Anemia among Women of Reproductive Age: An Overview of Global Burden, Trends, Determinants, and Drivers of Progress in Low- and Middle-Income Countries

Adolescent pregnancy, maternal and child anaemia: Empirical analysis from India, Bangladesh, and Nigeria

Early childbearing poses several potential risks to maternal and child health. This paper empirically analyses the association between teenage pregnancy and child nutritional status, maternal and child anaemia in three countries (Nigeria, India and Bangladesh) that account for the highest proportion of teenage births and/or total number of malnourished teenage mothers and children. Data were sourced from nine waves of Demographic and Health Surveys conducted in Bangladesh, India, and Nigeria from 2005-2018, covering a sample of 27,705 children from Bangladesh, 266,308 children from India and 54,719 children from Nigeria. Our outcome measures of maternal and child nutrition include (i) a composite measure of anthropometric failure for children (CIAF), (ii) maternal anaemia, (iii) childhood anaemia, and (iv) anaemia in maternal-child pairs. Using multivariate regression analysis, we examine the associations between early childbirth, child nutrition, and maternal and child anaemia, controlling for an array of household-level socioeconomic and demographic characteristics. Across all three countries, the prevalence of CIAF (childhood anthropometric failure) is significantly higher among children born to women aged below 17 at first birth. We further find that early pregnancy and childbearing are associated with significantly higher rates of severe/moderate anaemia among both mothers and children in Bangladesh and Nigeria. In the three countries studied, the proportions of teenage mothers with vulnerable socioeconomic status and suboptimal pre-conception care are relatively high, which raises the risk of maternal and child morbidity as well as mortality.

Dietary quality, anaemia prevalence and their associated factors among rural school- going adolescents in Acholi sub -region of Uganda

BACKGROUND

Globally, iron deficiency anaemia is a widespread public health problem affecting vulnerable populations including adolescents. However, over the years, the Uganda Demographic Health Surveys mostly report the status of anaemia for women of reproductive age (15-49 years) and children up to 5 years, leaving out the focus on adolescents. Moreover, high prevalence of anaemia among children below five years could suggest that anaemia still persists at adolescence. Therefore, the study aimed at determining dietary quality, prevalence of anaemia and their associated factors among school-going adolescents.

METHODS

A cross-sectional study involving 341 adolescent boys and girls aged 10-19 years was carried out in two rural schools in Gulu district. Prevalence of anaemia was determined by obtaining blood specimens from a finger prick into a microcuvette and analysed for haemoglobin (Hb) level using Haemoglobin analyser, whereas dietary quality was assessed using the Individual Dietary Diversity Score (IDDS). Socio-economic and demographic data were collected using a semi-structured questionnaire.

RESULTS

The overall prevalence of anaemia was 16.0% (Girls:18.1%; Boys:13.0%), while the mean Hb level was 13.2 ± 1.4 g/dl (Girls 13.0 ± 1.3 g/dl; Boys 13.5 ± 1.6 g/dl). The mean number of food groups consumed among the adolescents was 3.5 ± 2.1 for girls and 3.0 ± 1.8 for boys (p˃0.05). Animal source foods, fruits and vitamin A-rich vegetables, other fruits and vegetables were consumed by adolescent girls more than the boys. Similarly, a higher proportion of adolescent girls than boys consumed iron-rich foods: fish and meat, organ meat and dark green leafy vegetables. Further, all the socio-demographic factors in the study did not predict dietary diversity (p ˃ 0.05). On the other hand, education attainment by parent/guardian and nature of menstruation predicted the prevalence of anaemia amongst adolescents (p < 0.05).

CONCLUSIONS

The prevalence of anaemia was high among adolescents. Coupled with this, there, was low dietary diversity among the adolescents. The level of education of the parent/guardian and nature of the menstrual discharge were significant predictors of anaemia amongst girls. From this study, we recommend interventions by both health and agricultural-related practitioners to strengthen activities in rural schools such as health and nutrition education to create awareness about dietary diversity and promotion of agricultural practices such as school vegetable gardens, orchards poultry production and rearing of small ruminants to support consumption of diverse foods in schools with the view of reducing the burden from iron deficiency anaemia.

Burden and causes of anemia in Vietnam: insights from the global burden of disease data

BACKGROUND

Anemia is a significant global health issue, impacting 1.92 billion people and ranking as a leading cause of disability. It is marked by low hemoglobin levels, which hinder oxygen delivery to vital organs and result from causes such as nutritional deficiencies and chronic diseases. Despite some progress, anemia remains a major concern in Southeast Asia, including Vietnam. Although the country has reduced its anemia rates, the progress is insufficient to achieve the WHO's 2030 targets for anemia reduction among women of reproductive age. This study explores anemia trends and socio-economic determinants in Vietnam, with a focus on age and gender differences, to inform targeted interventions and policy development.

METHODS

This study used the Global Burden of Diseases, Injuries, and Risk Factors (GBD) dataset to explore the burden of anemia and its causes in Vietnam from 1990 to 2021. The GBD study provides data on anemia prevalence and years lived with disability (YLD) by age, sex, and 37 causes across 204 countries and territories. Further, this study employed a regression model to examine how the anemia burden (i.e., prevalence rate and YLD rate) relates to socio-economic factors such as the Human Development Index (HDI), gender disparities in human development achievement, and gender-based inequalities in reproductive health, empowerment, and economic status in Vietnam over this period.

RESULTS

In 1990, there were 16.30 million anemia cases in Vietnam, decreasing slightly to 16.05 million by 2021. Male prevalence dropped from 34.90 to 26.58%, while female prevalence increased from 65.10 to 73.42%. Iron deficiency was the main cause, affecting 68.35% of cases in 1990 and 68.84% in 2021, with 24.96% in males and 75.04% in females in 2021. While anemia has decreased among infants, young children, and adolescents due to improved healthcare, it has increased among middle-aged and older adults, especially females. Regression analysis shows that higher human development and gender equality reduce anemia prevalence and disability, whereas gender inequality worsens the issue.

CONCLUSIONS

The study underscores that anemia remains a major health concern in Vietnam, marked by significant gender and age disparities. Despite a decrease in overall anemia rates and the effectiveness of specific interventions like iron-folic acid supplementation, females, particularly those of reproductive age and older adults, continue to face higher rates. Socio-economic improvements, including higher income and better human development, are linked to lower anemia rates, though the impact differs by gender. The persistent gender disparity and the shift in burden to older adults highlight the need for more comprehensive, gender-sensitive interventions. Future efforts should integrate nutritional support with broader socio-economic enhancements to effectively address anemia and improve public health in Vietnam.

Knowledge and attitudes on anemia and menstrual health among Malaysian female university students

Anemia is a significant public health concern, particularly among young female adults due to its potential impact on reproductive health. This study investigated the association between anemia-related knowledge, attitudes, menstrual health, and anemia status among Malaysian university students. This was a cross-sectional study named "SCARF" - Study to Combat Anemia - Research for Female Students, involving 674 university students in Malaysia. Anemia status was determined based on haemoglobin level, while knowledge, attitude and menstrual health were measured using validated questionnaires. The mean menarche age of students in this study was 12.1 ± 1.21 years. Students who were anemic had significantly longer menstrual cycle duration (P = 0.034) and more days with heavy flow (P = 0.038). Most students had poor knowledge (44.5%) and attitudes (84.1%) towards anemia. Students with good knowledge were 1.1 times more likely to have better anemia status compared to those with poor knowledge (95% CI: 1.0-1.2, P = 0.049). This study highlighted a lack of practical application of the knowledge to dietary habits. Collaborative efforts between educators and healthcare providers are crucial in developing a comprehensive strategy, such as interventions to prioritise educational initiatives and practical support to enhance overall menstrual health among female students.

The concentration of hemoglobin is associated with the dietary iron availability, food insecurity and the use of oral contraceptives among women in socially vulnerable areas of a capital city in northeastern Brazil

This study aimed to assess hemoglobin concentration and its association with oral contraceptive (OC) use, food insecurity (FI) and dietary iron availability (DIA) in adult women of reproductive age (20-44 years). This is a population-based cross-sectional study that analysed 505 women living in favelas and urban communities in a capital city in northeastern Brazil. Hemoglobin concentration was determined using capillary blood samples. FI and DIA were assessed using the Brazilian Food Insecurity Scale and the 24-h food recall, respectively. Association analysis was carried out using logistic regression. A directed acyclic graph (DAG) was designed to illustrate the causal paths between hemoglobin concentration and DIA. A significance level of 5 % was adopted. Low hemoglobin concentrations (11·2 g/dl: (1·79)) and a high prevalence of anaemia (64·0 %) were observed; 28·7 % used OC (28·7 %) and 76·4 % were in FI. An average energetic intake of 1495 kcal/d (482·0) and 0·46 mg/d (0·27) of DIA were also observed. In the DAG-guided multivariable analysis, it was observed that hemoglobin concentrations ≥ 12 mg/dl were directly associated with higher DIA (OR: 1·67; 95 % CI (1. 08, 2·59)) and OC use (OR: 1·67; 95 % CI (1·10, 2·55)) and inversely associated with mild FI (OR: 0·60; 95 % CI (0·37, 0·96)) or severe FI (OR: 0·37; 95 % CI: (0·18, 0·76)). Women taking OC and with a higher DIA were less likely to have low hemoglobin concentrations, while those in the context of FI were in the opposite situation.

