ensemble framework, which includes the models VGG16, ResNet-50, and InceptionV3, achieved a high area under the curve score of 0.97. This score demonstrates the framework's exceptional capability in detecting anemia through a noninvasive approach.

CONCLUSIONS

This study introduces a noninvasive method for detecting anemia using conjunctiva images obtained with a smartphone and processed using advanced deep learning techniques.

Iron and folic acid supplementation compliance during pregnancy and its effect on post-pregnancy anaemia among reproductive-age women in East Africa

BACKGROUND

Despite the government's effort to reduce the prevalence of anaemia among reproductive-age women globally, it continues as a significant public health issue, especially in low- and middle-income countries. Iron-folic acid (IFA) supplementation is a widely used intervention to prevent anaemia, but compliance remains a major challenge. There is a lack of literature examining IFA supplementation compliance during pregnancy and its impact on preventing and controlling anaemia during post-pregnancy in the East Africa region.

OBJECTIVE

This study aims to investigate compliance with IFA supplementation during pregnancy and its impact on post-pregnancy anaemia among reproductive-age women in East Africa.

DESIGN

This study was designed as a cross-sectional survey.

METHODS

This study used data from 43,200 reproductive-age women from 2015 to 2022 demographic and health survey datasets. We used multilevel mixed-effect logistic regression analysis to identify associated factors with IFA supplementation compliance during pregnancy. Furthermore, a propensity score matching (PSM) analysis was used to determine the effect of IFA supplementation compliance on anaemia after pregnancy among women.

RESULTS

The level of compliance with IFA supplementation during pregnancy was 31.33% (95% confidence interval (CI): 30.89, 31.77), whereas the prevalence of anaemia among reproductive-age women was 32.08% (95% CI: 31.64, 32.52). Maternal education, the timing of antenatal care (ANC) visits, wanted index pregnancy (last pregnancy), wealth status, healthcare access, mass media exposure and ANC services from skilled healthcare providers were significantly associated with compliance with IFA supplementation among pregnant women. The PSM analysis indicated a significant positive association between IFA supplementation compliance during pregnancy and prevention of post-pregnancy anaemia among reproductive-age women, with an average treatment effect on the treated (ATT) of 25.55% (ATT = -0.2555, 95% CI: -0.3440, -0.1669, p < 0.0001).

CONCLUSION

Despite universal IFA supplementation, anaemia remains prevalent in East African countries due to low level of compliance with IFA supplementation. Targeting individual and socio-economic factors during IFA supplementation promotion helps to prevent anaemia after pregnancy. Further research is recommended to gain deeper insights.

Artificial intelligence in chronic kidney diseases: methodology and potential applications

Chronic kidney disease (CKD) represents a significant global health challenge, characterized by kidney damage and decreased function. Its prevalence has steadily increased, necessitating a comprehensive understanding of its epidemiology, risk factors, and management strategies. While traditional prognostic markers such as estimated glomerular filtration rate (eGFR) and albuminuria provide valuable insights, they may not fully capture the complexity of CKD progression and associated cardiovascular (CV) risks.This paper reviews the current state of renal and CV risk prediction in CKD, highlighting the limitations of traditional models and the potential for integrating artificial intelligence (AI) techniques. AI, particularly machine learning (ML) and deep learning (DL), offers a promising avenue for enhancing risk prediction by analyzing vast and diverse patient data, including genetic markers, biomarkers, and imaging. By identifying intricate patterns and relationships within datasets, AI algorithms can generate more comprehensive risk profiles, enabling personalized and nuanced risk assessments.Despite its potential, the integration of AI into clinical practice faces challenges such as the opacity of some algorithms and concerns regarding data quality, privacy, and bias. Efforts towards explainable AI (XAI) and rigorous data governance are essential to ensure transparency, interpretability, and trustworthiness in AI-driven predictions.

