{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:44:02Z","timestamp":1792086242592,"version":"4.4.0"},"reference-count":55,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2016,11,2]],"date-time":"2016-11-02T00:00:00Z","timestamp":1478044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Iron deficiency is commonly assumed to cause half of all cases of anemias, with hereditary blood disorders and infections such as hookworm and malaria being the other major causes. In countries ranked as low, medium, and high by the Human Development Index, we conducted a systematic review of nationally representative surveys that reported the prevalence of iron deficiency, iron deficiency anemia, and anemia among pre-school children and non-pregnant women of reproductive age. Using random effects meta-analyses techniques, data from 23 countries for pre-school children and non-pregnant women of reproductive age was pooled, and the proportion of anemia attributable to iron deficiency was estimated by region, inflammation exposure, anemia prevalence, and urban\/rural setting. For pre-school children and non-pregnant women of reproductive age, the proportion of anemia associated with iron deficiency was 25.0% (95% CI: 18.0, 32.0) and 37.0% (95% CI: 28.0, 46.0), respectively. The proportion of anemia associated with iron deficiency was lower in countries where anemia prevalence was &gt;40%, especially in rural populations (14% for pre-school children; 16% for non-pregnant women of reproductive age), and in countries with very high inflammation exposure (20% for pre-school children; 25% for non-pregnant women of reproductive age). Despite large heterogeneity, our analyses suggest that the proportion of anemia associated with iron deficiency is lower than the previously assumed 50% in countries with low, medium, or high Human Development Index ranking. Anemia-reduction strategies and programs should be based on an analysis of country-specific data, as iron deficiency may not always be the key determinant of anemia.<\/jats:p>","DOI":"10.3390\/nu8110693","type":"journal-article","created":{"date-parts":[[2016,11,2]],"date-time":"2016-11-02T10:00:35Z","timestamp":1478080835000},"page":"693","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":381,"title":["The Proportion of Anemia Associated with Iron Deficiency in Low, Medium, and High Human Development Index Countries: A Systematic Analysis of National Surveys"],"prefix":"10.3390","volume":"8","author":[{"given":"Nicolai","family":"Petry","sequence":"first","affiliation":[{"name":"GroundWork, Fl\u00e4sch 7306, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibironke","family":"Olofin","sequence":"additional","affiliation":[{"name":"GroundWork, Fl\u00e4sch 7306, Switzerland"},{"name":"Department of Epidemiology; Harvard School of Public Health, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9328-7300","authenticated-orcid":false,"given":"Richard","family":"Hurrell","sequence":"additional","affiliation":[{"name":"Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich 8092, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"Boy","sequence":"additional","affiliation":[{"name":"Harvest Plus, International Food Policy Research Institute, Washington, DC 20006, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Wirth","sequence":"additional","affiliation":[{"name":"GroundWork, Fl\u00e4sch 7306, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mourad","family":"Moursi","sequence":"additional","affiliation":[{"name":"Harvest Plus, International Food Policy Research Institute, Washington, DC 20006, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moira","family":"Donahue Angel","sequence":"additional","affiliation":[{"name":"Harvest Plus, International Food Policy Research Institute, Washington, DC 20006, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0579-6952","authenticated-orcid":false,"given":"Fabian","family":"Rohner","sequence":"additional","affiliation":[{"name":"GroundWork, Fl\u00e4sch 7306, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2016,11,2]]},"reference":[{"key":"ref_1","unstructured":"Benoist, B., McLean, E., Egli, I., and Cogswell, M. (2008). Worldwide Prevalence of Anemia: Who Global Database on Anemia, World Health Organization."