The prevalence of anemia during pregnancy and its correlates vary by trimester and hemoglobin assessment method in Eastern Maharashtra, India

Approximately half of pregnant women in India are anemic, representing over 7.5 million women. Few studies have assessed the relationship between multiple micronutrient deficiencies and anemia during pregnancy or the trajectory of hemoglobin (Hb) during pregnancy in low-resource settings. We enrolled 200 pregnant women from the Maternal and Newborn Health (MNH) registry, a population-based pregnancy and birth registry in Eastern Maharashtra, India to address these gaps. The women provided capillary (finger-prick) and venous blood specimens at enrollment (<15 weeks), and a second capillary specimen in the 3rd trimester (>27 weeks). Capillary specimens were analyzed at the time of collection with a HemoCue Hb 201+; venous specimens were shipped on dry ice to a laboratory for cyanmethemoglobin assessment. In the 1st trimester, mean Hb concentration and anemia (Hb<11.0 g/dL) prevalence using capillary specimens were 10.9 ± 1.5 g/dL and 51.1%; mean Hb concentration using venous blood specimens was estimated to be 11.3 ± 1.3 g/dL and anemia prevalence was 37.5%. The prevalence of iron, vitamin B12 and folate deficiencies were 40%, 30% and 0%, respectively. Among women with anemia in the 1st trimester (venous blood), 56% had concurrent iron deficiency (inflammation-adjusted serum ferritin <15 µg/L) indicating that their anemia may be amenable to iron supplementation. In total, 21% of women had ID and anemia, 19% ID in the absence of anemia, 16.5% anemia in the absence of ID and 43.5% had neither. By the 3rd trimester, mean Hb from capillary specimens had declined to 10.1 ± 1.35 g/dL and anemia prevalence increased to 70.7%, despite 99.4% mothers reporting receipt of iron-folic acid (IFA) supplements during her current pregnancy, and 83.9% reporting IFA consumption the previous day. Significant predictors of anemia in the 1st trimester (both venous and capillary) included the number of weeks gestation at the time of Hb assessment and inflammation-adjusted serum ferritin. For 3rd trimester anemia, significant predictors included 1st trimester height, BMI and IFA consumption during the 3rd trimester (but not 1st trimester micronutrient biomarkers), indicating that IFA supplementation over the course of pregnancy may have influenced micronutrient status and anemia risk. Our findings highlight the severity of the burden of anemia and micronutrient deficiencies in Eastern Maharashtra, but also highlight that in many cases, ID and anemia affect different individuals. Preventing and managing anemia in pregnancy in India will require strengthening both clinical and community-based strategies targeting iron deficiency, as well as other causes of anemia.

Association of household air pollution exposure and anemia among pregnant women: Analysis of baseline data from 'Household Air Pollution Intervention Network (HAPIN)' trial

BACKGROUND

Anemia is common in low- and middle-income countries (LMICs), causing significant health issues and social burdens. Exposure to household air pollution from using biomass fuels for cooking and heating has been associated with anemia, but the exposure-response association has not been studied.

OBJECTIVES

We evaluated the associations between personal exposure to air pollution and both hemoglobin levels and anemia prevalence among pregnant women in a multi-country randomized controlled trial.

METHODS

We studied 3,163 pregnant women aged 18-35 years with 9-20 weeks of gestation, recruited as part of the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial in Guatemala, India, Peru, and Rwanda. We assessed 24-hour personal exposures to fine particulate matter (PM2.5), black carbon (BC), and carbon monoxide (CO), and measured hemoglobin levels at baseline (15 ± 3 weeks gestation). Linear and logistic regression models were used to examine the associations of measured pollutants with hemoglobin levels and anemia prevalence, adjusting for confounding.

RESULTS

Single-pollutant models showed associations of CO with higher hemoglobin levels and lower anemia prevalence. Bipollutant models involving CO and PM2.5 also revealed that an interquartile range (IQR) increase in CO concentrations (2.26 ppm) was associated with higher hemoglobin levels [β = 0.04; 95 % confidence interval (CI): 0.01, 0.07], and a lower odds of anemia prevalence [odds ratios (OR) = 0.90; 95 % CI: 0.83, 0.98]. PM2.5 was inversely related to hemoglobin and positively associated with anemia, but results were not statistically significant at the 0.05 alpha level. County-specific results showed that 3 of 4 countries showed a similar association between CO and hemoglobin. We found no association of BC levels with hemoglobin levels or with anemia prevalence.

CONCLUSION

Our findings suggest that exposure to CO is associated with higher hemoglobin and lower anemia prevalence among pregnant women, whereas PM2.5 showed the opposite associations.

Determinants of Hemoglobin Among Pregnant Women at Agro-Pastoralist Communities in South Omo Zone, Ethiopia: Community Based Cross-Sectional Study, Nutrition Experience from Movable Community

Background

Low hemoglobin level is the most common public health problem during pregnancy in developing countries including Ethiopia, which is affecting both mother and fetus. However, the determinants of anemia among pregnant women are not well studied.

Objective

To assess the determinates of hemoglobin among pregnant women in rural agro-pastoralist communities in the South Omo zone, Ethiopia.

Method

Community-based cross-sectional study was done in rural agro-pastoralist communities. A multistage stratified sampling technique was used to select 526 pregnant women. Data were collected by using structured questionnaires. Hemoglobin level was measured by using HemoCue ® Hb301. Data were analyzed by using a statistical package for the social science version 26. Descriptive (Mean, standard deviation, frequency, range), bivariate and multivariate analysis was carried out to check the association between lower hemoglobin levels and independent variables. The output is presented in tables and figures.

Result

The mean (±SD) of hemoglobin concentration was 11.8 ± 1.7. The overall prevalence of anemia was 39.9% [95% CI: 35.5, 44.4], 19.4% (95% CI: 16.0, 23.2) was mild, 19.6% (95% CI: 16.27, 2.5) was moderate and 0.9% (95% CI: 0.25, 2.25) was severe anemia. Not taking IFA (AOR = 5.7(3.3, 9.8)), severe under nutrition (AOR = 8.9(2.1, 37.3)), no fish food (AOR = 2.4(1.3, 4.5)), drinking coffee (AOR = 1.6(1.0, 2.6)), moderate food insecurity (AOR = 2.5(1.4, 4.6)), and no malaria infection (AOR = 0.6(0.4, 0.9)) were statistically significant with anemia.

Conclusion

The anaemia is a public health problem in this study area. Therefore, nutrition education and counselling to enhance iron supplementation, dietary diversity and a flesh diets are very essential to enhance haemoglobin levels.

Association Between Tea Drinking and Anemia in Women of Reproductive Age: A Cross-Sectional Study From the Mekran Division, Balochistan, Pakistan

BACKGROUND

Anemia in females of the reproductive age group is an area of concern globally, but its prevalence is high in developing countries. Dietary habits and lifestyle impact the hematological parameters. It is important to evaluate the impact of tea drinking on hematological parameters in females of the reproductive age group.

OBJECTIVE

The study aims to determine the association of tea drinking with anemia among women of reproductive age (WRA) in the Mekran division of Balochistan.

METHODS

A cross-sectional observational study was conducted at Mekran Medical College (MMC), a teaching hospital in Turbat, Balochistan, by the Department of Obstetrics and Gynecology from December 2023 to May 2024. Using a non-probability convenience sampling technique, a total of 356 females, 16-35 years of age, were included in the study after getting informed consent. Pregnant females and those who were using any medication for anemia were excluded from the study. Blood samples were analyzed using a CBC hematology analyzer. Data were analyzed using SPSS 26 by applying an independent sample t-test and chi-square test.

RESULTS

Among all 356 included participants, 193 females were anemic. Among the tea drinkers (n = 266), 159 participants were mild to severely anemic. While among non-tea-drinking women (n = 90), only 34 participants were mild or moderately anemic with no severe anemia. A significant association was found between tea drinking and anemia among WRA (p < 0.05). A significant mean difference was found in the hemoglobin (Hb), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) levels among the tea-drinker and non-tea-drinker participants (p < 0.05).

CONCLUSION

The WRA group from the Mekran region is suffering from anemia. Women who drink tea suffer more from anemia. Effective healthcare strategies should be implemented to address the issue of anemia among WRA.

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.

OBJECTIVE

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 (NPW), 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 decline 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 (ANC) 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 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.

OBJECTIVE

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

Employing 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 comprehnsive 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 (OBDA) evaluated the relative contribution of direct and indirect factors.

RESULTS

Among non-pregnant 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 (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 healthcare 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. OBDA explained ∼50% of the observed change in mean Hb among NPW, with family planning (35%), household socio-demographics (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 healthcare access, women's empowerment, and poverty alleviation.

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 temporal trends of prevalence and years lived with disability of anaemia in China, Japan, and South Korea, from 1990 to 2021: Results from the Global Burden of Disease Study 2021

Background

Studies have shown that the disease burden of anaemia varies globally, yet they have not yet determined its exact extent in East Asian countries specifically. We thus aimed to investigate the prevalence and years lived with disability (YLDs) due to anaemia from 1990 to 2021 in China, Japan, and South Korea.

Methods

We extracted the prevalence and YLDs with their age-standardised rates (ASRs) in China, Japan, and South Korea from the Global Burden of Disease Study 2021, stratified by sex, age, and causes. We then examined the temporal trend of anaemia burden from 1990 to 2021 using joinpoint analysis and the association of anaemia burden with the Human Development Index and Universal Health Index through Spearman's correlation analysis.

Results

In 2021, anaemia affected 136 million people in China (95% uncertainty interval (UI) = 131, 141), with ASRs of prevalence of 8.9% (95% UI = 8.6, 9.3), and accounted for 3.0 million YLDs (95% UI = 2.0, 4.4). It affected 13.6 million people in Japan (95% UI = 11.8, 16.0), with ASRs of prevalence of 7.4% (95% UI = 6.1, 9.0), and caused 181 thousand YLDs (95% UI = 108, 282). It also affected 2.7 million individuals in South Korea (95% UI = 2.4, 3.0), with ASRs of prevalence of 5.2% (95% UI = 4.6, 5.7), and led to 34 thousand YLDs (95% UI = 22, 55). We observed a significant gender discrepancy in the anaemia burden in these three countries, with the prevalence and YLD rates in women being almost twice as high as those in men. Moreover, the peak age of the anaemia burden shifted toward higher age groups in all three countries, particularly in Japan. Chronic kidney disease was responsible for a growing share of anaemia cases and YLDs, especially in adults aged more than 60 years in Japan and South Korea. Haemoglobinopathies were another noticeable cause of anaemia in China, though dietary iron deficiency remained the leading cause. Both socioeconomic development and essential health service coverage showed negative associations with the anaemia burden in the three countries in the past three decades, though with differential patterns.

Conclusions

Anaemia remains a major public health issue in China, Japan, and South Korea; targeted surveillance and interventions are recommended for high-risk populations and cause-specific anaemia.

