Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence

Abstract

Anemia is a multifactorial condition, with a complex etiology that involves nutritional and non-nutritional factors. The misconception that iron deficiency is equivalent to anemia may mask the need to address other potential causative factors. This review paper aims to (1) assess the burden of anemia vs. iron deficiency anemia (IDA) amongst women of reproductive age (WRA), pregnant women (PW), and children under five years old (underfive children, U5C) in the Eastern Mediterranean region (EMR); (2) evaluate trends in anemia prevalence and whether countries are on track towards meeting the World Health Assembly (WHA) target for 2025; and (3) characterize anemia reduction efforts and provide a road map for future programs. A search of pertinent literature and databases was conducted. Anemia prevalence in the EMR ranged between 22.6% and 63% amongst PW, 27% and 69.6% amongst WRA, and 23.8% and 83.5% amongst U5C. Data showed that the EMR is not on course towards meeting the WHA target. The contribution of IDA to anemia was found to be less than half. Other potential contributors to anemia in the region were identified, including micronutrient deficiencies, parasitic infestations, and poor sanitation. A framework of action was proposed as a roadmap to meet the targets set by the WHA.

Keywords: anemia targets; iron deficiency anemia; non-nutritional causes; nutrition-specific interventions; pregnant women; underfive children; women; women of reproductive age.

Figure 1

Trends in the prevalence of anemia amongst WRA (15–49 years) in countries of the EMR. References: 2010, 2012, and 2014 data were based on the WHO GHO Database [27]. The latest data were based on the WHO GHO Data Repository–Prevalence of anemia in women (2016) [27] and on the WHO EMRO Monitoring health and health system performance in the Eastern Mediterranean Region, Core indicators and indicators on the health-related Sustainable Development Goals 2019 [30], with the following exceptions: the data for Morocco were based on the recent Moroccan NNS 2019–2020 [37]. The data for Oman were based on the recent Oman NNS in 2017 [36]. The data pertinent to Pakistan were based on the recent NNS 2018 [32]. Anemia was defined as an Hb concentration < 120 g/L, adjusted for altitude and smoking. Abbreviations: EMR: Eastern Mediterranean Region; EMRO: Regional Office for the Eastern Mediterranean; GHO: Global Health Observatory; Hb: hemoglobin; NNS: National Nutrition Survey; UAE: United Arab Emirates; WHO: World Health Organization; WRA: women of reproductive age.

Figure 2

Trends in the prevalence of anemia amongst PW in countries of the EMR. References: The 2010, 2012, and 2014 data were based on the WHO GHO Database [27]. The latest data were also based on the 2016 WHO GHO Database [27], with the exception of the data pertinent to Oman, which were based on the recent Oman NNS 2017 [36]. Anemia was defined as an Hb concentration <110 g/L, adjusted for altitude and smoking. Abbreviations: EMR: Eastern Mediterranean Region; GHO: Global Health Observatory; Hb: hemoglobin; NNS: National Nutrition Survey; PW: pregnant women; UAE: United Arab Emirates; WHO: World Health Organization.

Figure 3

Trends in the prevalence of anemia amongst U5C in countries of the EMR. References: The 2010 and 2014 data were based on the WHO GHO Database [28]. The latest data were also based on the 2016 WHO GHO Database [28], with the exception of those for Morocco, Oman, Pakistan, and Sudan; they were based on the recent Moroccan NNS 2019–2020 [37], Oman NNS 2017 [36], Pakistan NNS 2018 [32], and Sudan Simple Spatial Survey Method (S3M II) [39], respectively. Anemia was defined as an Hb concentration < 110 g/L, adjusted for altitude. Abbreviations: EMR: Eastern Mediterranean Region; GHO: Global Health Observatory; Hb: hemoglobin; NNS: National Nutrition Survey; U5C: underfive children; UAE: United Arab Emirates; WHO: World Health Organization.

Figure 4

Prevalence of IDA vs. anemia amongst WRA, U5C, and adolescent girls based on studies that have reported on both. For Afghanistan, Iran, Jordan, Qatar, and the UAE, the values for WRA and U5C may differ from those reported in Table 1, since the values in the figure are based on studies that have reported on both IDA and anemia. Abbreviations: EMR: Eastern Mediterranean Region; IDA: iron deficiency anemia; NNS: National Nutrition Survey; U5C: underfive children; UAE: United Arab Emirates; WRA: women of reproductive age.

Figure 5

A framework for action for optimizing anemia reduction efforts in countries of the EMR. Abbreviations: EMR: Eastern Mediterranean Region; IDA: iron deficiency anemia; PW: pregnant women; U5C: underfive children; WASH: Water, Sanitation, and Hygiene; WRA: women of reproductive age.