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Epidemiology and public health of anemia
Anemia is one of the leading public health problems worldwide, both because of its widespread prevalence and because of its negative impact on major indicators of population health, social development and economic growth. Its occurrence reflects the degree of equity, nutritional status and access to healthcare services within a population, making epidemiological analysis of anemia essential for the assessment and planning of public health interventions.
Historically, the earliest descriptions of conditions compatible with anemia can already be found in Egyptian papyri and Hippocratic writings; a modern epidemiological understanding, however, began to develop only during the nineteenth century, when it became possible to measure hemoglobin and red blood cells, associate the disease with nutritional deficiencies, infections and social conditions, and integrate the clinical dimension with population based observation.
Global prevalence and disease burden
According to the WHO, in 2023 anemia affected approximately 30.7% of women aged 15 to 49 years, 35.5% of pregnant women and 30.5% of nonpregnant women; among children aged 6 to 59 months, the available global estimate is approximately 39.8% in 2019. These estimates describe specific groups and should not be converted into a single global prevalence not directly provided by the source.
In Africa and Southeast Asia the burden of anemia is particularly high, but prevalence varies by age, sex, pregnancy status and country; it is not appropriate to attribute values above 50% indiscriminately to all children and all women of reproductive age. In high income countries the average burden tends to be lower than in many low and middle income regions, but there is no general threshold below 15% that can be applied indiscriminately to all populations; high risk groups also remain, including socially disadvantaged people, older adults and some migrant populations.
- Disability burden: according to the WHO, anemia accounted for approximately 50 million healthy years of life lost to disability in 2019, with a substantial burden among women and children.
- Impact on morbidity: anemia is associated with reduced physical capacity, adverse maternal and infant outcomes and poorer prognosis in many conditions; attribution of deaths requires specific causal analyses and cannot be inferred from prevalence alone.
- Economic costs: anemia may reduce productivity and labor force participation, but the economic magnitude varies considerably among countries, causes and estimation methods.
Distribution by age group and physiological condition
Anemia has a markedly heterogeneous epidemiological profile across different population groups, each characterized by specific risk factors, prevalent forms and clinical implications.
- Children aged 6 months to 5 years: this is the most vulnerable group, with an average global prevalence of approximately 40%, with higher values in many low and middle income countries. Causes are multifactorial: iron and other micronutrient deficiencies, endemic infectious diseases such as malaria and helminthiasis, inflammation, hemoglobinopathies, chronic malnutrition, limited access to healthcare services and insufficient dietary diversification contribute to varying degrees according to context. In this age group, anemia is associated with growth delay, increased susceptibility to severe infections, neurocognitive deficits and poorer school performance, with possible developmental consequences whose extent and reversibility depend on age, cause, duration, treatment and confounding factors.
- Women of reproductive age and pregnancy: the WHO estimates anemia in 30.7% of women aged 15 to 49 years and in 35.5% of pregnant women. Anemia during pregnancy is associated with adverse maternal and neonatal outcomes, but risk depends on severity, cause and comorbidity and does not support uniform causal attribution for every listed outcome. In industrialized countries, anemia during pregnancy remains relevant particularly because of unbalanced diets, closely spaced pregnancies, multiple chronic diseases and vulnerable minority groups.
- Older adults: prevalence increases progressively after 65 years of age; classic United States studies report estimates around 10% among community dwelling older adults, higher values after age 85 and generally greater prevalence in care facilities, with values depending on the population and criteria used. Causes include both nutritional deficiencies, often related to malabsorption, polypharmacy, poverty or social isolation, and chronic diseases, including kidney failure, cancer and chronic inflammation, as well as underlying hematologic disorders. Anemia in older adults is a strong predictor of frailty, functional disability, falls, institutionalization and premature mortality, but it is often underestimated or unrecognized.
- Vulnerable populations: migrants, refugees and socially vulnerable groups may have increased risk in specific settings, but prevalence is not uniformly higher and must be documented according to population, origin and living conditions. In these groups, risk is determined by a combination of food insecurity, poor housing conditions, exposure to endemic infectious diseases and barriers to accessing services. Reception centers require local data and screening based on clinical and nutritional risk, without assuming prevalence equivalent to that of other geographical regions.