Prevalence trends of anemia impairment in adolescents and young adults with HIV/AIDS

BACKGROUND

Anemia is a common complication of HIV/AIDS, particularly in adolescents and young adults across various countries and regions. However, little is known about the changing prevalence trends of anemia impairment in this population over time.

METHODS

Data on anemia in adolescents and young adults with HIV/AIDS from 1990 to 2019 were collected from the Global Burden of Disease. Prevalence was calculated by gender, region, and country for individuals aged 10-24, and trends were measured using estimating annual percentage changes (EAPC).

RESULTS

Globally, the prevalence of adolescents and young adults with HIV/AIDS increased from 103.95 per 100,000 population in 1990 to 203.78 in 2019. However, anemia impairment has decreased over the past three decades, with a global percentage decreasing from 70.6% in 1990 to 34.7% in 2019, mainly presenting as mild to moderate anemia and significantly higher in females than males. The largest decreases were observed in Central Sub-Saharan Africa, North America, and Eastern Sub-Saharan Africa, with EAPCs of -2.8, -2.34, and -2.17, respectively. Tajikistan (78.76%) and Madagascar (74.65%) had the highest anemia impairment percentage in 2019, while China (16.61%) and Iceland (13.73%) had the lowest. Anemia impairment was closely related to sociodemographic index (SDI) levels, with a high proportion of impairment in low SDI regions but a stable decreasing trend (EAPC = -0.37).

CONCLUSION

Continued anemia monitoring and management are crucial for patients with HIV, especially in high-prevalence regions and among females. Public health policies and interventions can improve the quality of life and reduce morbidity and mortality.

Persistent Impact of Antenatal Maternal Anaemia on Child Brain Structure at 6-7 Years of Age: A South African Child Health Study

Background

The study aim was to determine whether associations of antenatal maternal anaemia with smaller corpus callosum, putamen, and caudate nucleus volumes previously described in children at age 2-3 years persist to age 6-7 years in the Drakenstein Child Health Study (DCHS).

Methods

This neuroimaging sub-study was nested within the DCHS, a South African population-based birth cohort. Pregnant women were enrolled (2012-2015) and mother-child dyads were followed prospectively. A sub-group of children had magnetic resonance imaging at 6-7 years of age (2018-2022). Mothers had haemoglobin measurements during pregnancy and a proportion of children were tested postnatally. Maternal anaemia (haemoglobin<11g/dL) and child anaemia were classified using WHO and local guidelines. Linear modeling was used to investigate associations between antenatal maternal anaemia status, maternal haemoglobin concentrations, and regional child brain volumes. Models included potential confounders and were conducted with and without child anaemia to assess the relative roles of antenatal versus postnatal anaemia.

Results

Overall, 157 children (Mean [SD] age of 75.54 [4.77] months; 84 [53.50%] male) were born to mothers with antenatal haemoglobin data. The prevalence of maternal anaemia during pregnancy was 31.85% (50/157). In adjusted models, maternal anaemia status was associated with smaller volumes of the total corpus callosum (adjusted percentage difference, -6.77%; p=0.003), left caudate nucleus (adjusted percentage difference, -5.98%, p=0.005), and right caudate nucleus (adjusted percentage difference, -6.12%; p=0.003). Continuous maternal haemoglobin was positively associated with total corpus callosum (β=0.239 [CI: 0.10 to 0.38]; p<0.001) and caudate nucleus (β=0.165 [CI: 0.02 to 0.31]; p=0.027) volumes. In a sub-group (n=89) with child haemoglobin data (Mean [SD] age of 76.06[4.84]), the prevalence of antenatal maternal anaemia and postnatal child anaemia was 38.20% (34/89) and 47.19% (42/89), respectively. There was no association between maternal and child anaemia (c2 = 0.799; p=0.372), and child anaemia did not contribute to regional brain volume differences associated with maternal anaemia.

Conclusions

Associations between maternal anaemia and regional child brain volumes previously reported at 2-3 years of age were consistent and persisted to 6-7 years of age. Findings support the importance of optimizing antenatal maternal health and reinforce these brain regions as a future research focus on intervention outcomes.

Spatial distribution and associated factors of co-occurrence of overweight/obesity and Anemia among women in the reproductive age in sub-Saharan Africa: A multilevel analysis, DHS 2016-2021

BACKGROUND

Overweight/obesity is one of the major public health problems that affect both developed and developing nations. The co-occurrence of overweight/obesity and anemia is thought to be largely preventable if detected early. To date, no spatial analyses have been performed to identify areas of hotspots for the co-occurrence of overweight/obesity and anemia among reproductive women in sub-Saharan Africa. Therefore, this study aimed to assess the spatial distribution and associated factors of the co-occurrence of overweight/obesity and anemia among women of reproductive age.

METHODS

Data for the study were drawn from the Demographic and Health Survey, a nationally representative cross-sectional survey conducted in the era of Sustainable Development Goals, in which the World Health Assembly decided and planned to cease all forms of malnutrition by 2030. Seventeen sub-Saharan African countries and a total weighted sample of 108,161 reproductive women (15-49 years) were included in our study. The data extraction, recoding and analysis were done using STATA V.17. For the spatial analysis (autocorrelation, hot-spot and interpolation), ArcGIS version 10.7 software, and for the SaTScan analysis, SaTScan version 10.1 software was used. Descriptive statistics were presented using frequency tables and percentages. We employed multilevel logistic regression to investigate associated factors. In the multivariable analysis, variables with a p-value of ≤0.05 are considered as a significant factor associated with co-occurrence of overweight/obesity and anemia among women aged 15-49 years.

RESULTS

The overall co-occurrence of overweight/obesity and anemia among women in sub-Saharan Africa was 12% (95%CI: 9-14%). The spatial analysis revealed that the co-occurrence of overweight/obesity and anemia among women significantly varied across sub-Saharan Africa. (Global Moran's I = 0.583163, p<0.001). In the spatial window, the primary-cluster was located in Liberia, Guinea, Gambia, Sira Leon, Mauritania, Mali, Cameron and Nigeria with a Log-Likelihood Ratio (LRR) of 1687.30, and Relative Risk (RR) of 2.58 at a p-value < 0.001. In multilevel analysis, women aged 25-34 years (AOR = 1.91, 95%CI: 1.78, 2.04), women aged 35-49 years (AOR = 2.96, 95% CI: 2.76, 3.17), married (AOR = 1.36, 95% CI: 1.27, 1.46), widowed (AOR = 1.22, 95%CI: 1.06, 1.40), divorced (AOR = 1.36, 95% CI: 1.23, 1.50), media exposure (AOR = 1.31, 95%CI: 1.23, 1.39), middle income (AOR = 1.19, 95%CI: 1.11, 1.28), high income/rich (AOR = 1.36, 95%CI: 1.26, 1.46), not working (AOR = 1.13, 95% CI:1.07, 1.19), traditional contraceptive utilization (AOR = 1.39, 95%CI: 1.23, 1.58) and no contraceptive use (AOR = 1.27, 95%CI: 1.20, 1.56), and no health insurance coverage (AOR = 1.36, 95%CI: 1.25, 1.49), were individual level significant variables. From community-level variables urban residence (AOR = 1.61, 95%CI: 1.50, 1.73), lower middle-income country (AOR = 2.50, 95%CI: 2.34, 2.66) and upper middle-income country (AOR = 2.87, 95%CI: 2.47, 3.34), were significantly associated with higher odds of co-occurrence of overweight/ obesity and anemia.

CONCLUSION AND RECOMMENDATIONS

The spatial distribution of the co-occurrence of overweight/obesity and anemia was significantly varied across the sub-Saharan African country. Both individual and community-level factors were significantly associated with the co-occurrence of overweight/obesity and anemia. Therefore, public health programmers and other stalk holders who are involved in maternal healthcare should work together and give priority to hotspot areas of co-occurrence in sub-Saharan Africa.

Determinants of severity levels of anemia among pregnant women in Sub-Saharan Africa: multilevel analysis

Background

Anemia is a severe public health problem affecting 54% of pregnant women in SSA Yet, only a limited number of studies have provided a partial assessment of the pooled prevalence and related determinants of the severity levels of anemia in pregnant women in SSA. Therefore, this study provides the most recent estimates of anemia severity levels and related determinants.

Methods

The most recent Demographic Health Survey (DHS) dataset of 21 Sub-Saharan African countries which were collected between 2015 and 2022 were used. A total of 14,098 pregnant women were included. Multilevel ordinal logistic regression was used.

Results

The pooled prevalence of anemia was 51.26%. Pregnant women who were in the old age groups, and who have attended secondary and higher education were less likely to be at higher levels of anemia. Those women who have given birth to >1 children in the last 5 years, pregnant women in second and third trimester and living in poorest households had greater odds of being at higher levels of anemia.

Conclusion

In Sub-Saharan Africa, anemia is a severe public health concern for pregnant mothers. When developing and implementing strategies for the prevention and control of anemia, it is imperative to take into account the individual and community circumstances. Programs for the prevention and control of anemia should incorporate the economic and educational empowerment of women.

Immediate postpartum anemia and associated factors at shewarobit health facilities, Amhara, Ethiopia, 2022: a cross sectional study

BACKGROUND

Immediate postpartum anemia occurs when the amount of red blood cell count is reduced or hemoglobin concentration is below 10 g/dl in the immediate postpartum. It occurs primarily due to inadequate iron intake before and during pregnancy and blood loss during delivery. The aim of this study is to assess the proportion of immediate postpartum anemia and associated factors among mothers who gave birth at Shewarobit health facilities; in Amhara, Ethiopia.

METHODS

Institutional-based cross-sectional study was conducted from June to September 2022. A systematic random sampling method was employed to select the study participants. The data were collected through interviewer-assisted questions. Data were entered into Epi Data software version 4.6.0.4 and exported to SPSS 21 for analysis, and descriptive statistics were computed. Logistic regression was applied, and P-values less than 0.05 were considered statistically significant.

