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Anaemia as a challenge to world health 

Anaemia as a challenge to world health
Anaemia as a challenge to world health

David J. Roberts

, and David J. Weatherall

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date: 05 March 2021

Anaemia is a very common problem in low- and middle-income countries (LMICs): 27% of the world’s population or 1.93 billion people are affected by anaemia (2013) and more than 90% of people with anaemia live in the developing world. Preschool children and women of reproductive age are particularly affected by anaemia and more 60% of anaemia is caused by iron deficiency.

Causes of anaemia in LMICs—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—for example, tropical sprue; (6) hereditary—for example, thalassaemias, haemoglobin variants, glucose-6-phosphate dehydrogenase deficiency.

A series of vicious cycles exist in LMICs—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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