In addition to these key populations, consideration must be given to patients with chronic diseases, people with disabilities, individuals living in conditions of social exclusion and women during the postpartum period, all groups at increased risk of anemia for specific and often overlapping reasons.
Geographical differences and prevalent forms
The distribution of anemia closely reflects the geographical stratification of social and environmental determinants of health. Sub-Saharan Africa and South Asia are the macroregions with the highest burden, with prevalence among the highest worldwide and varying by country, age, pregnancy status and survey year. The burden is strongly associated with chronic malnutrition, endemic infections, food poverty and weak healthcare systems.
In Latin America and the Caribbean, the situation is intermediate, with prevalence varying among countries and population groups, marked differences between urban and rural areas, and pockets of very high prevalence associated with social inequalities and persistent food insecurity.
In Western Europe and North America, prevalence is generally lower than in the highest burden regions, but vulnerable groups remain. The correct term is anemia; “hyperanemia” does not describe pockets of higher prevalence.
This page does not have a representative national source for anemia prevalence in Italy. PASSI and ISTAT do not provide systematic clinical and laboratory surveillance of anemia comparable with WHO estimates.
- Iron deficiency anemia: the most common form worldwide, particularly prevalent among children, women and populations at risk of nutritional deficiencies and chronic blood loss.
- Megaloblastic anemias: common among older adults, people following restrictive diets or with malabsorption disorders, and in some areas characterized by specific forms of food poverty.
- Anemia of chronic disease: predominant among patients with chronic conditions such as kidney failure, cancer and chronic inflammation, and more common in high income countries.
- Inherited anemias: thalassemias and sickle cell disease represent a major public health emergency in the Mediterranean basin, the Middle East, Africa, Southeast Asia and populations of African descent in the Americas and Europe.
Historical trends and changes over time
Global progress has been insufficient: according to WHO estimates, prevalence among women aged 15 to 49 years increased from 27.6% in 2012 to 30.7% in 2023. Trends and determinants differ among countries and groups and do not allow a general change to be attributed to a single intervention.
In low and middle income countries, reductions in anemia prevalence have been much slower and are often hindered by political crises, armed conflicts, food insecurity, climate related emergencies and persistent barriers to healthcare and nutritional services. Annual variations in prevalence are often associated with acute events such as famines, epidemics and mass migration, which produce marked peaks of anemia among the most vulnerable groups.
Observed trends indicate insufficient progress toward the WHO global target for anemia among women aged 15 to 49 years; reducing anemia contributes to nutrition and health goals linked to the SDGs, but it is not a standalone SDG indicator with an identical target for every population.
Methodological limitations and epidemiological challenges
Despite the increasing availability of data and international surveys, the true prevalence and severity of anemia remain partly underestimated for methodological and organizational reasons.
The main limitations include:
- Variability in diagnostic cutoffs: hemoglobin thresholds used to define anemia may differ among countries and guidelines, including in relation to physiological factors such as age, sex, pregnancy and altitude; the 2024 WHO guideline does not recommend a general correction based on race or ethnicity.
- Quality of laboratory data: in many rural or low income areas, data are unreliable because of structural deficiencies, shortages of trained personnel and the inability to standardize collection and analytical methods.
- Underestimation in vulnerable groups: major surveys often exclude migrants, refugees, ethnic minorities and residents of remote areas, resulting in underestimation of the true prevalence of anemia in the most vulnerable segments of the population.
- Cross sectional rather than longitudinal data collection: most epidemiological studies measure prevalence at a given point in time and therefore cannot assess changes in the disease, its duration or the impact of prevention strategies over time.
- Limited detail regarding causes: major international databases often lack systematic disaggregation of the causes of anemia, including deficiency, chronic and inherited forms, hindering the planning of targeted interventions.
These limitations highlight the need to invest in standardizing indicators, digitalizing surveillance systems and including vulnerable groups in all major national and international surveys.