RESULTS

This study was conducted among 307 study participants and, the proportion of immediate postpartum anemia was 41.4% [95% CI: 36.7-46.6]. Having postpartum hemorrhage [AOR = 4.76, 95% CI: 2.44-9.28], not taking iron and folic acid supplementation [AOR = 6.19, 95% CI: 2.69, 14.22], having a prolonged second stage of labor [AOR = 2.52, 95% CI: 1.16-5.44], and mid-upper arm circumference < 23 cm [AOR = 2.02, 95% CI: 1.11-3.68] were factors significantly associated with immediate postpartum anemia.

CONCLUSIONS

The proportion of immediate postpartum anemia was public problem in Shewarobit health facilities. Following the progress of labor using a partograph, closely monitoring and immediate intervention of PPH, and prevent undernutrition during antenatal care is recommended.

The Association Between Hormonal Contraceptive Use and Anemia Among Adolescent Girls and Young Women: An Analysis of Data From 51 Low- and Middle-Income Countries

PURPOSE

This study explores whether adolescent girls and young women aged 15-24 who use hormonal methods of contraception are more or less likely to be anemic than their peers. We further examine whether the association between anemia and hormonal contraception varies based on the severity of anemia or the duration of method use.

METHODS

We conducted secondary analysis of data available for 51 low- and middle-income countries from the Demographic and Health Surveys. For each country, we used logistic regression models to explore the odds of being anemic (mildly, moderately, or severely) for those using hormonal methods of contraception. We also explored the odds of being moderately or severely anemic based on hormonal method use. Drawing on country-level effect estimates, we conducted meta-regression analyses to produce overall estimates of the association between anemia and hormonal contraception.

RESULTS

Overall, adolescent girls and young women using hormonal methods had lower odds of being mildly, moderately, or severely anemic (adjusted odds ratio 0.68; p < .001) and lower odds of being moderately or severely anemic (adjusted odds ratio 0.57; p < .001) compared to those not using any contraception. Both short- and long-term users of hormonal methods had lower odds of being anemic and lower odds of being moderately or severely anemic compared to those not using hormonal methods.

DISCUSSION

This study furthers our understanding of the association between anemia and use of hormonal contraception among adolescent girls and young women. More research is needed to assess causality and whether hormonal methods mediate the effects of heavy menstrual bleeding or other risk factors of anemia.

Perspectives on anemia: Factors confounding understanding of past occurrence

OBJECTIVE

This paper reviews factors confounding the understanding of the past occurrence of anemia. Using the evidence gathered, a framework is presented of ways forward to enable greater confidence in diagnosing acquired anemia in paleopathology, facilitating insights into longer-term perspectives on this globally relevant condition.

RESULTS

To date, porotic lesions have been central to paleopathological investigations of anemia. The fact that porotic bone lesions are omnipresent and have multiple causes but are likely to have a relatively low, age-related frequency in individuals with anemia, a condition that will have been common in past communities, is confounding.

METHODS

Establishing frameworks that move away from porotic lesions is proposed to facilitate higher levels of more accurate anemia diagnoses in paleopathology.

SIGNIFICANCE

Acceptance of the fundamental principle that anemia may be better considered as a condition requiring metric evaluation of bone structures, supplemented by careful consideration of lesions, will advance understanding of acquired anemia in past communities. Such an approach would provide a clear basis for further consideration of congenital conditions causing anemia, such as sickle-cell disease and thalassemia.

LIMITATIONS

This paper simply opens the conversation on the better diagnosis of anemia in paleopathology; it starts the iterative process of achieving some consensus and progress on diagnosing anemia in paleopathology.

SUGGESTIONS FOR FURTHER RESEARCH

Engagement with ideas presented, sharing data and development of metric parameters will assist in identifying the effects of marrow hyperplasia on bone, enabling more robust work on the important topic of anemia.

Prevalence and associated factors of severity levels of anemia among women of reproductive age in sub-Saharan Africa: a multilevel ordinal logistic regression analysis

Background

Sub-Saharan Africa is the most anemia-prone region, with several of the sub-region's countries having a substantial prevalence of the anemia among women of reproductive age. Nonetheless, no adequate study has been conducted to illustrate severity levels and associated factors of anemia among women of reproductive age. Therefore, this study presents the most recent estimates on the prevalence and severity levels of anemia and its associated factors among women of reproductive age in 21 Sub-Saharan Africa countries.

Methods

This study used the most recent Demographic Health Survey (DHS) datasets, which were collected in 21 sub-Saharan African countries between 2015 and 2022. A total of 171,348 women of reproductive age were included in the analysis. Multilevel (three-level) ordinal logistic regression was done to identify factors associated with severity levels of anemia.

Results

The pooled prevalence of anemia was 41.74%. The pooled prevalence of mild, moderate and severe anemia was 23.45, 17.05 and 1.24, respectively. Women who were living at distance to a health facility (AOR = 1.07), women living in the poorest households (AOR = 1.49), women living in the households with unimproved toilet (AOR = 1.12) and in households that were using solid cooking fuel (AOR = 1.10), pregnant women (AOR = 1.72) and those who have given birth to more than one children within 3 years (AOR = 1.43) had greater odds of higher levels of anemia as compared to their counterparts. Women who were in the age groups of 20-24 (AOR = 0.81), 25-29 (AOR = 0.78), 30-34 (AOR = 0.79), 35-39 (AOR = 0.88), and 45-49 (AOR = 0.89), women who have attended primary school (AOR = 0.50), secondary (AOR = 0.57) and higher education (AOR = 0.76) and who were living in rural area (AOR = 1.07) had lower odds of higher levels of anemia as compared to their counterparts.

Conclusion

Considering individual, household and community contexts is necessary while formulating and implementing anemia prevention and control policies. Adolescent women, and women who did not attend education and at a distance to a health facility should get especial attention while implementing anemia prevention and control programs.

Determinants and spatial factors of anemia in women of reproductive age in Democratic Republic of Congo (drc): a Bayesian multilevel ordinal logistic regression model approach

BACKGROUND

As a global public health problem, anemia affects more than 400 million women of reproductive age worldwide, mostly in Africa and India. In the DRC, the prevalence of anemia has decreased slightly from 52.9% in 2007, to 46.4% in 2012 and 42.4% in 2019. However, there is considerable regional variation in its distribution. The aim of this study is to determine the factors contributing to anemia in women of reproductive age and to explore its spatial distribution in the DRC.

METHODS

Based on the Bayesian Multilevel Spatial Ordinal Logistic Regression Model, we used the 2013 Democratic Republic of Congo Demographic and Health Survey (DHS-DRC II) data to investigate individual and environmental characteristics contributing to the development of anemia in women of reproductive age and the mapping of anemia in terms of residual spatial effects.

RESULTS

Age, pregnancy status, body mass index, education level, current breastfeeding, current marital status, contraceptive and insecticide-treated net use, source of drinking water supply and toilet/latrine use including the province of residence were the factors contributing to anemia in women of reproductive age in DRC. With Global Moran's I = -0.00279, p-value ≥ 0.05, the spatial distribution of anemia in women of reproductive age in DRC results from random spatial processes. Thus, the observed spatial pattern is completely random.

CONCLUSION

The Bayesian Multilevel Spatial Ordinal Logistic Regression statistical model is able to adjust for risk and spatial factors of anemia in women of reproductive age in DRC highlighting the combined role of individual and environmental factors in the development of anemia in DRC.

Risk factors for anaemia among women and their young children hospitalised with suspected thiamine deficiency in northern Lao PDR

Anaemia among women and young children remains a major public health concern. This secondary study describes the anaemia prevalence among young hospitalised children and their mothers in northern Lao People's Democratic Republic and explores possible nutritional causes and risk factors for anaemia. Hospitalised children (ages 21 days to <18 months) with clinical symptoms suggestive of thiamine deficiency disorders were eligible along with their mothers. Venous blood was collected for determination of haemoglobin, ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), erythrocyte glutathione reductase activation coefficient (EGRac), thiamine diphosphate (ThDP) and acute phase proteins. Risk factors for anaemia were modelled using minimally adjusted logistic regression controlling for age. Haemoglobin results were available for 436 women (mean ± SD age 24.7 ± 6.4 years; 1.6% pregnant) and 427 children (4.3 ± 3.5 months; 60.3% male). Anaemia prevalence (Hb < 120 g/L for nonpregnant women and <110 g/L for pregnant women and children) was 30.7% among women and 55.2% among children. In bivariate analyses, biomarkers significantly associated with anaemia in women were ferritin, sTfR, RBP, EGRac and ThDP. Other risk factors for women were lower BMI, mid-upper arm circumference < 23.5 cm, lower education, lower socioeconomic index, food insecurity, Hmong ethnicity, not/rarely having attended antenatal care, not having taken antenatal iron-containing supplements and not meeting minimum dietary diversity. Risk factors for anaemia among children were older age, male sex, stunting, sTfR, ThDP and alpha-1-acid-glycoprotein. Anaemia was common among women and their hospitalised children and was associated with micronutrient deficiencies and socioeconomic, dietary and health care-seeking risk factors, suggesting that multiple strategies are required to prevent anaemia among women and children.

Availability of national policies, programmes, and survey-based coverage data to track nutrition interventions in South Asia

Progress to improve nutrition among women, infants and children in South Asia has fallen behind the pace needed to meet established global targets. Renewed political commitment and monitoring of nutrition interventions are required to improve coverage and quality of care. Our study aimed to assess the availability of national nutrition policies, programmes, and coverage data of nutrition interventions for women, children, and adolescents in eight countries in South Asia. We reviewed relevant policy and programme documents, examined questionnaires used in the most recent rounds of 20 nationally representative surveys, and generated an evidence gap map on the availability of policies, programmes, and survey data to track progress on coverage of globally recommended nutrition interventions. Current policies and programmes in South Asian countries addressed almost all the recommended nutrition interventions targeted at women, children, and adolescents. There was a strong policy focus in all countries, except Maldives, on health system platforms such as antenatal and postnatal care and child growth and development. Survey data on nutrition intervention coverage was most available in India and Nepal, while Bangladesh and Bhutan had the least. Though countries in South Asia have committed to national nutrition policies and strategies, national surveys had substantial data gaps, precluding progress tracking of nutrition intervention coverage. Greater attention and effort are needed for multisectoral collaboration to promote and strengthen nutrition data systems.

