Microalgae-derived iron preparations are entering clinical discourse as a potentially better-tolerated alternative to conventional ferrous salt supplementation, which fails a substantial proportion of the approximately 571 million women globally affected by iron-deficiency anemia (IDA) due to gastrointestinal adverse effects. Yet translational readiness requires more than biological efficacy data it requires knowing whether patients would actually accept such preparations under realistic informational conditions. No study has addressed this question in a defined IDA population. We conducted a cross-sectional online survey among 71 Romanian adults with physician-diagnosed IDA and prior oral iron experience, measuring informed acceptance assessed only after participants received standardized clinical information, including current evidence limitations, using a validated 5-item composite score (ACC_score; α = 0.801). Health Belief Model (HBM) constructs, complementary and alternative medicine (CAM) attitudes, motivators, adverse-effect burden, and physician trust were examined as predictors via Spearman correlations and ordinary least squares regression. Acceptance was high overall (ACC_score = 20.68, SD = 3.25) though concentrated near the scale ceiling (IQR = 19-23), limiting variability in the outcome and likely attenuating observed associations. The multivariate model explained 63.8% of variance (p < 0.001); self-efficacy showed the strongest standardized association in the primary OLS model (β = 0.384), followed by perceived barriers (β = -0.275), CAM attitudes (β = 0.248), and perceived susceptibility (β = 0.229) though self-efficacy did not reach statistical significance in a binary logistic sensitivity analysis (OR = 4.01, p = 0.058), most likely reflecting information loss from outcome dichotomization. Critically, among individual barrier items, only the lack of long-term evidence reached statistical significance a specific, addressable target for patient communication. Notably, safety concerns about current iron formulations were positively, not negatively, associated with acceptance, consistent with an activated patient profile in which dissatisfaction with tolerability motivates alternative-seeking. The sample was highly selected (95.8% female and 91.5% university educated), and the findings should be interpreted as hypothesis-generating and require confirmation in larger, clinically verified, and more representative IDA populations.
Background:Anemia during pregnancy is considered one of the main risk factors contributing to 20%-40% of maternal mortality. Most causes of anemia in pregnancy are preventable. However, data on women's knowledge and practices regarding comprehensive strategies necessary for anemia prevention during pregnancy are limited in Ethiopia, particularly in the study area. Therefore, this study aimed to assess the knowledge and practice of anemia prevention strategies during pregnancy in South Wollo Zone, Northeastern Ethiopia. Methods:A hospital-based cross-sectional study design was employed from November 1 to December 10, 2024, among 420 pregnant women. A systematic sampling technique was used to select the study participants. Data were analyzed using SPSS Version 25. Descriptive statistics and generalized estimating equations with a binary logistic model were performed to assess the net effects of predictors while controlling for confounders and computing cluster-robust standard errors. Statistical differences were considered at p-value < 0.05, and the strength of association was assessed by odds ratio and respective cluster-robust 95% confidence intervals. Result:The study showed that 52.1% of pregnant women had good knowledge of anemia prevention strategies and 53.1% demonstrated good practice. Good knowledge was significantly associated with higher maternal education (AOR = 2.04, 95% CI: 1.11, 3.76), higher partner education (AOR = 3.19, 95% CI: 2.24, 4.57), and intended pregnancy (AOR = 3.78, 95% CI: 1. 41, 10.21). Good practice was significantly associated with urban residence (AOR = 2.98, 95% CI: 1.59, 5.63), higher maternal education (AOR = 2.17, 95% CI: 1. 19, 3.96), previous history of anemia (AOR = 3.20, 95% CI: 1.33, 7.72), and good knowledge (AOR = 2.01, 95% CI: 1. 32, 3.06). Conclusion:Just over half of the pregnant women in South Wollo Zone had good knowledge and practice regarding anemia prevention, leaving substantial, critical gaps in dietary habits, deworming, and bed net utilization. Therefore, healthcare providers and program managers should focus on reaching rural and less-educated women with targeted antenatal education, while expanding preconception family planning services to reduce unintended pregnancies.