Social, economic and environmental determinants
Anemia is a paradigmatic example of a pathological condition influenced by multiple determinants that interact at the individual, family, community and systemic levels. In public health, understanding social determinants is essential for designing effective and sustainable interventions.
The main determinants include:
- Poverty and food insecurity: limited economic resources restrict access to a varied, high quality diet and prevent adequate intake of iron, vitamins such as B12 and folate, proteins and essential micronutrients. In low income countries, dependence on iron poor cereals and the absence of animal sourced foods are structural dietary factors that sustain the cycle of anemia.
- Education and women's empowerment: low levels of education, particularly among women, are associated with a higher prevalence of anemia both in women themselves and in their children. Literacy and decision making autonomy lead to better dietary choices, greater use of healthcare services and a stronger ability to prevent nutritional deficiencies.
- Access to healthcare services: the availability of prevention, diagnostic and treatment services, together with trained and motivated healthcare professionals, is crucial for the early identification and management of anemia. Geographical inequalities, cultural or language barriers and inadequate healthcare infrastructure in rural and peripheral areas contribute to the persistence of anemia in many countries.
- Housing and environmental conditions: overcrowded housing and the absence of sanitation, safe drinking water and adequate hygiene promote the transmission of intestinal parasites, malaria and chronic infections, all of which are strongly associated with the development and persistence of anemia, particularly among children.
These determinants frequently act synergistically, increasing population vulnerability and concentrating anemia within specific groups or geographical areas.
Individual and collective risk factors
Risk factors for anemia, which are distinct from structural determinants, are conditions or behaviors that increase the likelihood of developing the disease without necessarily constituting its primary cause. From a public health perspective, identifying these factors makes it possible to target primary and secondary prevention measures toward the groups at greatest risk.
- Monotonous or inadequate diet: diets based almost exclusively on unfortified cereals, low consumption of animal sourced foods, fruit and vegetables, improperly balanced vegetarian or vegan diets, and absence of supplementation in at risk groups.
- Life stages at risk: growth and pregnancy increase iron requirements; in older adults, risk depends mainly on blood loss, inflammation, malabsorption and comorbidity. Breastfeeding entails relatively modest iron loss.
- Chronic diseases: chronic kidney disease, chronic inflammatory disorders, cancer, chronic infections such as HIV and tuberculosis, liver failure and gastrointestinal diseases impair the synthesis, metabolism and absorption of factors required for erythropoiesis.
- Chronic blood loss: heavy menstrual bleeding, gastrointestinal ulcers, hemorrhoids, tumors, intestinal parasitic diseases and hookworm infestations may cause iron losses that exceed the body's ability to compensate.
- Genetic and familial conditions: hemoglobinopathies such as thalassemia and sickle cell disease, together with enzymatic deficiencies such as G6PD deficiency, constitute nonmodifiable risk factors that are often associated with specific geographical areas or ethnic groups.
- Medication use: antacids and proton pump inhibitors may reduce iron absorption; some antiseizure drugs interfere with folate metabolism; chemotherapy may suppress erythropoiesis; and NSAIDs increase anemia risk mainly through occult or overt gastrointestinal bleeding.
At the population level, the coexistence of these factors multiplies vulnerability, particularly among children living in low income families, women with repeated and closely spaced pregnancies, older adults with multiple diseases and individuals experiencing social disadvantage.
Main pathogenetic mechanisms
From a pathophysiological perspective, anemia can be attributed to three major mechanisms: reduced red blood cell production, increased red blood cell destruction or excessive blood loss. From a public health perspective, most cases result from reduced production secondary to nutritional deficiencies, chronic diseases or infections.
- Iron deficiency: the most common cause worldwide, resulting from inadequate intake, increased requirements or excessive loss. Iron is essential for hemoglobin synthesis; deficiency causes iron restricted erythropoiesis and microcytic, hypochromic anemia. Deficiency may be aggravated by dietary phytates, polyphenols and calcium, which reduce nonheme iron absorption.
- Vitamin B12 and folate deficiency: deficiency of these micronutrients, which are essential for DNA synthesis and erythroblast maturation, results in megaloblastic anemia, typical among older adults, strict vegetarians and patients with chronic gastrointestinal disorders.