Exploring factors influencing the severity of pregnancy anemia in India: a study using proportional odds model

Pregnancy-associated anemia is a significant health issue that poses negative consequences for both the mother and the developing fetus. This study explores the triggering factors of anemia among pregnant females in India, utilizing data from the Demographic and Health Survey 2019-21. Chi-squared and gamma tests were conducted to find out the relationship between anemia and various socioeconomic and sociodemographic elements. Furthermore, ordinal logistic regression and multinomial logistic regression were used to gain deeper insight into the factors that affect anemia among pregnant women in India. According to these findings, anemia affects about 50% of pregnant women in India. Anemia is significantly associated with various factors such as geographical location, level of education, and wealth index. The results of our study indicate that enhancing education and socioeconomic status may serve as viable approaches for mitigating the prevalence of anemia disease developed in pregnant females in India. Employing both Ordinal and Multinominal logistic regression provides a more comprehensive understanding of the risk factors associated with anemia, enabling the development of targeted interventions to prevent and manage this health condition. This paper aims to enhance the efficacy of anemia prevention and management strategies for pregnant women in India by offering an in-depth understanding of the causative factors of anemia.

Mapping, trends, and factors associated with anemia among children aged under 5 y in East Africa

Child anemia is a severe public health concern in low- and middle-income countries. Identifying anemia change over time, its spatial heterogeneity, and the influencing factors is critical to monitoring and prioritizing successful interventions. This analysis uses nationally representative Demographic and Health Surveys administrated in 11 East African countries, which included 149 864 children. Trend analysis, interpolation, and Kulldorff scan statistics were used. Trend and hotspot areas were identified and multilevel (three-level) ordinal logistic regression analyzed. More than half of the children in East Africa suffer from anemia. In all but two countries, the prevalence of child anemia was considered a severe public health problem; no country had an anemia prevalence < 35%. Anemia reduction efforts and the prevalence of anemia exhibit fluctuations over time in East African countries. Zimbabwe has shown a more consistent reduction in all forms of anemia. Most countries have experienced a significant reduction in the severe form of anemia in recent years. Community-based spatial analysis indicates that child anemia is heterogeneous within and between countries. Many communities are experiencing a high prevalence of anemia among children, with a maximum of four of five and a minimum one of five of their children infected by any anemia. Nutrition, genetic hemoglobin disorders, physical environment, poverty, and maternal and community characteristics influence child anemia. Multisectorial interventions that improve maternal and child nutrition are needed. These analyses support the design and prioritization of interventions in high-risk areas and communities.

Determinants of anemia level among reproductive-age women in 29 Sub-Saharan African countries: A multilevel mixed-effects modelling with ordered logistic regression analysis

BACKGROUND

Despite the implementation of different nutritional and non-nutritional interventions, 43% of reproductive-age women in Africa suffer from anemia. Recent evidence also shows that none of the Sub-Saharan African (SSA) countries are on the track to achieve the nutrition target of 50% anemia reduction by 2030. To date, information on the level of anemia and its determinants among reproductive-age women at the SSA level is limited. Thus, this study aimed to estimate the pooled prevalence of anemia level and its determinants in SSA countries.

METHODS

We used a pooled data of 205,627 reproductive-age women from the recent demographic and health surveys of 29 SSA countries that were conducted between 2010-2021. A multilevel mixed-effects analysis with an ordered logistic regression model was fitted to identify determinants of anemia level and the deviance value was used to select the best-fitted model. First, bivariable ordinal logistic regression analysis was done and the proportional odds assumption was checked for each explanatory variable using a Brant test. Finally, in a multivariable multilevel ordinal logistic regression model, a p-value<0.05 and AOR with the corresponding 95% CI were used to identify determinants of anemia level. All analyses were done using Stata version 17 software.

RESULTS

The pooled prevalence of anemia among women of reproductive age in SSA was 40.5% [95% CI = 40.2%-40.7%], where 24.8% [95% CI: 24.6%-25.0%], 11.1% [95% CI = 10.9%-11.2%], and 0.8% [95% CI = 0.7%-0.8%] had mild, moderate, and severe anemia, respectively. The prevalence significantly varied from the lowest of 13% in Rwanda to the highest of 62% in Mali, and anemia was found as a severe public health problem (prevalence of ≥ 40%) in 18 countries. The regression result revealed that polygamous marriage, women and husband illiteracy, poor household wealth, shorter birth interval, non-attendance of antenatal care, underweight, unimproved toilet and water facilities, and low community-level women literacy were positively linked with high anemia level. Additionally, the likelihood of anemia was lower in women who were overweight and used modern contraception.

CONCLUSIONS

Overall results showed that anemia among women of reproductive age is a severe public health problem in SSA countries, affecting more than four in ten women. Thus, enhancing access to maternal health services (antenatal care and contraception) and improved sanitation facilities would supplement the existing interventions targeted to reduce anemia. Moreover, strengthening women's education and policies regulating the prohibition of polygamous marriage are important to address the operational constraints.

Prevalence and factors associated with anemia in women of reproductive age across low- and middle-income countries based on national data

Anemia is a global threat among women of reproductive age (WRA), or 15-49 years old women, both in developed and developing countries. Prevalence of anemia in WRA is higher by fourfold in developing countries, based on extensive studies and surveys conducted by WHO and UNICEF. However, there is limited studies that conducted pooled analysis of anemia prevalence in low resource countries. This study aimed to assess the prevalence and factors associated with anemia among women of reproductive age in low- and middle-income countries (LMICs). This study used secondary data from the Demographic and Health Survey (DHS) in 46 low- and middle-income countries during 2010-2021. Descriptive statistics of proportions between pregnant and non-pregnant mothers were assessed. Multilevel binary logistic regression was used to test the factors associated with anemia among women of reproductive age. A total of 881,148 women of childbearing age in LMICs were included. This study found a high prevalence of 45.20% (95% CI 41.21, 49.16) of anemia was observed in among pregnant women and 39.52% (95% CI 33.88, 45.15) anemia was observed in non-pregnant women. Educational status, wealth status, family size, media exposure, and residence were common factors significantly associated with anemia in both pregnant and non-pregnant women. The high global burden of anemia in LMICs continues to underline the need for unusual approaches and target interventions on an individual basis. Global commitment and movement to reduce the prevalence of anemia need to be revisited and redesigned for current circumstances.

Geospatial disparities and predictors of anaemia among pregnant women in Sub-Saharan Africa

BACKGROUND

Anaemia has become a major public health concern among women in Sub-Saharan Africa (SSA). However, little is known about the spatial disparities in anaemia prevalence and their associated factors among pregnant women in the region. This study analysed the spatial disparities in anaemia and their associated factors among pregnant women in rural and urban settings in SSA.

METHODS

This is a secondary analysis of the most recent demographic and health surveys of 26 countries in SSA. Spatial autocorrelation and hotspot assessment were conducted, while a multivariate logistic regression model was used to identify demographic factors associated with anaemia.

RESULTS

Anaemia was reported among ~50% of pregnant women in urban and rural areas of SSA. The hotspot analysis identified the West African sub-region as having a higher concentration of anaemia cases in rural settings. In urban areas, the odds of anaemia were significantly higher among pregnant women in their second trimester (Adjusted OR = 2.39, CI = 1.99, 2.76). On the other hand, pregnant women in their third trimester (Adjusted OR = 1.98, CI = 1.77, 2.22) and those who had taken intestinal parasite drugs (Adjusted OR = 1.12 CI = 1.02, 1.23) had a higher likelihood of having anaemia in rural areas. Pregnant women aged 35-39 years (Adjusted OR = 0.52, CI = 0.33, 0.81) and those aged 40-44 years (Adjusted OR = 0.69, CI = 0.50, 0.95) had a lesser likelihood of having anaemia compared to women aged 15-19 years in urban and rural areas respectively. Compared to Congo DR, Benin (OR = 2.22, CI = 1.51, 3.28) and Mali (OR = 3.71, CI = 2.73, 5.05) had higher odds of anaemia in urban and rural areas respectively.

CONCLUSIONS

Spatial disparities in anaemia persist among pregnant women in rural and urban settings in SSA. Prevailing spatial variations in anaemia may be addressed by specialised interventions considering the contextual residential settings and socio-economic factors highlighted in this study.

Comprehensive Approach for Improving Adherence to Prenatal Iron and Folic Acid Supplements Based on Intervention Studies in Bangladesh, Burkina Faso, Ethiopia, and India

BACKGROUND

The World Health Organization recommends daily iron and folic acid (IFA) supplementation during pregnancy, but consumption remains low, and high prevalence of anemia among pregnant women (PW) persists.

OBJECTIVES

This study aims to (1) examine factors at the health system, community, and individual levels, which influence adherence to IFA supplements; and (2) describe a comprehensive approach for designing interventions to improve adherence based on lessons learned from 4 country experiences.

METHODS

We conducted literature search, formative research, and baseline surveys in Bangladesh, Burkina Faso, Ethiopia, and India and applied health systems strengthening and social and behavior change principles to design interventions. The interventions addressed underlying barriers at the individual, community, and health system levels. Interventions were further adapted for integration into existing large-scale antenatal care programs through continuous monitoring.

RESULTS

Key factors related to low adherence were lack of operational protocols to implement policies, supply chain bottlenecks, low capacity to counsel women, negative social norms, and individual cognitive barriers. We reinforced antenatal care services and linked them with community workers and families to address knowledge, beliefs, self-efficacy, and perceived social norms. Evaluations showed that adherence improved in all countries. Based on implementation lessons, we developed a program pathway and details of interventions for mobilizing health systems and community platforms for improving adherence.

CONCLUSION

A proven process for designing interventions to address IFA supplement adherence will contribute to achieving global nutrition targets for anemia reduction in PW. This evidence-based comprehensive approach may be applied in other countries with high anemia prevalence and low IFA adherence.

The Prevalence of Anemia in Working Women

INTRODUCTION

Anemia can be defined as a reduction in the amount of hemoglobin (Hb) in red blood cells (RBCs). It is becoming a growing socioeconomic issue. It is important to identify the causes of anemia and educate people about its symptoms. This can aid in the early identification and diagnosis of anemia, thereby preventing the disease's complications. The complications of anemia include the risk of low birth weight, prematurity, prenatal and neonatal mortality, and maternal mortality.