Pica, the persistent ingestion of non-nutritive, non-food substances for ≥ 1 month at a developmentally inappropriate age, is regularly observed but understudied in sickle cell disease (SCD). Its prevalence and risk factors are unclear. This systematic review aims to estimate pica prevalence and synthesize evidence on associated characteristics and correlates in SCD. We searched Embase, MEDLINE ALL, Web of Science, Cochrane CENTRAL, PsycINFO and Google Scholar up to 31 October 2025, for studies reporting original data on the prevalence and characteristics of pica in individuals ≥ 2 years with SCD. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Meta-analysis of prevalence used random-effects models. Data on substances consumed were pooled. Literature on potential correlates was narratively summarized across biological, psychological and social domains. Ten studies (1585 participants) from North America (n = 6), Africa (n = 1), Europe (n = 1), the Middle East (n = 1) and South America (n = 1) were included, with sample sizes ranging from 55 to 395. The pooled prevalence of pica was 34% (95% CI: 24%-46%, I2 = 94%). Across four studies, the most commonly ingested materials were clay/dirt (n = 110, 39.3%), paper (n = 60, 21.4%) and fabric (n = 29, 10.4%). Narrative synthesis identified younger age, lower bodyweight, lower haemoglobin levels, higher impulsivity, lower socioeconomic status, lower family satisfaction and a positive family history as potential correlates of pica in SCD. Pica in SCD is highly prevalent. Psychosocial determinants may play a larger role than previously anticipated, alongside biological and disease-related contributors. However, current evidence is limited by small sample sizes, inconsistent findings, and lack of validated assessment tools. To advance understanding of the aetiology of pica, future longitudinal studies integrating biological, psychological, social and neuroimaging measures are needed.
Background:Sickle cell anaemia (SCA) is a hereditary haemoglobin disorder that continues to pose a significant public health burden worldwide. This systematic review aimed to synthesise evidence on plant-derived therapies investigated for their antisickling, antioxidant and membrane-stabilising effects in the management of SCA. Methods:A systematic search of PubMed, Scopus and Web of Science was performed according to PRISMA 2020 guidelines to identify studies (2010-2025) evaluating plant-based interventions for SCA. Results:Thirty-four studies published between 2010 and 2025 were included, with the majority (58.8%) published between 2018 and 2025, while 20.6% were published between 2010 and 2012. Most studies originated from Africa (58.8%), particularly Nigeria and the Democratic Republic of the Congo, followed by Asia (26.5%). Carica papaya was the most frequently investigated medicinal plant (21.2%), and leaves were the most commonly used plant part (39%). Strong antisickling activity was reported in 41.2% of studies, while 26.5% demonstrated inhibition of haemoglobin S (HbS) polymerisation and 17.6% reported membrane-stabilising or antihaemolytic effects. Antioxidant activity accounted for 45.5% of all oxidative assessments. Overall, inhibition of HbS polymerisation was the most frequently reported mechanism of action, identified in 60.6% of the included studies. Conclusion:The evidence demonstrates that plant-derived extracts and phytochemicals possess significant antisickling, antioxidant and membrane-protective activity, supporting their potential as adjunct therapies for SCA. Nonetheless, standardisation of experimental protocols, toxicological evaluation and clinical trials are essential to advance towards clinical application.
Background:In Ethiopia, approximately 10% of births are affected by adverse fetal birth outcomes. Yet, data was limited on the relationship of anemia with adverse fetal birth outcomes in Ethiopia, particularly in the study region. This study reported the association of maternal anemia and adverse fetal birth outcomes among women who gave birth at public hospitals in southern Ethiopia. Methods:A multicenter, unmatched case-control study was conducted from May 28 to July 27, 2024, in four selected public hospitals in the study region. Data was collected using a structured and pretested questionnaire. A total of 433 participants were randomly selected, where 152 were cases and 281 were controls. The logistic regression model was fitted to detect statistical associations between the outcome and predictors at a P value of < 0.05. Results:The majority of participants were in the age range of 20-35 years. Types of adverse fetal birth outcomes reported range from 10 (2.3%) others (asphyxia, anomaly, and post-term births) to 53 (12.2%) low birth weights. The overall anemic participants (anemia immediately before birth) among cases were 68 (44.7%), and controls were 48 (17.1%). The proportion of anemia status was highest with the stillbirths, 19 (73.1%), and lowest with the preterm births, 4 (20%). Participants with anemia status (immediately before birth) were 2.19 (95% CI: 1.26, 3.80) times more likely to have adverse fetal birth outcomes than non-anemia. Participants who have better adherence to iron-folic acid supplementations during pregnancy were 52% (AOR: 0.48; 95% CI: 0.28, 0.80) less likely to face adverse fetal birth outcomes. Participants who had a low level of educational attainment, a previous history of adverse fetal birth outcomes, and intermenstrual bleeding (current history) were likely to face adverse fetal birth outcomes in the current birth. Conclusions:Anemia has an association with adverse fetal birth outcomes. Adherence to iron-folic acid in pregnancy had a protective association with adverse fetal birth outcomes. Interventions to facilitate anemia prevention strategies in pregnancy should be encouraged.