},{"key":"ref_2","unstructured":"World Health Organization (WHO) (2015). The Global Prevalence of Anemia in 2011, World Health Organization."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1185\/030079906X100096","article-title":"Iron and the anaemia of chronic disease: A review and strategic recommendations","volume":"22","author":"Cavill","year":"2006","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1182\/asheducation-2010.1.276","article-title":"Anemia of Inflammation; In Hematology: Marrow Responses to Aging and Inflammation","volume":"2010","author":"Roy","year":"2010","journal-title":"Hematol. Am. Soc. Hematol. Educ. Program."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/S0035-9203(00)90057-9","article-title":"Anaemia in pregnant Ghanaian women: Importance of malaria, iron deficiency, and haemoglobinopathies","volume":"94","author":"Mockenhaupt","year":"2000","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/j.1753-4887.2011.00437.x","article-title":"Burden of anemia among indigenous populations","volume":"69","author":"Khambalia","year":"2011","journal-title":"Nutr. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1056\/NEJMra1401038","article-title":"Iron-deficiency anemia","volume":"372","author":"Camaschella","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_8","unstructured":"Serjeant, G.R., and Serjeant, B.E. (1992). Sickle Cell Disease, Oxford University Press."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1182\/blood-2013-06-508325","article-title":"A systematic analysis of global anemia burden from 1990 to 2010","volume":"123","author":"Kassebaum","year":"2014","journal-title":"Blood"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0140-6736(07)61693-6","article-title":"What works? Interventions for maternal and child undernutrition and survival","volume":"371","author":"Bhutta","year":"2008","journal-title":"Lancet"},{"key":"ref_11","first-page":"302","article-title":"The Prevalence of Anaemia in the World. La Prevalence de L\u2019anemie dans le Monde","volume":"38","author":"DeMaeyer","year":"1985","journal-title":"World Health Stat. Q."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1016\/S2214-109X(13)70001-9","article-title":"Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995\u20132011: A systematic analysis of population-representative data","volume":"1","author":"Stevens","year":"2013","journal-title":"Lancet Glob. Health"},{"key":"ref_13","unstructured":"Beaton, G. (2001, January 6\u201312). Functional outcomes of iron deficiency and iron deficiency in pregnancy and beyond. Proceedings of the INACG Symposium, Hanoi, Vietnam."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Laillou, A., Pham, T.V., Tran, N.T., Le, H.T., Wieringa, F., Rohner, F., Fortin, S., Le, M.B., Tran do, T., and Moench-Pfanner, R. (2012). Micronutrient deficits are still public health issues among women and young children in Vietnam. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0034906"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"546","DOI":"10.3945\/ajcn.2010.29284","article-title":"Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: A meta-analysis","volume":"92","author":"Thurnham","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"275","DOI":"10.21149\/spm.v55i3.7210","article-title":"Iron, zinc, copper and magnesium deficiencies in Mexican adults from the national health and nutrition survey 2006","volume":"55","author":"Villalpando","year":"2013","journal-title":"Salud Publica Mex."},{"key":"ref_17","unstructured":"United Nations Development Programme Human Development Index (HDI). Available online: http:\/\/hdr.undp.org\/en\/content\/human-development-index-hdi."},{"key":"ref_18","unstructured":"World Health Organization (2015). World Malaria Report, WHO."},{"key":"ref_19","unstructured":"Malaria Atlas Project Endemic Countries. Available online: http:\/\/www.map.ox.ac.uk\/explore\/countries\/."},{"key":"ref_20","unstructured":"World Health Organization (2012). Distribution of Schistosomiasis, Worldwide, 2011, WHO."