Anaemia remains an important global health problem. Almost 42% of all pregnant women worldwide (56 million) are thought to be anaemic. The prevalence is highest in low-income countries, especially in South and South East Asia, and Sub-Saharan Africa. Iron deficiency is often considered the chief cause, and often deemed synonymous with anaemia in the public health context. For example, WHO guidelines assume that at least half the worldwide burden of anaemia is attributable to iron deficiency. Indeed, the most recent global burden of disease report conflates iron deficiency with anaemia, using haemoglobin measurements to define the burden of disease attributable to iron deficiency .However, beyond iron deficiency, anaemia has many possible causes. In the public health context, inherited red cell disorders, particularly thalassaemia and haemoglo-binopathy (e.g. HbE) carrier and compound heterozygous and homozygous states, infections (especially malaria) and inflammation, and other micronutrient deficiencies (i.e. deficiencies of folate and vitamin B12 and A), may be important depending on the geographic setting and the population. Distinguishing these causes requires clinical observation and expensive laboratory investigation and, thus, relatively few studies have undertaken detailed analysis of the determinants of anaemia in populations. However, it is interesting that, where these have been performed, iron deficiency is sometimes a surprisingly minor player.
展开▼