Background:The burden and effects of anaemia remain high worldwide, with predictors varying by location, demographics, and socioeconomic factors. Knowing localised, specific predictors of anaemia helps develop targeted local interventions. We therefore set out to determine the prevalence and predictors of anaemia in a semiurban and rural community in Ghana. Methods:From June to August 2021, a community-based cross-sectional study using multilevel sampling was conducted in the Ejura-Sekyedumase Municipality, Ghana. Four hundred and seventy-six children, aged one to five, were recruited from four communities in the Kasei Subdistrict. Using a structured questionnaire, clinical, demographic, anthropometric, dietary and laboratory data, including blood haemoglobin, were obtained. The data were entered into EpiData and analysed with R statistical software. A multivariate ordinal logistic regression model was used to identify independent predictors of increasing anaemia severity. Results:The prevalence of anaemia was 76.3% (95% CI: 72.2-80.0), with mild, moderate and severe anaemia being 28.8% (95% CI: 24.7-33.1), 44.3% (95% CI: 39.8-48.9) and 3.2% (95% CI: 1.8-5.1), respectively. Two hundred and fifty (52.5%) children had malaria parasitaemia. Independent predictors of worsening anaemia severity were increasing age (aOR: 0.96, 95% CI: 0.95-0.98, p < 0.001), child eating from his/her bowl as opposed to communal eating (aOR: 0.47, 95% CI: 0.28-0.80, p = 0.005), stunting (aOR: 1.83, 95% CI: 1.17-2.88, p = 0.009), malaria parasitaemia (aOR = 3.62, 95% CI: 2.42-5.46, p < 0.001) and mothers' religion (aOR: 2.44, 95% CI: 1.62-3.68, < 0.001). Conclusions:The Ejura-Sekyedumase Municipality has a high burden of anaemia and malaria parasitaemia in children between one and five years old. Malaria parasitaemia, communal eating, younger age and the mother's religion were significantly associated with worsening anaemia. It is recommended that intermittent antimalarial treatment, routine administration of iron and trace elements, and counselling at well-baby and antenatal clinics on specific predisposing dietary habits be instituted for children under five years of age.
Introduction:Anemia is a prevalent but under-recognized cancer complication, particularly in low-resource countries like Ethiopia. It significantly impacts treatment outcomes, fatigue, quality of life, and mortality rates. This review aims to estimate the prevalence of anemia and its risk factors among cancer patients in Ethiopia for clinical decision-making and public health strategies. Methods:This study employed a systematic review and meta-analysis design, sourcing evidence from various electronic databases until August 03, 2025. The data were extracted from June 01 to 30 and analyzed from July 01 to 25, with report generation till August 03, 2025, using R software. Meta-analysis was performed using a random-effects model, with forest plots illustrating pooled prevalence and associated factors. Heterogeneity was assessed using the I2 statistic, and study quality was evaluated using a validated tool. Results:Eleven studies involving diverse cancer populations across Ethiopia were included. The pooled prevalence of anemia among cancer patients was 39.5% (95% CI: 26.9%-52.1%). Advanced cancer stage, female sex, older age, poor nutritional status, rural residence, presence of comorbidities, hematologic malignancies, ≥ six cycles of chemotherapy, bone metastasis, and history of bleeding were factors associated with the development of cancer in patients who received treatment. Conclusion:Anemia is common among Ethiopian cancer patients, driven by both disease- and treatment-related factors. Routine screening and targeted interventions are needed to improve outcomes.