},{"key":"ref_21","unstructured":"World Health Organization (2016). Global Health Observatory Map Gallery, WHO."},{"key":"ref_22","unstructured":"UNAIDS Available online: http:\/\/www.unaids.org\/en\/regionscountries\/countries."},{"key":"ref_23","unstructured":"World Health Organization (2010). Who Global Infobase\u2014Data for Saving Lives, WHO."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1214\/aoms\/1177729756","article-title":"Transformations related to the angular and the square root","volume":"21","author":"Freeman","year":"1950","journal-title":"Ann. Math. Stat."},{"key":"ref_25","first-page":"138","article-title":"The inverse of the freeman-tukey double arcsine transformation","volume":"32","author":"Miller","year":"1978","journal-title":"Am. Stat."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"369","DOI":"10.3945\/jn.112.167775","article-title":"Plasma ferritin and soluble transferrin receptor concentrations and body iron stores identify similar risk factors for iron deficiency but result in different estimates of the national prevalence of iron deficiency and iron-deficiency anemia among women and children in Cameroon","volume":"143","author":"Nankap","year":"2013","journal-title":"J. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1017\/S136898001300222X","article-title":"Prevalence and public health relevance of micronutrient deficiencies and undernutrition in pre-school children and women of reproductive age in C\u00f4te d\u2019Ivoire, west Africa","volume":"17","author":"Rohner","year":"2014","journal-title":"Public Health Nutr."},{"key":"ref_28","unstructured":"MoH Kenya National Micronutrient Survey, KNMS 2011, unpublished (expected end 2016)."},{"key":"ref_29","unstructured":"UNICEF (2011). Liberia National Micronutrient Survey 2011\u2014Selected Preliminary Findings, UNICEF, Liberia Institute of Statistics."},{"key":"ref_30","unstructured":"MoH Mozambique Micronutrient Survey 2012\u20132013, unpublished (expected end 2016)."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Wirth, J.P., Rohner, F., Woodruff, B.A., Chiwile, F., Yankson, H., Koroma, A.S., Russel, F., Sesay, F., Dominguez, E., and Petry, N. (2016). Anemia, micronutrient deficiencies, and malaria in children and women in Sierra Leone prior to the Ebola outbreak\u2014Findings of a cross-sectional study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0155031"},{"key":"ref_32","first-page":"245","article-title":"National food consumption survey-fortification baseline (NFCS-FB): South Africa, 2005","volume":"21","author":"Labadarios","year":"2008","journal-title":"S. Afr. J. Clin. Nutr."},{"key":"ref_33","unstructured":"UNICEF (2013). National Nutrition Survey Afghanistan (2013), Available online: http:\/\/static1.squarespace.com\/static\/56424f6ce4b0552eb7fdc4e8\/t\/57490c778259b5de672ae2e3\/1464405132287\/Afghanistan_Report+NNS+2013.pdf."},{"key":"ref_34","unstructured":"ICDDRB (2013). National Micronutrients Status Survey 2011\u20132012, Bangladesh, Centre for Nutrition and Food Security, UNICEF, GAIN, and Institute of Public Health and Nutrition. Available online: http:\/\/static1.squarespace.com\/static\/56424f6ce4b0552eb7fdc4e8\/t\/57490d3159827e39bd4d2314\/1464405328062\/Bangladesh_NMS_final_report_2011-12.pdf."},{"key":"ref_35","unstructured":"(2015). Cambodia Demographic and Health Survey 2014, National Institute of Statistics, Directorate General for Health, and The DHS Program. Available online: https:\/\/dhsprogram.com\/pubs\/pdf\/FR312\/FR312.pdf."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.1017\/S000711451300158X","article-title":"Impact of inflammation on the biomarkers of iron status in a cross-sectional survey of Lao women and children","volume":"110","author":"Knowles","year":"2013","journal-title":"Br. J. Nutr."},{"key":"ref_37","unstructured":"MoH (2011). Nutrition Status of Mongolian Population; fourth National Nutrition Survey Report, 2010."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1177\/15648265130342S104","article-title":"Infant and young child feeding practices in urban Philippines and their associations with stunting, anemia, and deficiencies of iron and vitamin A","volume":"34","author":"Rohner","year":"2013","journal-title":"Food Nutr. Bull."