Iron deficiency anaemia

Iron deficiency is a highly prevalent form of undernutrition, affecting around one-fourth of the world’s women and children, and is one of the most common causes of anaemia. We conducted comprehensive reviews of published literature linking iron deficiency to disability and death for four potential outcomes: child mortality, perinatal mortality, maternal mortality and mild mental retardation. For all of these outcomes, the best available data were prospective observational studies in which anaemia or haemoglobin concentration was the risk factor. Data on child mortality were not adequate for this task, although a true risk cannot be precluded by the data. Summary relative risks for perinatal mortality (10 studies), maternal mortality (six studies) and mental retardation (five studies) were estimated using random effects models (both mortality outcomes) or a fixed-effects model (retardation) and weighting individual estimates by the inverse of their within-study variance. For mortality outcomes, the bivariate relations between haemoglobin and death were used. In two studies of perinatal mortality, unadjusted and multivariate adjusted odds ratios were compared to assess the potential degree of bias in the unadjusted associations. For mental retardation, published multivariate adjusted relations between haemoglobin and IQ were used. Global anaemia prevalence data were supplied by the World Health Organization (WHO), and converted to mean haemoglobin concentrations, assuming normal distribution and observed standard deviations from a large number of studies. To estimate the haemoglobin distribution if iron deficiency were corrected, we assumed the prevalence of anaemia in women and children would be reduced by 50%. On average, for the world, this would increase haemoglobin concentration by about 0.45g/dl (range: 0.0g/dl to 1.28g/dl). Chapter 3