Background:Anemia is one of the most common worldwide public health problems related to pregnancy. However, there is a scarcity of evidence regarding anemia among pregnant women in Somaliland, particularly in Hargeisa city. Therefore, this study aimed to assess the prevalence and its associated factors of anemia among pregnant women attending antenatal care in health institutions of Hargeisa, Somaliland. Method:A cross-sectional study was carried out by involving 402 pregnant women in health institutions of Hargeisa between August 30 and September 30, 2023. Data were collected by four certified midwives using a structured face-to-face interview questionnaire, while four experienced laboratory professionals collected the necessary laboratory samples. A probability proportion to size sampling method was used, followed by simple random selection to select the study participants. The hemoglobin level was measured using the HemoCue 301 System. Data were entered into EpiData Version 4.6 and exported to SPSS Version 26 for analysis. A logistic regression model was fitted to determine the factors associated with anemia. Variables with a p value less than 0.25 in the bivariable analysis were considered for the multivariable logistic regression model. Statistical significance was set at p < 0.05, and results were reported as adjusted odds ratios with 95% confidence intervals. Results:Of the 402 pregnant women, 56.2% (95% CI: 51%-61%) of the participants were anemic, of which 20.4% were mild anemia, 32.6% were moderate anemia, and 3.2% were severe anemia. Pregnant women who had no ANC follow-up before the current visit (AOR = 3.42, 95% CI = 1.91, 6.18), pregnant women who did not use iron supplementation (AOR = 3.18, 95% CI = 1.85, 5.48), pregnant women who were in the third trimester (AOR = 3.29, 95% CI = 1.69, 6.42), pregnant women infected with intestinal parasitosis (AOR = 5.12, 95% CI = 1.08, 24.15), and pregnant women who were positive for malaria (AOR = 7.71, 95% CI = 1.81, 32.54) were all significantly associated with maternal anemia. Conclusions:The prevalence of anemia among pregnant women in Hargeisa is a significant public health concern, with more than half of the study participants affected.
Background: Diabetes mellitus (DM) is a major public health concern, and anemia is a common but often overlooked complication that can worsen fatigue, quality of life, and clinical outcomes. In Uganda, where diabetes is increasing, evidence on red cell indices-based anemia patterns among adults with DM remains limited. We determined the prevalence, anemia subtypes, and associated factors among adults with DM at Mubende Regional Referral Hospital (MRRH). Methods: We conducted a hospital-based cross-sectional study among consecutively recruited adults with DM (n = 246) at MRRH. Sociodemographic and clinical data were collected using a structured questionnaire and physical examination. Hemoglobin was measured using an automated hematology analyzer. Anemia was defined using the World Health Organization cutoffs, and anemia subtypes were classified by mean corpuscular volume (microcytic, normocytic, and macrocytic). Data were analyzed in STATA 15.1. Logistic regression was used to identify factors independently associated with anemia; p < 0.05 was considered statistically significant. Results: The prevalence of anemia was 28.0% (69/246; 95% CI: 22.8%-34.3%). Among anemic participants, normocytic anemia was most common (76.81%; 95% CI: 66.85%-86.77%), followed by microcytic anemia (13.04%; 95% CI: 5.10%-20.98%) and macrocytic anemia (10.14%; 95% CI: 3.02%-17.27%). In multivariable analysis, older age (> 60 years) (AOR = 5.17, p = 0.022), neuropathy (AOR = 4.97, p < 0.001), diabetes duration > 5 years (AOR = 2.25, p = 0.045), obesity (AOR = 5.94, p = 0.049), and poor glycemic control (AOR = 2.96, p = 0.002) were independently associated with anemia. Conclusion: Anemia was common among adults with DM at MRRH, with normocytic anemia as the predominant red cell indices-based subtype. Routine anemia screening should be integrated into diabetes care, with further etiologic evaluation (e.g., iron studies, vitamin B12/folate, and renal markers) where feasible.