},{"key":"ref_39","unstructured":"MoH (2014). Rep\u00fablica Dominicana-Encuesta Nacional de Micronutrientes, 2009."},{"key":"ref_40","unstructured":"MoH (2014). Ecuador-Encuesta Nacional de Salud y Nutricion, Ensanut-Ecu 2012."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"372","DOI":"10.21149\/spm.v57i5.7616","article-title":"Nutritional status of iron, vitamin b12, folate, retinol and anemia in children 1 to 11 years old: Results of the Ensanut 2012","volume":"57","author":"Villalpando","year":"2015","journal-title":"Salud Publica Mex."},{"key":"ref_42","unstructured":"Mora, J.O. (2007). Integrated Anemia Control Strategy (IACS) Has Significantly Reduced Anemia in Women and Children in Nicaragua, Micronutrient Initiative. Available online: https:\/\/www.k4health.org\/sites\/default\/files\/mora_2007.pdf."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1177\/156482651203300207","article-title":"Association of elevated alpha(1)-acid glycoprotein (AGP) and the prevalence of anemia in Nicaraguan preschool children","volume":"33","author":"Sullivan","year":"2012","journal-title":"Food Nutr. Bull."},{"key":"ref_44","unstructured":"UNICEF (2013). Iraq National Micronutrient Deficiencies: Assessment and Response 2011\u20132012."},{"key":"ref_45","unstructured":"MoH (2009). Oman-National Micronutrient Status and Fortified Food Coverage Survey."},{"key":"ref_46","unstructured":"UNICEF (2013). Azerbaijan Nutrition Survey (azns), 2013, USAID, World Bank Group, UNICEF."},{"key":"ref_47","unstructured":"UNICEF (2010). Report of the Georgia National Nutrition Survey, UNICEF, CDC, GAIN. Available online: http:\/\/unicef.ge\/uploads\/Report_of_the_Georgia_National_Nutrition_Survey_2009_-_eng.pdf."},{"key":"ref_48","unstructured":"UNICEF (2010). Micronutrient Status Survey in Tajikistan, 2009, Available online: http:\/\/www.slideshare.net\/UNICEF-Tajikistan\/micronutrient-status-survey-in-tajikistan."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Hund, L., Northrop-Clewes, C.A., Nazario, R., Suleymanova, D., Mirzoyan, L., Irisova, M., Pagano, M., and Valadez, J.J. (2013). A novel approach to evaluating the iron and folate status of women of reproductive age in Uzbekistan after 3 years of flour fortification with micronutrients. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0079726"},{"key":"ref_50","unstructured":"WHO Serum Ferritin Concentrations for the Assessment of Iron Status and Iron Deficiency in Population. Available online: http:\/\/www.who.int\/vmnis\/indicators\/serum_ferritin.pdf."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"De-Regil, L.M., Jefferds, M.E., Sylvetsky, A.C., and Dowswell, T. (2011). Intermittent iron supplementation for improving nutrition and development in children under 12 years of age. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD009085.pub2"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Fernandez-Gaxiola, A.C., and De-Regil, L.M. (2011). Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD009218.pub2"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Glinz, D., Hurrell, R.F., Ouattara, M., Zimmermann, M.B., Brittenham, G.M., Adiossan, L.G., Righetti, A.A., Seifert, B., Diakite, V.G., and Utzinger, J. (2015). The effect of iron-fortified complementary food and intermittent preventive treatment of malaria on anaemia in 12-to 36-month-old children: A cluster-randomised controlled trial. Malaria J., 14.","DOI":"10.1186\/s12936-015-0872-3"},{"key":"ref_54","unstructured":"Stein, A.J., Meenakshi, J.V., Qaim, M., Nestel, P., Sachdev, H.P., and Bhutta, Z.A. (2005). Analyzing the Health Benefits of Biofortified Staple Crops by Means of the Disability-Adjusted Life Years Approach: A Handbook Focusing on Iron, Zinc and Vitamin A, IFPRI\/CIAT."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"349","DOI":"10.3945\/an.115.010215","article-title":"Overview of the biomarkers reflecting inflammation and nutritional determinants of anemia (BRINDA) project","volume":"7","author":"Suchdev","year":"2016","journal-title":"Adv. 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