Reducing anaemia in low income countries: control of infection is essential

Pasricha, Sant‐Rayn; Armitage, Andrew E.; Prentice, Andrew M.; Drakesmith, Hal

doi:10.1136/bmj.k3165

Cited by 59 publications

(74 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The influence of improved WASH on anemia reduction could operate through several possible mechanisms: preventing infections, reducing elevated hepcidin levels, and/or reduced enteropathy causing improved intestinal surface area leading to better iron absorption and reduced loss of nutrients through lower diarrhea prevalence . In relation to infection, a recent Cochrane review looking at the interaction between iron and infections concluded that for anemia control, it is necessary to not only focus on iron deficiency but to tackle infections, particularly in settings subject to high‐infection burden . Our study also shows that in nearly 60% of countries, children who received deworming medication had lower odds of being anemic.…”

Section: Discussionmentioning

confidence: 73%

See 1 more Smart Citation

Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys

Kothari

Coile

Huestis

et al. 2019

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

Globally, no countries are on track to achieve the adopted global nutrition targets set for anemia in 2025. Given the linkages between water, sanitation, and hygiene (WASH) and nutrition, this secondary data analysis explores potential associations with anemia. Forty‐seven demographic and health surveys were used to explore the association between unimproved water and sanitation and anemia in women and children with adjusted odds ratios (ORs) calculated by country and cumulatively. In over 60% of countries, children with off‐premises water access had significantly increased odds of anemia. In over a quarter of countries, children exposed to surface water had higher odds of anemia. In Burundi, children were 1.65 times more likely to be anemic when reported to be living in households using surface water. However, in India, a protective effect was noted (adjusted OR: 0.70, P < 0.001) for surface water. In 60% and 65% of countries, women and children exposed to an open sanitation facility had higher odds of being anemic, respectively. There is evidence of an association between selected water and sanitation indicators and anemia. Promoting policies, practices and research that strengthen access to improved WASH should be considered for reducing anemia prevalence alongside standard nutrition interventions.

show abstract

Section: Discussionmentioning

confidence: 73%

“…Among women, education, residence, and maternity status seem to be the most prominent factors to be considered in anemia reduction program planning . We suggest increased efforts to reach the most vulnerable groups, to ensure equitable gains in anemia reduction among all subpopulation groups …”

Section: Discussionmentioning

confidence: 93%

Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys

Kothari

Coile

Huestis

et al. 2019

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

show abstract

“…The exact role of iron deficiency, as one of the few preventable and treatable causes of anaemia, remains unclear due to its diagnostic challenges in HIV-infected patients in low resource settings [3,4,7]. However iron supplementation has been shown to be a risk factor for infections in areas of high infectious burden [8,9]. Peripheral blood markers for iron deficiency, including erythrocyte indices, serum iron, ferritin, and soluble transferrin receptor (sTfR), have been evaluated but their accuracy is often negatively affected by inflammatory states, and renal and liver conditions, which are common in both the African and HIVinfected populations [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi

et al. 2020

View full text Add to dashboard Cite

Introduction Iron deficiency is a treatable cause of severe anaemia in low-and-middle-income-countries (LMIC). Diagnosing it remains challenging as peripheral blood markers poorly reflect bonemarrow iron deficiency (BM-ID), especially in the context of HIV-infection. Methods Severely anaemic (haemoglobin �70g/l) HIV-infected adults were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. BM-ID was evaluated. Accuracy of blood markers (including hepcidin, mean corpuscular volume, mean cellular haemoglobin concentration, serum iron, serum ferritin, soluble transferrin receptor (sTfR), sTfR index, sTfR-ratio) to detect BM-ID was evaluated by ROC area under the curve (AUC ROC). Results Seventy-three patients were enrolled and 35 (48.0%) had BM-ID. Although hepcidin and MCV performed best (AUC ROC of 0.593 and 0.545 respectively) all markers performed poorly in identifying BM-ID (ROC<0.6). The AUC ROC of hepcidin in males was 0.767 (sensitivity 80%, specificity 78%) and in women 0.490 (sensitivity 60%, specificity 61%). Conclusion BM-ID deficiency was common in severely anaemic HIV-infected patients. It is an important and potential treatable contributor to severe anaemia but lack of definitive biomarkers

show abstract

“…181 A similar consideration must be made regarding the use of dietary iron supplementation to treat anaemia in low-to moderate-income countries, where aggravating already high rates of infant diarrhoea is a clear risk; reducing inflammation and improving sanitary conditions will be instrumental if oral iron supplementation to treat anaemia is to prove fruitful. 156,182 Impaired gut health is a common reason for poor compliance with dietary iron supplementation regimens, even in high-income countries. 183 There is interest in developing dietary iron supplements that are bioavailable to the host but not the microbiota, hopefully avoiding dysbiosis.…”

Section: Targeting the Pathogenmentioning

confidence: 99%

The battle for iron in enteric infections

et al. 2020

Self Cite

View full text Add to dashboard Cite

Iron is an essential element for almost all living organisms, but can be extremely toxic in high concentrations. All organisms must therefore employ homeostatic mechanisms to finely regulate iron uptake, usage and storage in the face of dynamic environmental conditions. The critical step in mammalian systemic iron homeostasis is the fine regulation of dietary iron absorption. However, as the gastrointestinal system is also home to >10 14 bacteria, all of which engage in their own programmes of iron homeostasis, the gut represents an anatomical location where the interkingdom fight for iron is never-ending. Here, we explore the molecular mechanisms of, and interactions between, host and bacterial iron homeostasis in the gastrointestinal tract. We first detail how mammalian systemic and cellular iron homeostasis influences gastrointestinal iron availability. We then focus on two important human pathogens, Salmonella and Clostridia; despite their differences, they exemplify how a bacterial pathogen must navigate and exploit this web of iron homeostasis interactions to avoid host nutritional immunity and replicate successfully. We then reciprocally explore how iron availability interacts with the gastrointestinal microbiota, and the consequences of this on mammalian physiology and pathogen iron acquisition. Finally, we address how understanding the battle for iron in the gastrointestinal tract might inform clinical practice and inspire new treatments for important diseases.

show abstract

Reducing anaemia in low income countries: control of infection is essential

Abstract: In settings with high infection burdens, iron interventions for anaemia may be neither safe nor effective. Strategies to tackle the global burden of anaemia must take this into account, argue Sant-Rayn Pasricha and colleagues

Cited by 59 publications

References 46 publications

Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys

Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys

A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi

The battle for iron in enteric infections

Contact Info

Product

Resources

About