Therapeutic efficacy of Punarnavadi mandura against phenylhydrazine-induced hemolytic anemia in rats

Background & aim

Hemolytic anemia is a blood disorder whose incidence is increasing in the world in recent years especially after the pandemic. Conventional treatments include use of steroids and immunosuppresants that are accompanied by numerous adverse effects. With growing interest in using complex multi-component formulations for multi-targeted therapy, the present study aims to investigate the therapeutic efficacy of a traditional Ayurvedic herbomineral preparation, Punarnavadi Mandura, which has been traditionally used as a supplement in iron-deficiency anemia, against phenylhydrazine-induced hemolytic anemia in rodent models.

Experimental approaches

We employ a combination of in vivo and in silico methods in this work to study the therapeutic potential and to understand the possible molecular targets of this traditional formulation. Conventional drugs prednisolone and ferrous sulphate were used for comparison.

Results and conclusion

The in vivo studies confirm the ability of Punarnavadi Mandura to reverse pathological changes associated with hemolytic anemia at 100 mg/kg and 200 mg/kg concentration. It restored hemoglobin, bilirubin and white blood cell levels to normal and reduced reticulocytes, hemosiderin and Gamna Gandy bodies in the liver, spleen and kidney. In silico studies suggested that the key constituents in Punarnavadi Mandura interact with high affinity to erythropoietic receptor which could contribute to erythropoiesis. The in silico study also predicted that the phytoconstituents of Punarnavadi Mandura could inhibit TNF-α activity which was validated using gene expression studies.

Prevalence of anemia among children aged 6-59 months in the Ntele camp for internally displaced persons (Cabo Delgado, Mozambique): a preliminary study

In July 2022, we conducted a pilot cross-sectional study, within a project funded by the United Nations International Children's Emergency Fund, to investigate the prevalence and predictors of anemia in children aged 6-59 months living in the Ntele camp (Mozambique), created for internally displaced persons (IDPs). We analyzed blood samples for hemoglobin (Hb) and Plasmodium antigens; stool and urine for parasites. Associations between variables were assessed by performing univariate and multivariate logistic regressions. Based on the World Health Organization's Hb cut-offs, we defined anemia (Hb < 110 g/L) as mild (Hb = 100-109 g/L), moderate (Hb = 70-99 g/L), and severe (Hb < 70 g/L). We included 245 children, 212 (83%) were anemic, with 30 (12%) being severely anemic, and 95 (39%) suffered from malaria. Children with moderate-severe anemia were younger than others (mean age = 25.3 and 29.5 months, respectively; p = 0.02). Malaria was positively correlated with moderate to severe anemia (crude OR [95%CI] = 2.5 [1.5-4.5]; sex and age-adjusted OR [95%CI] = 3.1 [1.7-5.6]). Anemia in children under 5 years of age represents an urgent public health threat in the IDPs camp of Ntele, with malaria potentially making them much more susceptible to moderate-severe anemia and other diseases.

Exploring the association between hemoglobin, albumin, lymphocyte, and platelet score and all-cause mortality among middle-aged and older patients with osteoarthritis

Integrating hemoglobin, albumin, lymphocyte, and platelets (HALP) scores can simultaneously reflect systemic inflammation and nutritional status. Some evidence suggests its prognostic value in certain malignancies, however, the impact of HALP on individuals with osteoarthritis (OA) who are middle-aged and older remains unknown. This retrospective cohort study included 3566 individuals from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. The study endpoint was the all-cause mortality of OA patients. Weighted Cox models were used to assess the relationship between HALP score and all-cause mortality. Subgroup analyses stratified by age, gender, diabetes, dyslipidemia, and cardiovascular disease were conducted. After the follow-up was terminated, 920 participants experienced all-cause mortality, and 2646 participants survived. After adjusting for covariates, the continuous analysis revealed an inverse association between HALP score and all-cause mortality (hazard ratio (HR) = 0.89, 95% confidence interval (CI): 0.83-0.95). The categorical analysis indicated that the lowest quartile of HALP score was related to higher all-cause mortality by using the highest quartile of HALP score as a reference (HR = 1.46, 95% CI: 1.18-1.81). The association between HALP score with lowest quartile and all-cause mortality remained significant across different subgroups. This study suggested that HALP score was linked with all-cause mortality among middle-aged and older individuals diagnosed with OA, thereby indicating its potential as a reliable prognostic indicator for this patient population.

