Controlling infection essential to tackle global anaemia

Anaemia affects 273 million children and 529 million women globally, accounting for 8.8% of all years lived with disability. Anaemia prevalence in children under-5 years is highest in sub-Saharan Africa (62.3%) and South-East Asia (53.8%). Iron is an essential micronutrient required for many biological processes, and iron deficiency can compromise diverse physiological functions and commonly leads to anaemia. It is therefore unsurprising that until now, public health strategies to control anaemia emphasised iron replenishment, and focused on strategies such as food fortification with iron and universal distribution of iron supplements. However, the prevalence of anaemia across the developing world has not markedly improved despite decades of iron-focussed nutritional programmes. This failure to resolve the anaemia burden has frequently been attributed to programmatic limitations, such as financing, supply, distribution or adherence to interventions.

“The mechanistic work we do in the lab, and our collaborations with MRC Gambia, have shown at a molecular level how infections and inflammation prevent absorption of dietary iron. This has given us some insight into why anaemia rates across the developing world have been persistently very high for so long despite huge efforts by aid agencies. Unless we emphasize the fight against infection, we fear anaemia will continue to be a huge global health problem. - Prof Hal Drakesmith

In his latest paper, published in the The BMJ, Prof Hal Drakesmith at the MRC Human Immunology Unit (Radcliffe Department of Medicine) and collaborators in Australia and MRC Gambia provide a cross-disciplinary synthesis of data from fields of infection, haematology, nutrition and global health to address the problem of anaemia. Their analysis showed that in countries where there is a high infection burden, for example from malaria or intestinal pathogens, providing iron supplements may increase patient susceptibility to infection, and often does not improve anaemia. This is particularly important because the majority of young children affected by anaemia live in sub-Saharan Africa and Asia, areas endemic to many of these infections.

Their analysis concludes with a series of proposals for changes to the World Health Organisation recommendations, and for new research agendas. This work was funded by the Medical Research Council and the Haematology Theme, NIHR Oxford Biomedical Research Centre.