Anemia is a frequent diagnosis in premature and critically ill infants and is caused by phlebotomy, which is essential for medical care. The severity of anemia often correlates with the acuity of illness. We recently showed that severe neonatal anemia causes a "leaky gut" in neonatal mouse pups by altering the structure and function of epithelial adherens junctions through decreased E-cadherin expression. We hypothesize that microtubules play a major role in maintaining adherens junction integrity. To test this hypothesis, C57BL/6 mice were subjected to timed phlebotomy between postnatal days (P) 2-10 to induce severe anemia (hematocrits 20%-24%). Microtubular assembly was evaluated by electron microscopy, quantitative real-time polymerase chain reaction (qRT-PCR), immunohistochemistry, and/or immunoblotting on intestinal tissues, Caco-2 intestinal epithelial-like cells, and colonic organoids. The electron micrographs showed loss of microtubules in the anemic intestine and disrupted intestinal epithelial microtubular assembly. Microtubular disruption was associated with decreased expression of the α-tubulin 4a (tuba4a) subunit. The observed ultrastructural changes that disrupt epithelial barrier functions result from hypoxia-induced microRNA let-7e destabilizing tuba4a expression in the anemic intestinal epithelium. In conclusion, phlebotomy-induced anemia in mouse neonates is associated with a "leaky gut" by the disruption of microtubular assembly.
BackgroundThe weekly intake of oral iron-folic acid in pregnancy is an optional recommendation by the World Health Organization and the International Federation of Gynaecology and Obstetrics (FIGO). Although evidence was limited to justify its benefit or harm in Ethiopia, weekly iron-folic acid could be optional in the regions of Ethiopia. This trial compared twice-weekly versus daily regimens for the outcomes of haemoglobin level and gastric side effects.MethodsAn open-label, noninferiority randomized controlled trial was employed in the maternity clinics of southern Ethiopia. Eligibility criteria were as follows: age (18-40 years), gestation (12-20 weeks) and haemoglobin level (11-13 g/dL). Participants were randomly assigned to a treatment and control arm using blocks of six, and a sealed envelope was used by a statistician, not a trial member. The control arm received a single capsule of the daily iron-folic acid regimen, and the intervention arm received a double capsule of the twice-weekly regimen. The primary outcome was blood haemoglobin levels. The secondary outcome was gastrointestinal and related side effects.ResultsA total of 282 participants were enrolled in the intervention cohort. Participants who completed 12 weeks of follow-up were 271. Participant characteristics were balanced at baseline. Analysis output suggests no clinical differences between the groups for the mean maternal blood haemoglobin level and the incidence of anaemia. The risk of high haemoglobin concentration was not different between the groups. The gastrointestinal side effect was 33% less likely in the twice-weekly group than in the daily group.ConclusionsThe twice-weekly regimen was clinically noninferior to the daily regimen. The new approach could be considered an alternative regimen in pregnancy. Trial Registration: Pan African Clinical Trials Registry (PACTR): PACTR202402484795209ConclusionsThe twice-weekly regimen was clinically noninferior to the daily regimen. The new approach could be considered an alternative regimen in pregnancy. Trial Registration: Pan African Clinical Trials Registry (PACTR): PACTR202402484795209
Background Anemia is a major global public health concern with marked regional and global variation; however, data on its prevalence, severity, and subtypes among the Kurdish population in Zakho, Kurdistan Region of Iraq, are limited. This study aimed to determine the prevalence, severity, and morphological subtypes of anemia among Kurdish individuals undergoing premarital screening in Zakho. Methods A prospective cross-sectional study was conducted at the Premarital Screening Centre of Zakho Emergency Teaching Hospital from March 2022 to October 2024. A total of 5948 participants were enrolled. Their sociodemographic data and blood samples were collected for complete blood count parameters. Anemia prevalence and its severity were classified according to the WHO criteria and morphologically subtyped based on red cell indices. Results Anemia was detected in 505 participants (8.49%), predominantly in females (p < 0.001), especially aged 18-39 years. No significant differences were observed by the religious group. Mild anemia occurred in 300 cases (5.04%), moderate in 202 (3.40%), and severe in 3 (0.05%). However, no significant difference in anemia severity was observed by sex (p = 0.072). Hypochromic microcytic anemia was most frequent (408 cases, 6.86%), mainly in females (p < 0.001). In comparison, normochromic normocytic anemia was identified in 96 cases (1.61%), more often in males, while macrocytic anemia was rarely detected in only one male (0.02%). There is a significant sex-based difference in anemia subtypes (p < 0.001). Conclusion The overall anemia prevalence in Zakho represents a mild public health concern, but the high proportionately affected young reproductive age group females have a significant public health concern and predominantly of mild to moderate severity. The high prevalence of hypochromic microcytic anemia in females and normochromic anemia in males suggests that iron deficiency, hemoglobinopathy, and anemia of chronic disorders are the primary underlying causes.