High prevalence of anemia and overweight among women workers in three palm plantations in Indonesia: a cross sectional study

Anemia is a disorder of decreased erythrocyte mass. Indonesia is one of the countries with the highest (31.2%) prevalence of anemia among women of childbearing age in Southeast Asia in 2019. Women currently play a dual role, not only as housewives but also play a role in the public sector namely working outside the home. Women workers in the oil palm plantation sector generally experience health problems such as maternal mortality rate, malnutrition, poor pregnancy care and delivery services, and anemia. The purpose of this study was to uncover nutrition situation among women workers in the oil palm plantation sector at company X, Central Kalimantan Province, company Y, Riau Province and company Z, South Papua Province. The study design was cross-sectional which involved 105 respondents of women workers selected purposively in the study areas. Data were obtained from field measurement of hemoglobin, semi quantitative food frequency questionnaire and other questionnaire. This study found that almost half (45.7%) of respondent were anemic and around 48.6% were overweight. Around 20% were both anemic and overweight. Low iron intake, low vitamin C intake, high calcium intake, multiparity, and poor physical environment condition were all significantly related to higher risk of anemia. Various causes of anemia should be considered in intervention or supplementation program. A combination of nutrition and other health surveillance would be suggested not only to alleviate but also to prevent the problem.

Efficacy of probiotic, prebiotic, and synbiotics supplements in individuals with anemia: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Anemia is a common global health problem, particularly in impoverished regions, with a high incidence rate. The condition is multifactorial, with iron deficiency being one of the most prevalent causes. Current treatment for anemia often relies on iron supplements or erythropoiesis-stimulating agents, although these therapies may show limited efficacy for some patients. Recent evidence suggests that probiotics, prebiotics, and synbiotics, as microbiome modulators, hold significant potential in the treatment of anemia. These interventions may enhance iron absorption and improve overall blood health through their impact on gut microbiota, thus providing an alternative or complementary approach to conventional treatments.

METHODS

Six databases, including the Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), and WangFang data library, were searched up to November 20, 2024. Studies published in English and Chinese were included. We included randomized controlled trials (RCTs) evaluating the effects of probiotics, prebiotics, or synbiotics in treating anemia. The experimental groups received probiotics, prebiotics, or synbiotics, while the control groups received placebo, alternative treatments, or no treatment. The primary outcome was hemoglobin (Hb) levels. Secondary outcomes included serum iron (SI) and serum ferritin (SF). A descriptive analysis was conducted for studies where meta-analysis was not feasible. The GRADE tool was used to assess the quality of evidence, and the Cochrane guidelines were employed to evaluate the risk of bias in each study.

RESULTS

Seven studies were included comprising a total of eight RCTs, with the main types of anemia being iron deficiency anemia (IDA) and anemia of chronic kidney disease (CKD), involving 632 patients. The analysis revealed that probiotics, prebiotics, or synbiotics significantly improved Hb levels in patients with anemia (WMD = 10.760, 95% CI: 4.593 to 16.747, p = 0.001), though heterogeneity was high (I² = 96.5%). Two RCTs (n = 120 participants) reported significant increases in serum iron levels in the probiotic group (WMD = 3.835, 95% CI: 3.271 to 4.400), with moderate heterogeneity (I² = 38.7%). Two RCTs (n = 192 participants) reported no significant differences were observed between the groups in serum ferritin levels (WMD = 8.048, p = 0.115), and heterogeneity remained high (I² = 62.6%). Subgroup analyses revealed that probiotics improved Hb levels in renal and iron-deficiency anemia, as well as across different doses. The synbiotic group showed consistent efficacy (I² = 0%), while the prebiotic group did not exhibit significant effects, with extremely high heterogeneity (I² = 99.3%). This indicates that heterogeneity may stem from variations in intervention types, and the results should be interpreted with caution.

CONCLUSION

There is moderate-quality evidence suggesting that probiotics, prebiotics, and synbiotics may improve anemia management, particularly by enhancing Hb levels. Further high-quality RCTs are required to explore the specific role of synbiotics in anemia management, including their comparative efficacy against probiotics and prebiotics alone, and their impact on gastrointestinal factors such as gut microbiota modulation and inflammation reduction.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024590073.