- Chronic infections and inflammation: malaria, helminth infections, schistosomiasis, tuberculosis and HIV, together with chronic inflammatory diseases, cause anemia through multiple mechanisms: reduced erythropoietin production, iron sequestration within macrophages, red blood cell destruction and inhibition of bone marrow proliferation.
- Inherited diseases: thalassemias, sickle cell disease and other hemoglobinopathies cause anemia through the production of abnormal hemoglobin, chronic hemolysis and reduced red blood cell survival. The impact of these conditions, often neglected within public health programs, is enormous in terms of morbidity, transfusion requirements, complications and healthcare costs.
- Acute and chronic blood loss: in the absence of adequate nutritional compensation and timely diagnosis, even modest chronic bleeding may lead to depletion of iron stores and subsequent iron deficiency anemia.
The coexistence of multiple mechanisms, particularly in low income countries and vulnerable populations, often makes it difficult to classify anemia clearly; the disease therefore frequently has a multifactorial nature and requires integrated prevention strategies.
Pathophysiology and systemic impact
Pathophysiologically, anemia reduces oxygen transport and activates cardiovascular, renal and vascular responses. There is no standard compensatory response defined as increased consumption of glucose and fatty acids.
In children, severe anemia and iron deficiency may be associated with impaired cognitive and motor development; the extent and persistence of these effects depend on cause, severity, duration and confounding factors.
During pregnancy, anemia is associated with adverse maternal and fetal outcomes, with risk depending on severity, cause and comorbidity; in older adults, anemia is associated with an increased risk of heart failure, functional decline, falls, fractures and institutionalization.
At the public health level, anemia therefore acts as a risk multiplier for many other diseases, triggering a vicious cycle that reinforces poverty, social exclusion and health inequalities worldwide.
Public health impact: direct and indirect consequences
Anemia is one of the leading preventable causes of health loss worldwide and acts as a risk multiplier for a wide range of adverse outcomes. Its impact is not limited to clinical consequences but also involves demographic, economic and social dimensions, making it a cross cutting priority in national and international healthcare planning.
- Maternal and infant outcomes: severe anemia contributes to maternal and neonatal risk and may reduce tolerance of hemorrhage; it should not be described generically as one of the leading direct causes of death in pregnancy.
- Impaired neurocognitive development: in children, anemia and especially iron deficiency may be associated with impaired development and performance; persistence and reversibility depend on cause, severity, duration and context and should not automatically be attributed to anemia itself.
- Worsening prognosis of chronic diseases: in older adults and in patients with heart failure, kidney failure, cancer or chronic infection, anemia is associated with greater morbidity, longer hospitalization, higher complication risk and earlier mortality.
The indirect consequences, often underestimated, are equally serious:
- Reduced work productivity: chronic fatigue, reduced exercise tolerance and possible impairment of cognitive function may be associated with productivity losses. The magnitude of the macroeconomic impact varies among populations, causes of anemia and estimation methods and cannot be translated into a single share of GDP.
- Increased poverty and social inequality: anemia fuels a vicious cycle in which illness causes job loss, healthcare costs and reduced educational opportunities, perpetuating marginalization of vulnerable populations.
- Intergenerational effects: as children with anemia grow up, they tend to perpetuate conditions of malnutrition and poor health in their own children, reinforcing the transmission of risk across generations.
These factors justify including anemia among the principal indicators used for global health surveillance and planning, with a WHO global nutrition target linked to the health and nutrition objectives of the SDGs; anemia prevalence among women aged 15 to 49 years, by pregnancy status, is also SDG indicator 2.2.3.
Economic burden and healthcare system costs
Anemia generates substantial direct and indirect costs for healthcare systems, increasing pressure on already limited resources in low and middle income countries. Direct costs include expenditure on medical consultations, diagnostic investigations, medications, transfusions and management of complications.
Indirect costs are even greater and include loss of productivity, school and workplace absenteeism, expenditure related to permanent disability and reduced individual and collective development potential.