Background: Pain is a common symptom and a cause of hospitalization in patients with sickle cell disease (SCD). Traditionally linked to vaso-occlusive crises and categorized as acute and nociceptive, this perspective does not reflect the complexity of pain in this population, which includes pain with neuropathic features caused by lesions or dysfunctions in the somatosensory nervous system. Ion channels such as transient receptor potential vanilloid 1 (TRPV1), involved in neuropathic pain mechanisms, play a role in nociceptive transduction and can be affected by genetic variants. This study examined the prevalence of neuropathic pain in patients with SCD and its link to TRPV1 gene polymorphisms, combining clinical and genetic data to develop a comprehensive understanding of pain in this population. Methods: A cross-sectional study included 84 patients followed at a hematology center in Northeast Brazil. Neuropathic pain was assessed using the Douleur Neuropathique 4 (DN4) questionnaire, and four TRPV1 polymorphisms (rs224534, rs222747, rs8065080, and rs222749) were genotyped using standard PCR. Results: Neuropathic pain was present in 36.9% of participants and was significantly associated with age over 34 years, self-identification as Black, and a higher number of pain episodes in the past year (p < 0.05). Patients with three or more episodes were nine times more likely to have neuropathic pain. There were no differences in gender, opioid use, or hospitalizations. None of the analyzed polymorphisms showed an association with neuropathic pain. Conclusion: Neuropathic pain is a common and underrecognized feature of SCD. Although no association was observed between the evaluated TRPV1 polymorphisms and neuropathic pain, these findings do not exclude a role for TRPV1 and likely reflect the multifactorial nature of pain in SCD. Further studies using genetic approaches and larger samples are warranted to elucidate the mechanisms underlying neuropathic pain.
ObjectiveOur research investigated the connection between anemia and all-cause mortality.MethodsThis study included cancer patients from the NHANES (2003-2018) cycles. The causes of death and mortality status of the participants were obtained from the National Death Index records. Multivariable Cox proportional hazards regression models and subgroup analyses were utilized to evaluate the relationship between anemia and all-cause mortality in cancer patients. Propensity score matching was employed to identify patients with similar baseline characteristics and to adjust for bias caused by potential confounding factors.ResultsA total of 1789 participants were included in this study. During a median follow-up of 77.0 months, 592 of the 1789 cancer patients (33.1%) died. Multivariable Cox proportional hazards regression showed a significantly higher death risk among anemic patients compared to nonanemic patients within the cancer population (HR = 1.85, 95% CI: 1.11 to 3.09) after all covariates were adjusted. Even mild anemia is associated with a considerable and clinically underappreciated mortality risk.ConclusionsAnemia is associated with all-cause mortality in cancer patients, and further research is needed to explore the heterogeneity across different types of cancer.
Anemia is a public health problem affecting mainly children under 5 years and pregnant women. However, school-age children are also affected but are often neglected in research. This study aimed to assess the prevalence and factors associated with anemia among primary school children in public schools in the Plateau Central Region of Burkina Faso. Hemoglobin (Hb) concentration was determined using a HemoCue HB201(+) analyzer. Data were collected from 551 schoolchildren aged 5-14 years. Anemia was established if the Hb level was lower than 11.5 g/dL in children aged 5-11 years and less than 12 g/dL in children aged 12-14 years. Binary logistic regression was adjusted to identify factors associated with anemia at a p value < 0.05. The prevalence of anemia was 59.2%, including 52.6% of the girls. Schoolchildren aged 5-11 years were the most affected, with a rate of 58.5%, versus 60.2% for schoolchildren aged 12-14 years. The fact of dwelling in the provinces of Ganzourgou (OR = 2.12; 95% CI: 1.35-3.31) and Oubritenga (OR = 1.71; 95% CI: 1.09-2.69), working as a dressmaker (OR = 0.29; 95% CI: 0.08-0.95), and having mothers who are civil servants (OR = 0.42; 95% CI: 0.16-1.12) are associated with anemia. Improving women's income levels and province-specific actions could help to reduce the prevalence of anemia in this region.
