Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries

Abstract

Anemia affects a third of the world's population and contributes to increased morbidity and mortality, decreased work productivity, and impaired neurological development. Understanding anemia's varied and complex etiology is crucial for developing effective interventions that address the context-specific causes of anemia and for monitoring anemia control programs. We outline definitions and classifications of anemia, describe the biological mechanisms through which anemia develops, and review the variety of conditions that contribute to anemia development. We emphasize the risk factors most prevalent in low- and middle-income countries, including nutritional deficiencies, infection/inflammation, and genetic hemoglobin disorders. Recent work has furthered our understanding of anemia's complex etiology, including the proportion of anemia caused by iron deficiency (ID) and the role of inflammation and infection. Accumulating evidence indicates that the proportion of anemia due to ID differs by population group, geographical setting, infectious disease burden, and the prevalence of other anemia causes. Further research is needed to explore the role of additional nutritional deficiencies, the contribution of infectious and chronic disease, as well as the importance of genetic hemoglobin disorders in certain populations.

Keywords: anemia; anemia of inflammation; iron deficiency anemia; nutritional anemias.

Figure 1

Mean hemoglobin concentrations (and –2 SD values) by age and sex. Compiled from data from the United States, Europe, and Caucasian populations.^–

Figure 2

A conceptual model of anemia etiology. Determinants outlined with heavier borders are considered primary contributors to anemia globally. Adapted from Refs. ,, and .