OBJECTIVE

The objective of the study is to investigate the factors contributing to anemia among working-class women employed in government or private sectors located in Karachi, Pakistan. By identifying the causes and risk factors of anemia, participants can be counseled to adopt a healthier lifestyle, a well-balanced diet, and activities that may eliminate the causes of anemia, further preventing the incidence of anemia. The objectives of the study are specific, measurable, achievable, realistic, and time-bound (SMART). The study was conducted from November 2019 to August 2021 despite facing COVID-19-related restrictions. The sample size fit the inclusion criteria, and the objectives were accomplished successfully with adequate resources.

METHODOLOGY

The cross-sectional study was conducted after receiving clearance from institutions and consent from participants. A total of 180 participants provided consent after receiving a thorough explanation of the study, and they had the right to refuse to participate. In respect of confidentiality, the participants were not required to provide their names, as they were not included in our data analysis. The inclusion criteria included women of the working class, aged 18-45 years, working a minimum of four to five hours per week, and employed in government or private sectors located in Karachi, Pakistan. The exclusion criteria included women with bleeding or hematological disorders, a history of surgery in the last 12 months, pregnancy, or systemic disease. Data collection was divided into two sections: section one (questionnaire) and section two (investigations). The questionnaire was given to each participant via Google Forms and was filled out before section two of data collection, which included blood tests via a finger prick to measure hemoglobin with a Veri-Q Multi Meter hemoglobin monitoring system (manufactured by Q-line BIOTECH, New Delhi, India).

RESULTS

The mean Hb was 11.15 ± 1.29 mg/dl (n = 180). The study revealed that 58.3% of the participants had a normal hemoglobin concentration according to the WHO anemia classification, while 41.7% were anemic. Overall, the prevalence of anemia was 41.7%, and the majority (56%) of the participants had mild anemia.

CONCLUSION

The majority of the participants had mild anemia. Education on anemia and its symptoms, eating habits, occupational status, and stress-related factors can affect the hemoglobin concentration in RBCs. A diet low in meat, leafy vegetables, and fruit leads to anemia. Despite knowledge of anemia and its symptoms, non-medical professionals, especially young adults, had a higher prevalence of anemia than medical professionals, although the difference was minor.

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

Anemia is a major global public health concern with a complex etiology. The main determinants are nutritional factors, infection and inflammation, inherited blood disorders, and women's reproductive biology, but the relative role of each varies between settings. Effective anemia programming, therefore, requires evidence-based, data-driven, contextualized multisectoral strategies, with coordinated implementation. Priority population groups are preschool children, adolescent girls, and pregnant and nonpregnant women of reproductive age. Opportunities for comprehensive anemia programming include: (i) bundling interventions through shared delivery platforms, including antenatal care, community-based platforms, schools, and workplaces; (ii) integrating delivery platforms to extend reach; (iii) integrating anemia and malaria programs in endemic areas; and (iv) integrating anemia programming across the life course. Major barriers to effective anemia programming include weak delivery systems, lack of data or poor use of data, lack of financial and human resources, and poor coordination. Systems strengthening and implementation research approaches are needed to address critical gaps, explore promising platforms, and identify solutions to persistent barriers to high intervention coverage. Immediate priorities are to close the gap between access to service delivery platforms and coverage of anemia interventions, reduce subnational coverage disparities, and improve the collection and use of data to inform anemia strategies and programming.

Sociodemographic factors associated with anemia among reproductive age women in Mali; evidenced by Mali malaria indicator survey 2021: spatial and multilevel mixed effect model analysis

INTRODUCTION

Anemia is a severe global public health problem that threatens human health as well as social and economic development in both developing and developed nations. Anemia is a significant public health issue because; it affects people from all backgrounds. Anemia affected about one-third of non-pregnant women, 41.8% of pregnant women, and more than a quarter of the world's population. Any stage of a woman's life might result in anemia, due to physiological factors, infections, hormonal imbalances, pregnancy related complications, genetic factors, nutritional deficiency and environmental factors. Mali is a developing country with substantial anemia prevalence, particularly in the developing areas. In order to reduce anemia among women of reproductive age, the Mali government worked to enhance preventative and integrative interventions. One of the government's objectives is to reduce the prevalence of anemia in order to decrease maternal and infant mortality and morbidity.

METHODS

Secondary data analysis was conducted using data from Mali Malaria Indicator Survey 2021 datasets. The study comprised a total of 10,765 reproductive-age women. Spatial and multilevel mixed effect analysis, chi-square, bivariate and multivariate logistic regression were employed on determinant factors of anemia among reproductive age women in Mali. Finally, the percentage and odd ratio, its 95% confidence intervals, and the result of spatial analysis were reported.

RESULTS

This study includes a total weighted sample of 10,765 reproductive-age women from Mali Malaria Indicator Survey 2021. The prevalence of anemia was 38%. Of them, 1.4%, were severely anemic, while 23.5% and 13.1% were moderately and mildly anemic, respectively in Mali. In the spatial analysis, the spatial distribution of anemia showed that a higher proportion of anemia found in southern and south west region of Mali. The northern and north east region of Mali had a low of proportion of anemia. being youngest age [20-24] years [ AOR = 0.817; 95% CI = (0.638,1.047); P = 0.000], attending higher education [AOR = 0.401; 95% CI= (0.278,0.579); P = 0.000], being male headed household [AOR = 0.653; 95% CI= (0.536,0.794); P = 0.000] and being richest [AOR = 0.629; 95% CI= (0.524,0.754) P = 0.000] were protective factors for anemia among reproductive age women. In contrast to this, living in rural area [ AOR = 1.053; 95% CI = (0.880,1.260); P = 0.000], being animist religion follower [AOR = 3.10; 95% CI= (0.763,12.623) P = 0.04], using unimproved drinking water sources [AOR = 1.117; CI= (1.017,1.228); P = 0.021} and using unimproved toilet facility [AOR = 1.018; CI= (0.917,1.130); P = 0.041} were considered as the risk factors for anemia among reproductive age women.

CONCLUSION

In this study, anemia was linked to socio-demographic characteristics, and there were regional variations in the frequency of anemia among women of reproductive age. The most important measures to prevent anemia among women of reproductive age in Mali included empowering women to have higher levels of education, raising the wealth index, rise in awareness of improved drinking water sources and toilet facilities, spreading anemia education through religiously acceptable routes, and using an integrated approach to prevention and intervention in high-prevalent regions of the country.

Global profile of anemia during pregnancy versus country income overview: 19 years estimative (2000-2019)

Anemia is a worldwide public health problem that is worst in low- and middle-income countries (LMICs), reaching 60% of prevalence. The etiology of anemia is diverse and multifactorial, with iron deficiency being the most prevalent, and often found in pregnant women. Iron is indispensable for the production of red blood cells and approximately 80% of the available heme iron is used for hemoglobin synthesis in mature erythroblasts. Iron deficiency affects oxygen transport, compromising energy and muscle metabolism and can occur with depletion of iron storage, defective erythropoiesis, and low hemoglobin levels. We analyzed anemia prevalence in pregnant women from 2000 to 2019 worldwide correlating them with current (2022) country income, with especial attention to LMICs using WHO dataset. Our analysis indicates that pregnant women from LMICs had a higher probability (40%) of anemia during pregnancy especially those from Africa and South Asia. Africa and the Americas showed a higher decrease in the prevalence of anemia from 2000 to 2019. The Americas and Europe have a lower prevalence, concentrated in 57% of most upper-middle- and high-income countries. Black women are also more prone to develop anemia during pregnancy, especially if they are from LMICs. However, the prevalence of anemia appears to decrease with an increase in educational level. In conclusion, anemia prevalence fluctuated from 5.2 to 65.7% worldwide in 2019, validating it as a public health problem.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

A continuous quality improvement strategy to strengthen screening practices and facilitate the routine use of intravenous iron for treating anaemia in pregnant and postpartum women in Nigeria: a study protocol

BACKGROUND

Pregnancy-related anaemia is a public health challenge across Africa. Over 50% of pregnant women in Africa get diagnosed with this condition, and up to 75% of these are caused by iron deficiency. The condition is a significant contributor to the high maternal deaths across the continent and, in particular, Nigeria, which accounts for about 34% of global maternal deaths. Whereas oral iron is the mainstay treatment for pregnancy-related anaemia in Nigeria, this treatment is not very effective given the slow absorption of the medication, and its gastrointestinal adverse effects which lead to poor compliance by women. Intravenous iron is an alternative therapy which can rapidly replenish iron stores, but fears of anaphylactic reactions, as well as several misconceptions, have inhibited its routine use. Newer and safer intravenous iron formulations, such as ferric carboxymaltose, present an opportunity to overcome some concerns relating to adherence. Routine use of this formulation will, however, require addressing misconceptions and systemic barriers to adoption in the continuum of care of obstetric women from screening to treatment. This study aims to test the options to strengthen routine screening for anaemia during and immediately after pregnancy, as well as evaluate and improve conditions necessary to deliver ferric carboxymaltose to pregnant and postpartum women with moderate to severe anaemia.

METHODS

This study will be conducted in a cluster of six health facilities in Lagos State, Nigeria. The study will employ continuous quality improvement through the Diagnose-Intervene-Verify-Adjust framework and Tanahashi's model for health system evaluation to identify and improve systemic bottlenecks to the adoption and implementation of the intervention. Participatory Action Research will be employed to engage health system actors, health services users, and other stakeholders to facilitate change. Evaluation will be guided by the consolidated framework for implementation research and the normalisation process theory.

DISCUSSION

We expect the study to evolve transferable knowledge on barriers and facilitators to the routine use of intravenous iron that will inform scale-up across Nigeria, as well as the adoption of the intervention and strategies in other countries across Africa.