Background Screening for anaemia in pregnancy and the postpartum period is an important component of maternal care to prevent associated morbidity and mortality. However, the implementation of routine screening practices for pregnancy‐related anaemia remains variable, inconsistent, and suboptimal. This review aimed to synthesise the literature on practices, facilitators, barriers, implementation strategies, and outcomes of routine screening for pregnancy‐related anaemia. Methods This scoping review followed the JBI methodology and PRISMA‐ScR checklist with a comprehensive systematic search of seven academic databases (PubMed, EMBASE, Scopus, CINAHL, Web of Science, Global Index Medicus, and African Journals Online) and selected grey literature sources. Retrieved citations were screened, and relevant references were assessed for eligibility. Articles included were analysed qualitatively and presented descriptively by concept, comparing settings with high and low prevalence of anaemia in pregnancy. Results We identified 9497 references and included 116 articles in this review. Clinical practice guidelines recommend universal screening for anaemia during pregnancy and selective screening in the postpartum period using automated or point‐of‐care haemoglobin testing and iron studies, with variations in screening frequency and timing. Screening coverage for anaemia in pregnancy was lower in high‐prevalence compared to low‐prevalence settings. Effective supportive supervision was the main facilitator of anaemia screening in pregnancy, while lack of screening materials served as the main barrier, particularly in high‐prevalence settings. Training health workers on point‐of‐care testing in high‐prevalence settings was the most common strategy used to improve the implementation of routine screening for anaemia in pregnancy, and its feasibility was the most studied implementation outcome. Conclusion Implementing routine screening practices for pregnancy‐related anaemia in all settings will benefit from harmonised clinical practice guidelines. Efforts are required to address implementation challenges and move from the early phase of implementation towards sustainability. Future research should aim to fill the knowledge gaps in implementing anaemia screening, particularly in the postpartum period.
Background Iron deficiency anemia (IDA) is common in diabetic nephropathy, yet understudied in Type 2 diabetes (T2D) without nephropathy. Aim This study assessed the prevalence of IDA and its risk factors in T2D patients. Methods A cross-sectional study in 2023 included 404 T2D patients. Sociodemographic data, anthropometric measurements, and dietary intake (energy, macronutrients, iron, and vitamin C) were obtained using two nonconsecutive 24-h dietary recalls. Laboratory tests included complete blood count, serum ferritin, HbA1c, fasting glucose, creatinine, and urea. IDA was defined as hemoglobin < 13 g/dL (men) or < 12 g/dL (women) with ferritin < 30 & micro;g/L. Results Anemia affected 25.7% of participants, iron depletion 57.9%, and IDA 19.1%. Females showed slightly higher anemia (26.9% vs. 22.8%) and iron depletion (60.3% vs. 51.6%) rates. Those with IDA had lower estimated glomerular filtration rates (82.6 vs. 91.7 mL/min/1.73 m(2), p = 0.003), although values remained within the nonchronic kidney disease range. Males had higher dietary iron intake (16.6 mg/day vs. 10.3 mg/day, p < 0.001). Patients with diabetes >= 20 years were 2.3 times more likely to have IDA (OR: 2.334; 95% CI: 1.045-5.212, p = 0.039). Conclusions Nearly one-fifth of T2D patients had IDA. T2D patients with diabetes for 20 years or more are over twice as likely to develop IDA. Regular IDA screening, especially in long-standing T2D, may improve diabetes management.
Introduction: Anemia remains a significant public health problem among women and children in Ghana. Dietary intake is a significant predictor of anemia risk, yet the role of Ghanaian diets in the prevailing endemic anemia is little known. This study examined anemia prevalence and the association between Ghanaian mother-child dyads' dietary patterns and anemia status. Methods: The study utilized data from the 2022 Ghana Demographic and Health Survey, a nationally representative cross-sectional survey. We analyzed data from 3744 mother-child dyads with complete dietary and hemoglobin measurements. Dietary patterns were derived using principal component analysis from reported food group consumption and categorized into tertiles. Anemia was defined using World Health Organization cut-offs. Poisson regression with robust variance estimation was used to estimate crude and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), adjusting for maternal education, household wealth, household head's sex, interview month, number of children under 5 years, marital status, region, and residence. Results: Anemia prevalence was 67.4% in children and 41.6% in mothers. Compared with the northern belt, children in the southern (aPR = 0.82; 95% CI: 0.69-0.98; p = 0.027) and middle belts (aPR = 0.68; 95% CI: 0.56-0.84; p = 0.0002) were less likely to be anemic; urban residence was protective (aPR = 0.95; 95% CI: 0.91-0.99; p = 0.040). Risks were higher for children from poorer households and those of younger mothers, while maternal education showed an inverse association with anemia. Anemia was more common among children whose mothers had anemia (p < 0.001). Dietary patterns showed weak associations, limited to maternal westernized dietary pattern (PR = 0.97; 95% CI: 0.93-0.99; p = 0.047). Conclusion: Anemia among Ghanaian mother-child dyads is primarily driven by structural, geographic, and intergenerational factors, with dietary patterns contributing minimally. Tackling socioeconomic inequities, enhancing malaria and infection control, and implementing family-centered, regionally tailored strategies are essential to reducing Ghana's anemia burden.
