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ch Anaemia
Anaemia is a condition in which the haemoglobin concentration in the blood is below a defined level, resulting in a reduced oxygen-carrying capacity of red blood cells. About half of all cases of anaemia can be attributed to iron deficiency; other common causes include infections, such as malaria and schistosomiasis, and genetic factors, which result in thalassaemias and sickle-cell disease.

In its severe form, anaemia is associated with fatigue, weakness, dizziness and drowsiness. Pregnant women and children are particularly vulnerable. Micronutrient deficiencies
Iron deficiency anaemia

The challenge
Iron deficiency is the most common and widespread nutritional disorder in the world. As well as affecting a large number of children and women in developing countries, it is the only nutrient deficiency which is also significantly prevalent in industralized countries. The numbers are staggering: 2 billion people over 30% of the worlds population are anaemic, many due to iron deficiency, and in resource-poor areas, this is frequently exacerbated by infectious diseases. Malaria, HIV/AIDS, hookworm infestation, schistosomiasis, and other infections such as tuberculosis are particularly important factors contributing to the high prevalence of anaemia in some areas. Iron deficiency affects more people than any other condition, constituting a public health condition of epidemic proportions. More subtle in its manifestations than, for example, protein-energy malnutrition, iron deficiency exacts its heaviest overall toll in terms of ill-health, premature death and lost earnings. Iron deficiency and anaemia reduce the work capacity of individuals and entire populations, bringing serious economic consequences and obstacles to national development. Overall, it is the most vulnerable, the poorest and the least educated who are disproportionately affected by iron deficiency, and it is they who stand to gain the most by its reduction.

The response: a three-pronged offensive

Invisible yet ubiquitous in many developing countries, the true toll of iron deficiency and anaemia lies hidden in the statistics of overall death rates, maternal haemorrhage, reduced school performance and lowered productivity. Iron deficiency anaemia affects millions. The health consequences are stealthy but devastating,

invisibly eroding the development potential of individuals, societies and national economies. This need not be so. We not only know the causes; we also have solutions that are both inexpensive and effective. Because of their close links, iron deficiency and anaemia should be tackled simultaneously using a multifactorial and multisectorial approach. It should also be tailored to local conditions and take into account anaemia's specific aetiology and the population groups affected.

It need not be so
WHO has developed a comprehensive package of public health measures addressing all aspects of iron deficiency and anaemia. This package is being implemented in countries with high levels of iron deficiency and anaemia, malaria, helminth infections and schistosomiasis. Increase iron intake. Dietary diversification including iron-rich foods and enhancement of iron absorption, food fortification and iron supplementation. Control infection. Immunization and control programmes for malaria, hookworm and schistosomiasis. Improve nutritional status. Prevention and control of other nutritional deficiencies, such as vitamin B12, folate and vitamin A.

Why stop iron deficiency anaemia?

The benefits are substantial. Timely treatment can restore personal health and raise national productivity levels by as much as 20%. To support countries in combating anaemia, WHO has developed guidelines on prevention and control of iron deficiency and anaemia together with a manual for assessing the magnitude of the problem and monitoring interventions. Because iron deficiency anaemia drains the life and vitality out of development. We have both the means and potential to achieve widespread improvement. We need to apply both energetically.

Anaemia
Anaemia is common throughout the world. Its main cause, iron deficiency, is the most prevalent nutritional deficiency in the world. Several infections related to hygiene, sanitation, safe water and water management are significant contributors to anaemia in addition to iron deficiency. These include malaria, schistosomiasis and hookworm.

The disease and how it affects people

Anaemia is a condition that occurs when the red blood cells do not carry enough oxygen to the tissues of the body. Anaemia affects all population groups. However the most susceptible groups are pregnant women and young children. In the milder form, anaemia is silent, without symptoms. In the more severe form, anaemia is associated with fatigue, weakness, dizziness and drowsiness. The signs include loss

of normal colour in the skin (in fair skinned people) and also in the lips, tongue nail beds and the blood vessels in the white of the eye. Without treatment, anaemia can worsen and become an underlying cause of chronic ill health, such as impaired fetal development during pregnancy, delayed cognitive development and increased risk of infection in young children, and reduced physical capacity in all people. Low birth weight infants, young children and women of childbearing age are particularly at risk of anaemia. Women of childbearing age need to absorb 2-3 times the amount of iron required by men or older women.

The cause
The main causes of anaemia are nutritional and infectious. They usually coexist in the same individual and make anaemia worst. Among the nutrition factors contributing to anaemia, the most common one is iron deficiency. It is due to a diet that is monotonous, but rich in substances (phytates) inhibiting iron absorption so that dietary iron cannot be utilised by the body. Iron deficiency may also be aggravated by poor nutritional status, especially when it is associated with deficiencies in folic acid, vitamin A or B12, as is often the case in populations living in developing countries With regard to infections, malaria is another major cause of anaemia : it affects 300500 million people, and in endemic areas it may be the primary cause of half of all severe anaemia cases (WHO, 2000). Hookworm infection and in some places schistosomiasis also contribute to anaemia. Approximately 44 million pregnant women have hookworm infections and 20 million people are severely infected with schistosomiasis. Anaemia can also be due to excessive blood loss, such as gastrointestinal infections associated with diarrhoea. The most important waterrelated causes of anaemia are malnutrition and water-borne or water-related infections.

Distribution
Anaemia is a common problem throughout the world and iron deficiency is the most prevalent nutritional deficiency in the world. It affects mainly the poorest segment of the population, particularly where malnutrition is predominant and the population exposed to a high risk of water-related infection.

Scope of the problem

Nine out of ten anaemia sufferers live in developing countries, about 2 billion people suffer from anaemia and an even larger number of people present iron deficiency (WHO, 2000). Anaemia may contribute to up to 20% of maternal deaths.

Intervention
Full discussion of strategies towards anaemia prevention are beyond the scope of this Fact Sheet. Because anaemia is the result of multiple factors, the identification of these factors and of the causes and type of anaemia is important. Important actions include addressing underlying causes correcting iron deficiency, treatment of

underlying disease processes (in particular nutritional deficiencies - Folic acid, Vitamin A and B12). In children, promoting breastfeeding and proper complementary foods are important in controlling anaemia. Improving hygiene, sanitation and water supply; and improving water resource management to contribute to control of schistosomiasis and malaria where they occur are important contributory measures in prevention of anaemia.

Reference
WHO. Turning the tide of malnutrition: responding to the challenge of the 21st century. Geneva: WHO, 2000 (WHO/NHD.007) Prepared for World Water Day 2001. Reviewed by staff and experts in the Department of Nutrition for Health and Development (NHD) and the Water, Sanitation and Health Unit (WSH), World Health Organization (WHO), Geneva.