Anemia and iron deficiency may produce substantial productivity losses and healthcare costs, but this page does not document a generalizable estimate of 2% to 4% of annual GDP. Even in advanced healthcare systems, anemia increases hospital stay, complication rates and the need for home or institutional care, significantly affecting public and household budgets.
Epidemiological surveillance: systems and indicators
- Population surveys: surveys that measure hemoglobin, including DHS and MICS in some countries. PASSI and OKkio alla SALUTE collect other indicators and are not laboratory surveillance systems for anemia.
- Health registries and surveillance systems: collection of clinical and laboratory data from healthcare centers, public and private laboratories, hospitals and primary care networks.
- Nutritional monitoring and vertical programs: detection of anemia during food fortification campaigns, micronutrient supplementation programs and school based screening.
The main indicators include:
- Prevalence and incidence of anemia according to age group, sex, geographical area, social group and clinical severity based on WHO cutoffs.
- Rates of anemia during pregnancy, childhood and older age and among special populations.
- Data disaggregated by cause, including iron or vitamin deficiencies, chronic anemia, inherited disorders and parasitic infections, where available.
- Impact of interventions: changes in prevalence following prevention campaigns, food fortification, supplementation and improved access to services.
Despite international efforts, numerous problems remain: in many countries, surveillance systems are incomplete or fragmented, vulnerable populations are underrepresented and the quality of laboratory data is often variable. Digitalization and integration among data sources are currently the main challenges for effective and timely epidemiological surveillance.
Monitoring and evaluation of interventions
Assessing the effectiveness of strategies for preventing and treating anemia requires clearly defined outcome indicators and the ability to compare results among different geographical areas and populations. Periodic monitoring makes it possible to adapt interventions to actual needs, identify emerging problems and reduce the risk of wasting resources.
- Collection of longitudinal data to assess the persistence and recurrence of anemia within the same populations.
- Integration of clinical, nutritional and social data to provide a multidimensional interpretation of outcomes.
- Community involvement in data collection and intervention assessment to improve adherence to and effectiveness of preventive measures.
- Continuous feedback to healthcare professionals and decision makers to guide strategies promptly.
In Italy, PASSI monitors risk factors and prevention in the adult population but does not systematically measure hemoglobin or anemia prevalence. However, national limitations also remain in coverage, data representativeness and reporting timeliness.
Primary prevention strategies
Prevention of anemia is based on integrated interventions implemented at the individual, family and community levels. Primary strategies, which aim to prevent the onset of the disease, represent the most effective approach for reducing the global burden, particularly in high incidence settings.
The main pillars of primary prevention include:
- Nutrition education: promotion of a balanced diet rich in foods containing more readily absorbed heme iron, such as red meat and fish, and nonheme iron, such as legumes and eggs, together with vitamin C, which promotes nonheme iron absorption, folate and vitamin B12. Education should target both adults and parents, with particular attention to women of reproductive age and at risk groups.
- Food fortification: addition of iron and other essential micronutrients to widely consumed products such as flour, cereals, salt and powdered milk. This strategy has shown a significant impact in reducing anemia prevalence in many countries, particularly where the staple diet is low in iron.
- Targeted supplementation: provision of iron, folic acid and vitamin B12 supplements to the most vulnerable population groups, including pregnant women, young children, adolescents, frail older adults and migrant populations. The WHO recommends daily iron and folic acid supplementation during pregnancy as part of antenatal care; other supplementation programs should be adapted to age, risk, local prevalence and causes.
- Infection control: prevention, diagnosis and timely treatment of malaria, helminth infections, schistosomiasis and other chronic infections that contribute to the development of anemia. School based deworming campaigns involving periodic treatment of intestinal parasitic infections are an example of an effective and sustainable intervention in high risk settings.
- Promotion of maternal and child health: improvement of antenatal care, promotion of exclusive breastfeeding during the first six months of life and growth monitoring. Anemia screening, when included in programs or indicated by risk, belongs to secondary prevention.
To be genuinely effective, these strategies must be accompanied by structural interventions aimed at improving living conditions, food security, access to safe drinking water and sanitation, school attendance and women's empowerment.
