Exploring the Anemia Ecology: A New Approach to an Old Problem

Abstract

Our ability to identify anemia and all its permutations demands an approach that integrates the key elements of a complex "ecology," which intertwines biology and mechanistic aspects of nutrients with both the health status and underlying factors-physical, economic, social, behavioral, demographic, and environmental. The complexity of anemia demands an ecologic approach that appreciates systems biology, translates sensitive and specific assessment methodologies and interventions, and ultimately improves clinical and public health outcomes. This series of technical papers on anemia by the U.S. Agency for International Development (USAID) Advancing Nutrition Anemia Task Force (ATF) is a first step in translating our ecologic approach to anemia with a view toward balancing research with its translation to effective programs, interventions, and policy. This introductory overview describes the components of our ecologic approach-linking the biology of anemia with its assessment and using the learning from that confluence to devise context-specific interventions. This introductory review briefly discusses the topics that underlie the biology and primary etiologies of anemia and presents a framework for public health assessment of anemia, leading to appropriate public health interventions. The other 3 manuscripts in the supplement provide the details of the arguments laid out in the introduction.

Keywords: anemia ecology; assessment methods; etiology; public health interventions.

FIGURE 1

A stepwise approach to addressing anemia. Our stepwise approach to anemia includes an understanding of biology, linking biology and biological mechanisms to assessment of anemia, and finally translating biology and assessment information to action via effective interventions.

FIGURE 2

Anemia assessment process. The anemia assessment process begins by estimating the prevalence of anemia by accurate hemoglobin measurement, followed by a measurement of categorical causes, such as infection/inflammation, nutrition deficits, genetic conditions, or a combination of the 3. Within those categories, we carry out a differential diagnosis by conducting additional tests until we identify the cause (or causes).