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Meta-Analysis
. 2023 Apr 17;23(1):184.
doi: 10.1186/s12905-023-02291-6.

Role of iron in the reduction of anemia among women of reproductive age in low-middle income countries: insights from systematic review and meta-analysis

Sumera Aziz Ali  1 , Shama Razzaq  2 , Savera Aziz  3 , Ahreen Allana  4 , Arzina Aziz Ali  4 , Shahla Naeem  5 , Nayab Khowaja  6 , Fazal Ur Rehman  4
Affiliations
Meta-Analysis

Role of iron in the reduction of anemia among women of reproductive age in low-middle income countries: insights from systematic review and meta-analysis

Sumera Aziz Ali et al. BMC Womens Health. .

Abstract

Background: Iron deficiency anemia is a common public health issue among women of reproductive age (WRA) because it can result in adverse maternal and birth outcomes. Although studies are undertaken to assess iron efficacy, some gaps and limitations in the existing literature need to be addressed. To fill the gaps, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the role of iron in reducing anemia among WRA in low-middle-income countries (LMICs).

Methods: A comprehensive search strategy was used to search Medline through PubMed, Embase, and Science Direct for RCTs published between 2000 and 2020. The primary outcome was the mean change in hemoglobin level. We used standardized mean differences and their respective 95% CI to estimate the pooled effect. We used I2 statistics and Egger's test to assess heterogeneity and publication bias, respectively. This review was carried out in accordance with revised guidelines based on the Preferred Reporting Items for Systematic Review and Meta-analysis.

Results: The findings showed that iron therapy improved hemoglobin and ferritin levels, though the results varied across studies. An overall pooled effect estimate for the role of iron therapy in improving the hemoglobin levels among WRA was -0.71 (95% CI: -1.27 to -0.14) (p = 0.008). Likewise, the overall pooled effect estimate for the role of iron therapy in improving the ferritin levels among WRA was -0.76 (95% CI: -1.56 to 0.04) (p = 0.04). The heterogeneity (I2) across included studies was found to be statistically significant for studies assessing hemoglobin (Q = 746.93, I2 = 97.59%, p = 0.000) and ferritin level (Q = 659.95, I2 = 97.88%, p = 0.000).

Conclusion: Iron therapy in any form may reduce anemia's burden and improve hemoglobin and ferritin levels, indicating improvement in iron-deficiency anemia. More evidence is required, however, to assess the morbidity associated with iron consumption, such as side effects, work performance, economic outcomes, mental health, and adherence to the intervention, with a particular focus on married but non-pregnant women planning a pregnancy in the near future.

Trial registration: Registered with PROSPERO and ID is CRD42020185033.

Keywords: Anemia; Iron therapy; Low-middle income countries; Meta-analysis; Systematic review; Women of reproductive age.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram summarizing the identification and selection of relevant Randomized Controlled Trials
Fig. 2
Fig. 2
Forest plot summarizing the overall pooled effect of iron supplementation on the primary outcome, hemoglobin (n = 19)
Fig. 3
Fig. 3
Forest plot summarizing the overall pooled effect of iron supplementation on the secondary outcome, Serum Ferritin (n = 15)
Fig. 4
Fig. 4
A Funnel plot to evaluate the publication bias among included studies in the meta-analysis for the primary outcome, hemoglobin (n = 19). B Funnel plot to evaluate the publication bias among included studies in the meta-analysis for the secondary outcome, Serum Ferritin (n = 15)
See this image and copyright information in PMC

References

    1. Milman N. Anemia—still a major health problem in many parts of the world! Ann Hematol. 2011;90(4):369–377. doi: 10.1007/s00277-010-1144-5. - DOI - PubMed
    1. Khan AM, Kidwai SS, Akhtar S, Ara J. Knowledge, apptitude and practice: smoking and gutka habits in a lower socio-economic cohort. Int J Res Med Sci. 2018;6(5):1643. doi: 10.18203/2320-6012.ijrms20181752. - DOI
    1. Beckert RH, Baer RJ, Anderson JG, Jelliffe-Pawlowski LL, Rogers EE. Maternal anemia and pregnancy outcomes: a population-based study. J Perinatol. 2019;39(7):911–919. doi: 10.1038/s41372-019-0375-0. - DOI - PubMed
    1. Hare GM, Freedman J, Mazer CD. risks of anemia and related management strategies: can perioperative blood management improve patient safety? Can J Anesthesia/J Can d'anesthésie. 2013;60(2):168–175. doi: 10.1007/s12630-012-9861-y. - DOI - PubMed
    1. Kavle JA, Stoltzfus RJ, Witter F, Tielsch JM, Khalfan SS, Caulfield LE. Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania. J Health Popul Nutr. 2008;26(2):232. - PMC - PubMed