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Anaemia as a challenge to world health 

Anaemia as a challenge to world health

Chapter:
Anaemia as a challenge to world health
Author(s):

D.J. Roberts

and D.J. Weatherall

DOI:
10.1093/med/9780199204854.003.220503_update_002

Update:

Updated section on the role of hepcidin in chronic anaemia associated with infection.

Updated on 30 May 2013. The previous version of this content can be found here.
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date: 30 March 2017

Anaemia is a very common problem in the developing world: 47% of women aged 15 to 49 years have haemoglobin less than 12 g/dl; 59% of pregnant women have haemoglobin less than 11 g/dl; 26% of men aged 15 to 49 years have haemoglobin less than 13 g/dl. About 20% of perinatal mortality and 10% of maternal mortality in developing countries is attributable to iron deficiency.

Causes of anaemia in developing countries—this is often multifactorial, with causes including (1) nutritional deficiencies—iron, folate, vitamin B12; (2) chronic infection—including malaria, tuberculosis, AIDS; (3) blood loss—hookworm, schistosomiasis; (4) protein–energy malnutrition; (5) malabsorption—e.g. tropical sprue; (6) hereditary—e.g. thalassaemias, haemoglobin variants, glucose-6-phosphate dehydrogenase deficiency.

A series of vicious cycles in the developing world—maternal anaemia due to iron or folate deficiency and chronic malaria is associated with the birth of underweight infants who frequently have low iron stores, may also be folate deplete, and are usually anaemic from about 6 months of age. Such infants are prone to infection, particularly gastrointestinal, and may be further depleted of iron or folate by inappropriately prolonged breastfeeding or weaning onto an inadequate diet. They are exposed to hookworm infection as soon as they start to crawl, malaria becomes an important problem after 6 months, and in many populations the increasingly common haemoglobinopathies are a further cause of anaemia after the first few months of life.

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