Secondary prevention and early diagnosis
Secondary prevention aims to identify and promptly treat anemia in affected individuals, with the goal of preventing complications and reducing its impact on quality of life.
In public health, this involves:
- Screening or case finding according to national programs, pregnancy, age, symptoms and risk factors; older adults and migrants do not automatically constitute universal indications for periodic screening.
- Collection of clinical and laboratory data integrated at local and national levels to identify abnormal trends and risk clusters promptly.
- Training of healthcare professionals in the appropriate use of screening tools and multidisciplinary management of anemia.
- Improved access to diagnostic and therapeutic services, including in rural or marginalized areas, through mobile campaigns, telemedicine and local healthcare networks.
The effectiveness of secondary prevention depends closely on the ability of healthcare systems to reach at risk populations proactively and overcome economic, cultural and logistical barriers.
Control and integrated management within public health programs
Managing anemia in public health requires an integrated approach based on synergies among healthcare, education, social services, agriculture, rural development and social protection.
The most effective interventions combine action at multiple levels:
- Multisectoral programs combining food fortification, supplementation, infection control and improved hygiene and sanitation conditions.
- Continuous monitoring of anemia prevalence and risk factors through integrated epidemiological surveillance systems.
- Community participation in the design and implementation of strategies to increase acceptability and adherence to interventions.
- Support for vulnerable groups through targeted economic, nutritional and healthcare measures, such as food vouchers, free access to supplementation and home care for frail older adults.
Effective interventions should be selected according to local causes, for example fortification, targeted supplementation, infection control, maternal health and diagnostic access. This page does not document a specific effect of vaccination campaigns integrated with anemia screening.
Tertiary prevention strategies and reduction of complications
Tertiary prevention aims to limit complications among individuals already affected by chronic or severe anemia, improving prognosis and quality of life.
Interventions include:
- Specialist management of inherited anemias, including thalassemia, sickle cell disease and Fanconi anemia, through dedicated networks, improved access to transfusions and iron chelation therapy, and bone marrow transplantation programs where indicated.
- Rehabilitation and multidisciplinary care for patients with disability resulting from chronic anemia, for example children with neurocognitive delay and older adults with functional disability.
- Prevention of cardiovascular and infectious complications through structured follow up, clinical monitoring and nutritional and pharmacological support.
- Psychosocial support for patients and families, which is essential in low income settings and situations of social marginalization.
Regulations, international recommendations and the role of institutions
The fight against anemia is addressed by numerous recommendations and initiatives from major international agencies and national institutions. The WHO has extended to 2030 the global target of reducing, relative to 2012, anemia prevalence by 50% among women aged 15 to 49 years; the target is not formulated as a 50% reduction among children.
International guidelines recommend:
- Daily iron and folic acid supplementation during pregnancy as part of antenatal care, according to WHO recommendations.
- Assessment of anemia within maternal and child healthcare according to national programs and guidelines.
- Food fortification when supported by assessment of deficiency, diet, feasibility, safety and national policy.
- Implementation of integrated infection control strategies.
In Italy, prevention and treatment of anemia are included in clinical, maternal and child health, nutrition and chronic disease management programs; this page does not document a general ministerial recommendation for voluntary fortification or permit regional differences in coverage to be quantified.
Promotion of research and innovation in public health
Improving strategies for preventing and controlling anemia requires continuous investment in epidemiological research, technological innovation and healthcare professional training.
The main areas of development include:
- New screening systems that are simple, rapid and reliable for the early identification of cases in resource limited settings.
- Digital technologies for collecting, integrating and analyzing surveillance data, with the aim of optimizing the healthcare response and allocation of resources.
- Effectiveness and cost effectiveness studies concerning different fortification and supplementation strategies adapted to local characteristics.
- Nutritional innovation: development of functional foods, new supplements and personalized approaches to preventing nutritional deficiencies.
Active involvement of communities, patient organizations and local stakeholders is essential to ensure the adoption of innovations and the sustainability of interventions.
Prognosis and population outcomes
The prognosis of anemia, at both the individual and population levels, depends on its etiology, severity, timeliness of diagnosis and the effectiveness of prevention and treatment interventions. From a public health perspective, however, the predictive value of anemia extends well beyond its direct mortality: it represents a sentinel indicator of a population's nutritional health, human development and social equity.