A New Artificial Intelligence Approach Using Extreme Learning Machine as the Potentially Effective Model to Predict and Analyze the Diagnosis of Anemia

The procedure to diagnose anemia is time-consuming and resource-intensive due to the existence of a multitude of symptoms that can be felt physically or seen visually. Anemia also has several forms, which can be distinguished based on several characteristics. It is possible to diagnose anemia through a quick, affordable, and easily accessible laboratory test known as the complete blood count (CBC), but the method cannot directly identify different kinds of anemia. Therefore, further tests are required to establish a gold standard for the type of anemia in a patient. These tests are uncommon in settings that offer healthcare on a smaller scale because they require expensive equipment. Moreover, it is also difficult to discern between beta thalassemia trait (BTT), iron deficiency anemia (IDA), hemoglobin E (HbE), and combination anemias despite the presence of multiple red blood cell (RBC) formulas and indices with differing optimal cutoff values. This is due to the existence of several varieties of anemia in individuals, making it difficult to distinguish between BTT, IDA, HbE, and combinations. Therefore, a more precise and automated prediction model is proposed to distinguish these four types to accelerate the identification process for doctors. Historical data were retrieved from the Laboratory of the Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia for this purpose. Furthermore, the model was developed using the algorithm for the extreme learning machine (ELM). This was followed by the measurement of the performance using the confusion matrix and 190 data representing the four classes, and the results showed 99.21% accuracy, 98.44% sensitivity, 99.30% precision, and an F1 score of 98.84%.

How can pharmacists contribute to anaemia management? A review of literature and exploratory study on pharmacists' role in anaemia

Background

Iron deficiency anaemia (IDA) is the leading cause of anaemia globally, most frequently found in children and pregnant women. With their increasing role in the healthcare system, pharmacists may contribute to the management of anaemia. Through the International Pharmaceutical Federation (FIP) Multinational Needs Assessment Programme, the FIP explored the contribution of pharmacists in anaemia, specifically IDA, focusing on five countries: India, Indonesia, Malaysia, Philippines and Singapore.

Objective

To explore information on pharmacists' roles in a variety of settings related to 1) IDA management; 2) education and training needed to support the roles; and 3) barriers and enablers to expanding or developing the roles.

Methods

This study involved a literature review and a focus group discussion with twelve participants selected purposively and nominated by national professional leadership bodies across five countries. A literature search was conducted using PubMed Database. A focus group discussion explored pharmacists' roles, education and training needs, as well as barriers and enablers to support their roles in anaemia management, specifically in IDA. A codebook thematic analysis approach was conducted according to the study objectives.

Results

Sixteen articles were included in the analysis. The pharmacists' roles in anaemia identified from literature ranged from patient management and monitoring, collaboration with other healthcare professionals and involvement in guideline development, in which the roles vary according to the workplace. Twelve participants attended the focus group discussion. Participants highlighted pharmacists' roles in screening and detection, medication therapeutic management, patient counselling and patient monitoring. Participants emphasised a need for guidelines or toolkits with subsequent training or workshops to support their competency development in anaemia. Monitoring the success of pharmacist delivered anaemia programmes was recommended to support advocating for active pharmacist roles.

Conclusion

Pharmacists have a growing opportunity to contribute to achieving the global targets on anaemia through their involvement in screening and managing anaemia and increasing anaemia awareness among the patients and community.

Recognizing who is at risk for postpartum hemorrhage: targeting anemic women and scoring systems for clinical use

Iron deficiency anemia during pregnancy is a common concern, affecting 38% of women worldwide and up to 50% in developing countries. It is defined differently throughout all 3 trimesters. It has several detrimental effects on pregnancy outcomes for both the mother and the fetus, such as increasing the risk for postpartum depression, preterm delivery, cesarean delivery, preeclampsia, and low birthweight. Management of iron deficiency anemia is done classically via oral iron supplementation. However, recent evidence has shown that intravenous iron is a good alternative to oral iron if patients are unable to tolerate it, not responding, or present with a new diagnosis very late in pregnancy. Management of iron deficiency anemia was demonstrated to be protective against postpartum hemorrhage. Other ways to prevent postpartum hemorrhage include improving prediction tools that can identify those at risk. Several risk assessment kits have been developed to estimate the risk for postpartum hemorrhage among patients and have been proven useful in the prediction of patients at high risk for postpartum hemorrhage despite limitations among low-risk groups. More comprehensive tools are also being explored by determining clinically relevant factors through nomograms, with some proving their efficacy after implementation. Machine learning is also being used to develop more complete tools by including risk factors previously not accounted for. These newer tools, however, still require external validation before being adopted despite promising results under testing conditions.

Determinants of anaemia prevalence in women of reproductive age in Nigeria: A cross-sectional study using secondary data from Nigeria Demographic and Health Survey 2018

BACKGROUND

Anaemia disproportionately affects women of reproductive age in sub-Saharan Africa including Nigeria. Yet, community-based studies on the prevalence and determinants of anaemia among women of reproductive age are scarce in Nigeria.

DESIGN

A cross-sectional community-based survey using a nationally representative sample.

OBJECTIVES

This study described anaemia prevalence and its associated factors among women of reproductive age, pregnant women, and non-pregnant women in Nigeria.

METHODS

We analysed data from the 2018 Nigeria Demographic and Health Survey. Pregnant women with a haemoglobin level less than 11 g/dL and non-pregnant women with a haemoglobin level less than 12 g/dL were considered anaemic. Anaemia was also categorized as mild, moderate, and severe. Pearson's chi-square test was used to evaluate the association between anaemia status and independent variables. All variables with ρ ⩽ 0.25 in bivariate analyses were further analysed using complex sample logistic regression.

RESULTS

Anaemia prevalence was 57.8%, 57.4%, and 61.1% for women of reproductive age, non-pregnant women, and pregnant women, respectively. The prevalence of severe anaemia was 1.6%, 1.5%, and 2.3% for overall women of reproductive age, non-pregnant women, and pregnant women, correspondingly. The southern regions, rural residence, low education, unemployment, low wealth index, and non-use of modern contraceptives significantly increased the likelihood of anaemia and severe anaemia among women of reproductive age and non-pregnant women. The likelihood of being anaemic was significantly increased by large family size among women of reproductive age and by being underweight among non-pregnant women. The South-East region, rural residence, low education, and unemployment were significantly associated with anaemia among pregnant women. The South-South region and unemployment increased the likelihood of severe anaemia among pregnant women. Short stature significantly reduced the odds of being anaemic and severely anaemic among pregnant women.

CONCLUSIONS

Anaemia prevalence among all categories of women of reproductive age is high in Nigeria. Predictors of anaemia prevalence and severity should be considered in policies intended to reduce anaemia among women of reproductive age in Nigeria.

Spatial distribution and identifying biochemical factors affecting haemoglobin levels among women of reproductive age for each province in Indonesia: A geospatial analysis

Anaemia is still a public health problem in Indonesia. The iron supplement program, known as Tablet Tambah Darah (Blood Add Tablet) has not yet produced optimal results. This study aimed to identify the cause of anaemia and the factors that influence it. Biochemical indicator data are haemoglobin (Hb), C-reactive protein (CRP), ferritin and serum transferrin receptor (sTfR) from 9,463 women of reproduction age. Data from the Basic Health Research (Riskesdas) project of 2013 were used for the study. ANOVA as well as global and local regression approaches (classical regression and geo-weighted regression) were used to compare the mean Hb and CRP values between provinces and to determine the factors that influence Hb concentrations. The results showed that the distribution of anaemia in Indonesia is uneven and not always caused by iron deficiency. The lowest Hb mean coupled with the highest iron deficiency was found in Papua, where there are high rates of parasitic infections. In contrast, the highest mean Hb coupled with low iron deficiency, and also low infection rates, was found in North Sulawesi. The Hb concentrations were significantly associated by ferritin, CRP and sTfR and there were varying magnitudes between provinces. Although anaemia is mainly influenced by the iron concentration, CRP, ferritin and sTfR can also affect it through their association with inflammatory reactions. Identification of all causes of anaemia in each province needs to be done in the future, while blanket iron supplementation should be reviewed.

The geo-spatial perspective of biological, social and environmental determinants of early pregnancy anaemia in rural Sri Lanka: Need for context-specific approaches on prevention

We provide a novel approach to understanding the multiple causations of maternal anaemia in a geospatial context, highlighting how genetics, environment and socioeconomic disparities at the micro-geographical level lead to the inequitable distribution of anaemia. All first-trimester pregnant women registered for the antenatal care programme in Anuradhapura District, Sri Lanka from July to September 2019 were invited to the Rajarata Pregnancy Cohort (RaPCo), which assessed the prevalence of anaemia in early pregnancy. The combination of the prevalence of anaemia and minor haemoglobinopathy-related anaemia (MHA) with the poverty headcount index of the 22 health divisions in the district was investigated using GeoDa spatial K-means clustering. Sociodemographic and economic data at the divisional level were compared between identified clusters. Combining the analysis with the geographical and environmental characteristics of the region, further hypotheses regarding anaemia in this community were formulated. The study included data from 3,137 pregnant women in early pregnancy. The anaemia and MHA prevalence varied from 13.6 to 21.7% and from 2.6% to 5%, respectively. We identified four distinct spatial clusters. The cluster with the highest anaemia prevalence also included high poverty and the highest prevalence of MHA. The clusters had significant differences with regard to ethnic distribution, access to water, sanitation and dietary patterns. Areas supplied by major irrigation projects had significantly low levels of anaemia, probably attributable to internal migration and improved livelihood. It was evident that genetic, socioeconomic and environmental risk factors were grouped at the divisional level, and that their complex interactions make controlling anaemia with blanket interventions unsuccessful. Analysis of the distribution of heterogeneous risk factors at the micro-geospatial level helped identify context-specific approaches to tackle anaemia in pregnancy.