Introduction The diagnosis of beta thalassemia trait is primarily based on an elevated HbA2 level (> 3.5%) measured by high-performance liquid chromatography or capillary electrophoresis. Iron deficiency (ID) can influence HbA2 levels, raising concern about potential diagnostic misclassification, particularly in individuals with borderline HbA2 values. This study aimed to evaluate the effect of ID and its correction on HbA2 levels and the diagnosis of beta thalassemia trait. Methods A prospective interventional study conducted between June 2021 and June 2022 at a National Thalassemia Centre, Sri Lanka. Ninety-two participants aged 12-57 years with low red cell indices (MCV <= 80 fL, MCH <= 27 pg) and HbA2 < 3.5% were included. All had serum ferritin < 30 ng/mL indicating ID. Hematological and iron parameters, including HbA2 levels, were assessed before and after 3 months of oral iron therapy. Comparisons were made between subgroups with serum ferritin levels of < 15 ng/mL and 15-30 ng/mL. Correlations between Hb, HbA2, ferritin, and other iron indices were also examined. Results A significant positive correlation was observed between Hb and HbA2 levels prior to treatment. Following iron therapy, HbA2 levels increased significantly in iron-deficient individuals (p < 0.001). In three of eight participants with borderline HbA2 levels, treatment raised HbA2 above the 3.5% diagnostic threshold. Conclusions Oral iron therapy significantly affects HbA2 levels in iron-deficient individuals and may cause borderline values to cross the diagnostic threshold for beta thalassemia trait. Iron status should therefore be considered when interpreting HbA2 results in thalassemia screening.
Background: The World Health Assembly (WHA) resolution urges African countries with a high burden of sickle cell anemia (SCA) to design and implement national programs emphasizing early identification through newborn screening (NBS) and prompt access to adequate preventive care. Despite this recommendation, NBS and early prophylactic interventions remain insufficiently implemented in many sub-Saharan African countries. This pilot program aimed to establish and evaluate NBS for sickle cell disease (SCD) as a health intervention in C & ocirc;te d'Ivoire, determine the birth prevalence of SCD, and assess the feasibility of linkage to comprehensive care. Methods: We conducted a prospective, multicenter cross-sectional study from June 2022 to December 2024. The study population included all women who delivered in five maternity hospitals and received pre- and post-test counseling. Umbilical cord blood samples from all live newborns were screened using a rapid diagnostic test (RDT) (HemotypeSC). All positive RDT results were confirmed using reference capillary electrophoresis. Results: A total of 6,337 newborns were screened using RDTs, of whom 825 (13.02%) had abnormal hemoglobin profiles (including 9.45% HbS and 3.57% HbC). Among the 825 RDT-positive cases, only 506 newborns underwent confirmatory capillary electrophoresis. Confirmatory testing showed 84 (16.6%) with normal hemoglobin (HbAA); 112 (22.13%) with SCD-including 1.98% HbSS, 2.17% HbSC, 1.38% HbS/beta(0)-thalassemia, and 16.60% HbS/beta(+)-thalassemia; 217 (42.8%) with sickle cell trait (HbAS); and 93 (18.3%) with HbAC. Among the 112 infants confirmed with SCD, only 68 were successfully enrolled in comprehensive care services. Conclusions: This study represents the first report of an NBS program for SCD implemented as a public health intervention in C & ocirc;te d'Ivoire. The findings demonstrate that NBS is both necessary and feasible within the country. Low-cost RDTs present a practical first-line screening option but require confirmation with gold-standard diagnostic tools such as capillary electrophoresis. Immediate linkage to comprehensive care for infants diagnosed with SCD remains a critical component of program success and warrants further strengthening.