- Preterm birth and low birth weight
- Maternal and neonatal mortality
- Reduced tolerance of hemorrhage and greater clinical vulnerability in severe forms
In older adults, anemia is associated with an increased risk of functional decline, falls, fractures, institutionalization and premature mortality. In populations affected by inherited anemias, prognosis depends on the availability of specialist care, management of chronic complications and access to transplantation or innovative therapies.
- Reduced healthy life expectancy (HALE: Healthy Life Expectancy)
- Worsening human development indices (HDI: Human Development Index)
- Increased health inequalities and reinforcement of the poverty and disease cycle
Anemia therefore represents not only a disease, but also a systemic warning signal for healthcare institutions and society as a whole.
Main complications and burden of consequences
- Cardiovascular complications: chronic anemia may cause, particularly when severe or prolonged, tachycardia, ventricular remodeling, heart failure and, in individuals at risk, myocardial ischemia. In patients with preexisting cardiovascular disease, even mild anemia may precipitate acute events.
- Infections: anemia and infections may coexist and share determinants, but reduced oxygenation does not by itself demonstrate that anemia causes recurrent infections.
- Neurocognitive and psychosocial deficits: during childhood and adolescence, chronic deficiency of iron and other micronutrients is associated with alterations in brain development and function affecting memory, learning and social functioning.
- Deterioration in quality of life: chronic fatigue, reduced physical endurance and loss of independence severely limit social and occupational participation, affecting mental health and overall well being.
- Obstetric and neonatal outcomes: maternal anemia, particularly when severe, is associated with preterm birth, low birth weight and greater maternal vulnerability; fetal malformations and breastfeeding difficulties are not demonstrated specific complications of anemia in general.
- Need for transfusions and chronic therapies: in severe or inherited forms, anemia imposes a considerable healthcare burden, with risks associated with repeated transfusions, including iron overload, transmissible infections and immunization, together with dependence on chelation therapy and frequent hospitalizations.
The burden of complications is particularly high in resource limited countries, where lack of timely access to diagnosis and treatment worsens consequences at both the individual and population levels.
Public health implications and conclusions
Anemia remains a multidimensional problem requiring integrated approaches to prevention, early diagnosis, clinical management and structural interventions addressing nutrition, education, housing conditions and social protection. Epidemiological surveillance, public health innovation and the promotion of multisectoral programs are essential strategies for interrupting the cycle of poverty and disease.
Within the Sustainable Development Goals (SDGs), reducing anemia, particularly among children and women, represents a cross cutting challenge reflecting a system's ability to protect the most vulnerable, promote equity and invest in future generations. Integrated action by institutions, healthcare professionals, local communities and scientific research is necessary to effectively address a persistent and unequally distributed public health problem.
- Stevens GA et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011. Lancet Glob Health. 2013;1(1):e16-e25.
- Kassebaum NJ et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615-624.
- World Health Organization. Worldwide prevalence of anaemia 1993–2005: WHO Global Database on Anaemia. WHO. 2008; Geneva:1-40.
- McLean E et al. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr. 2009;12(4):444-454.
- Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013;121(14):2607-2617.
- Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet. 2011;378(9809):2123-2135.
- World Health Organization. WHO global anaemia estimates: key findings, 2025. Geneva: World Health Organization; 2025.
- World Health Organization. Conclusions and recommendations of the WHO Consultation on prevention and control of iron deficiency in infants and young children in malaria-endemic areas. Food Nutr Bull. 2007;28(4 Suppl):S621-S627.
- GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023;10(9):e713–e734. doi:10.1016/S2352-3026(23)00160-6.
- Bhutta ZA, Das JK, Rizvi A, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452-477.
- Lanier JB, Park JJ, Callahan RC. Anemia in Older Adults. Am Fam Physician. 2018;98(7):437-442.
- Brannon PM, Taylor CL. Iron Supplementation during Pregnancy and Infancy: Uncertainties and Implications for Research and Policy. Nutrients. 2017;9(12):1327.
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