Effect of inulin, galacto oligosaccharides and iron fortification on iron deficiency anemia among women of reproductive age; a randomized controlled trial

Iron supplementation and fortification are the well-known approaches to treat iron deficiency anemia (IDA) in women of reproductive age. The objective of the current randomized controlled trial (RCT) was to evaluate the cumulative effects of prebiotics and iron fortification among women of reproductive age. For this purpose, a total of 75 iron deficient women of childbearing age were recruited and randomly divided into 5 groups (4 treatment groups and 1 control group). Four different types of fortified wheat flour were prepared using two iron fortificants (NaFeEDTA and FeSO4) and two prebiotics [inulin and galacto oligosaccharides (GOS)], while control group was treated with iron fortified flour without any prebiotics. Blood samples were collected from overnight fasted women on monthly basis up to 90 days. Hematological indices such as Hemoglobin (Hb), Hematocrit, Red Blood Cell (RBC) Count and Mean Corpuscular Volume (MCV), as well as iron biomarkers including serum iron, ferritin, transferrin, and Total Iron Binding Capacity (TIBC) were evaluated for analyses. The results showed a considerable positive improvement in all iron biomarkers as well as hematological indices among the treatment groups (P-value &lt; 0.05), as compared to the control group. A maximum Hb (11.86 ± 0.24 mg/dL) and hematocrit value (35.06 ± 1.32%), was reported in group G3 which was treated with fortified wheat flour at a dose of 963 mg/kg GOS + 15 ppm FeSO4. On the other hand, highest mean values for RBC Count (4.73 ± 0.41 mil/mm3), MCV (81.41 ± 3.21 fL), serum iron (75.62 ± 2.79 μg/dL), serum transferrin (16.82 ± 0.30 mg/dL), and TIBC (403.68 ± 7.27 μg/dL) were observed in G4 group receiving the fortified wheat flour at a dose of 963 mg/kg GOS + 30 ppm FeSO4 level. The study concluded that prebiotic fortification along with iron salts helps to enhance iron absorption among iron deficiency anemic women of reproductive age.

Factors associated with early pregnancy anemia in rural Sri Lanka: Does being 'under care' iron out socioeconomic disparities?

Globally, more than a third of pregnant women are anemic, and progress in its prevention and control is slow. Sri Lanka is a lower-middle-income country with a unique public health infrastructure that provides multiple interventions across the lifecycle for anemia prevention, despite which anemia in pregnancy remains a challenge. Studying the factors associated with maternal anemia in this context would provide unique information on challenges and opportunities encountered as low-and-middle-income countries attempt to control anemia by improving health care coverage. All first-trimester pregnant women registered for antenatal care in the Anuradhapura district between July 2019 to September 2019 were invited to participate in the baseline of a cohort study. Interviewer-administered and self-completed questionnaires were used. Anemia was defined using a full blood count. A hierarchical logistic regression model was built to identify factors associated with anemia. Out of 3127 participants, 451 (14.4%) were anemic. According to the regression model (Chi-square = 139.3, p<0.001, n = 2692), the odds of being anemic increased with the Period of gestation (PoG) (OR = 1.07, 95% CI = 1.01-1.13). While controlling for PoG, age and parity, history of anemia (OR = 3.22, 95%CI = 2.51-4.13), being underweight (OR = 1.64, 95%CI = 1.24-2.18), having the last pregnancy five or more years back (OR = 1.57,95%CI = 1.15-2.15) and having used intrauterine devices for one year or more (OR = 1.63, 95%CI = 1.16-2.30) increased the odds of anemia. Breast feeding during the last year (OR = 0.66, 95%CI = 0.49-0.90) and having used contraceptive injections for one year or more (OR = 0.61,95%CI = 0.45-0.83) reduced the risk of anemia. Proxy indicators of being in frequent contact with the national family health program have a protective effect over the socioeconomic disparities in preventing early pregnancy anemia. Maintaining the continuum of care through the lifecycle, especially through optimizing pre and inter-pregnancy care provision should be the way forward for anemia control.

High Prevalence of Anemia and Poor Compliance with Preventive Strategies among Pregnant Women in Mwanza City, Northwest Tanzania: A Hospital-Based Cross-Sectional Study

Anemia in pregnancy is prevalent in Tanzania despite the implementation of existing prevention strategies. This study aims to determine the level of compliance with anemia preventive strategies among pregnant women and the factors associated with poor compliance. A cross sectional study was conducted among 768 pregnant women who attended the Bugando Medical Center, Sekou-Toure Regional Hospital, Nyamagana District Hospital, and Buzuruga Health Center in Mwanza, Northwest Tanzania. The prevalence of anemia at term was 68.8% (95% CI, 65.5-72.0%). The average hemoglobin level at term was 10.0 g/dL (95% CI, 9.8-10.1). Only 10.9% of pregnant women complied fully with anemia-preventive strategies. A decrease in mean hemoglobin level was observed across levels of compliance, with women who were non-compliant displaying a significantly lower mean hemoglobin level (8.3 g/dL) compared to women who were fully compliant (11.0 g/dL). Poor compliance was associated with no formal or primary education and initiating antenatal care in the 2nd or 3rd trimester. Anemia in pregnancy was commonly associated with lack of compliance with preventive strategies among participants. There is a need for community-based health education on the importance of complying with anemia-preventive strategies in order to reduce the burden during pregnancy and the consequences of anemia to the unborn baby.

A portable smartphone-based hemoglobin point-of-care testing platform for accurate anemia diagnostics

Anemia affects over 2 billion people worldwide, with the heaviest burden borne by women and children. At present, anemia is diagnosed by measuring hemoglobin (Hb) levels, which must be done in hospitals or commercial laboratories by skilled operators. In this work, we report a portable, affordable ($3), easy-to-operate (1 min) and accurate smartphone-based Hb analyzer (SHbA) that uses a drop of finger-pricked blood for anemia point-of-care test (POCT) applications. POCT of Hb was achieved using a smartphone ambient light sensor (ALS) to accurately measure the absorbance of colorimetric Hb biochemical analysis reagents in a microcuvette, as well as an Android-based application for results analysis. SHbA validation results agreed well with those reported by a hematology analyzer, and the SHbA has an anemia diagnosis sensitivity of 95.4% and specificity of 96.3% for venous blood (n = 360) and a sensitivity of 96.39% and specificity of 95.58% for fingertip blood (n = 475). In addition, SHbA exhibits excellent performance in the diagnosis and treatment guidance of anemia high-risk populations, including tumor chemotherapy patients (n = 424), pregnant women (n = 214) and thalassemia patients (n = 208). Importantly, volunteer self-testing results (n = 20) indicate that SHbA can be used for home-based anemia diagnosis and monitoring. SHbA has the advantages of high sensitivity and specificity while being cheap and easy to operate, making it widely applicable for the diagnosis and treatment of anemia, especially for high-risk patients in areas with poor medical resources.

Lower socioeconomic status strengthens the effect of cooking fuel use on anemia risk and anemia-related parameters: Findings from the Henan Rural Cohort

The established evidence of cooking fuel use and socioeconomic status related to anemia is limited in low- and middle-income countries. The current study aims to examine the independent and combined effects of cooking fuel use and socioeconomic status on anemia risk as well as anemia-related parameters in rural China. A total of 21,050 participants were included from the baseline of the Henan Rural Cohort. Anemia was determined according to the World Health Organization criteria. Data on cooking fuel use (electricity, gas and solid fuel) and socioeconomic status (education and income levels) were collected using a standardized questionnaire by face-to-face interview. Logistic and linear regression models were applied to evaluate the effects of cooking fuel use or socioeconomic indicators on anemia risk, hemoglobin (HGB), red blood count (RBC), and hematocrit (HCT) levels. Using gas or solid fuel for cooking was positively associated with prevalent anemia risk and negatively related to HGB, RBC, and HCT levels compared to using electricity. Significant independent associations were also found between socioeconomic status (education and income levels) and prevalent anemia risk as well as these anemia-related parameters. In general, with decreased socioeconomic status, associations of using gas or solid fuel for cooking with advanced anemia risk as well as lower anemia-related parameters were increased. Furthermore, participants using gas or solid fuel for cooking and with lower education or income level were related to increased high anemia risk as well as low HGB, RBC and HCT levels, compared to those using electricity for cooking and with high education or income level (P <0.05 for all). The finding suggested that lower socioeconomic status strengthens the adverse effect of cooking fuel use on the higher anemia risk and lower HGB, RBC, and HCT levels in rural China.

Targeted and Population-Wide Interventions Are Needed to Address the Persistent Burden of Anemia among Women of Reproductive Age in Tanzania

Recent evidence suggests that 44.8% of women of reproductive age (WRA) in Tanzania suffer from anemia. Addressing this public health challenge calls for local evidence of its burden and determinants thereof for policy and tailored interventions. This secondary data analysis used Tanzania Demographic and Health Surveys (TDHS) 2004−2005 and 2015−2016 with a total of 23,203 WRA. Data were analyzed using descriptive statistics to characterize the burden of anemia, regression analyses to examine the adjusted change in the prevalence of anemia and remaining determinants thereof, and the Global Information System (GIS) to map the differences in the burden of anemia in Tanzania over the period of one decade. Considering the risk factors of anemia observed in our study, WRA in Tanzania should have been 15% less likely to suffer from anemia in 2015 compared to 2005. However, a small decline (3.6%) was not evenly distributed across the regions in Tanzania. Factors that remained significantly associated with anemia among WRA in the latest survey include age above 35 years (AOR = 1.564, p = 0.007), education level (AOR = 0.720, p = 0.001), pregnancy status (AOR = 1.973, p < 0.001), and use of contraception (AOR of 0.489, p < 0.001). Our findings suggest that WRA in Tanzania aged above 35 should be the target population to accept the more tailored interventions.

OsVIT2 Mutation Increases Fe and Zn of Grain Without Compromising the Growth in Paddy Field

Nearly 2 billion people who reside in developing countries are suffering from nutrient deficiency, also known as hidden hunger. A hidden hunger includes iron (Fe) and zinc (Zn) deficiency. One of the most efficient solutions to hidden hunger is the biofortification of crops through breeding. In this study, we characterized the mutant 1095_k, which has high grain Fe (~1.4-fold) and Zn (~1.2-fold) concentration compared with wild-type plants for a 5-year field trial. The yield components of 1095_k are similar to wild-type plants in a paddy field. In addition, 1095_k has a non-sense mutation in OsVIT2, a vacuolar localized Fe transporter. F2 crosses between 1095_k and wild type having the mutation showing higher grain Fe and Zn concentration. In contrast, plants without the mutation showed similar element concentrations as the wild type. These results suggest that OsVIT2 would be responsible for high Fe and Zn of grain and the 1095_k would be a useful breeding material for the biofortification of Fe and Zn.