Dr. Shyam P Lohani

Anemia is still a global health problem despite the adequate knowledge of its cause and remedy. It affects billions of people throughout the world in terms of health, quality of life, and working capacity. Anemia is a condition in which the number of red blood cells (RBCs) circulating in the body decreases or the hemoglobin concentration within red blood cells is lower than normal. Hemoglobin is the main protein in our red blood cells with a life span of 120 days.
Hemoglobin is an essential component of red blood cells and responsible to carry oxygen to the tissues in the body. With too few or abnormal red blood cells, or not enough hemoglobin, there will be a decreased capacity of the blood to carry oxygen. It is the most common blood disorder throughout the world.

Global health problem
Anemia is a serious global public health problem that particularly affects young children, usually under the age of five and pregnant women as well as women of reproductive age group. The World Health Organisation (WHO) estimates that 42 per cent of children less than five years of age and 40 per cent of pregnant women worldwide are anemic. Around 35.14 per cent of women of reproductive age and 42.7 per cent of children under the age of five in Nepal were anemic in 2016 (WHO, 2021).
Anemia usually develops as a result of a number of other health issues that interfere with the production of healthy RBCs or increase the rates of the breakdown or loss of these cells. The presence of anemia is an indicator of both poor nutritional intake and poor health status. Besides causing direct effects, it can also influence other global nutritional concerns that include stunting and wasting, low birth weight and childhood overweight, and also obesity due to lack of energy to exercise. Both poor school performance in children and reduced work productivity in adults owing to anemia can have additional social and economic influences on individuals, family, and the country.
Children under the age of five years and pregnant women are especially vulnerable to anemia which causes an increased risk of maternal and child mortality. The prevalence of anemia remains high worldwide, particularly in low-income countries. A significant proportion of young children and women of childbearing age are anemic in those countries. Iron deficiency anemia has also been implicated for impairment in both the cognitive and physical development in children. It also reduces productivity among adults.
The most common cause of anemia is nutritional deficiencies, particularly iron deficiency. Deficiencies in folic acids, vitamin B12, and vitamin A are also important causes for anemia. Haemoglobinopathies and infectious diseases such as malaria, tuberculosis, HIV, and parasitic infections are the additional causes of anemia.
The most common symptom of anemia is fatigue. Other symptoms such as pale skin, a fast or irregular heartbeat, shortness of breath, chest pain, headaches, light-headedness are also found among people with anemia. People with mild anemia may experience few or sometimes no symptoms at all.
Some forms of anemia causes specific symptoms, including aplastic anemia, which in turn result in a fever, frequent infections, and skin rashes. Folic acid deficiency anemia can cause irritability, diarrhea, and a smooth tongue. Hemolytic anemia can cause jaundice, dark urine, a fever, and abdominal pain. Sickle cell anemia causes swelling in the feet and hands that is often painful, fatigue as well as jaundice.
In nutritional deficiencies anemia, eating more iron-rich foods can help. The following foods are high in iron such as iron-fortified cereals and bread, pulses and beans, brown rice, white or red meats, nuts and seeds, fish, tofu, eggs, dried fruits, including apricots, raisins, and prunes and leafy green vegetables such as kale, spinach, and watercress.
People of all ages, sexes, ethnicities, and nationalities are affected by anemia. The factors that increase the risk of developing a form of the condition are born prematurely, being between 6 months and two years old, menstruating, being pregnant, and expecting birth. Other risk factors are having a diet low in vitamins, minerals, and iron, regularly taking pain medications that erode the stomach lining, such as aspirin and ibuprofen.
Having a family history of inherited anemia, such as sickle cell anemia or thalassemia, having Crohn’s disease, an intestinal disorder that affects the absorption of nutrients, losing blood due to surgery or trauma, having a chronic illness, such as AIDS, diabetes, kidney disease, cancer, rheumatoid arthritis, heart failure, or liver disease are also responsible for the development of anemia.
Treatment
Iron deficiency anemia is the most common form particularly in developing countries and is relatively easy to treat through dietary modifications. Other forms of anemia require specialised health interventions that may be less accessible in developing countries. Finding the actual cause responsible for anemia is critical to understand the burden and epidemiology of the problem. It is also key for planning public health interventions, and for clinical care of people of all ages’ especially young children and women of reproductive age group.
Having taken anemia as a serious public health problem, Nepal government has developed strategies to reduce the rate of anemia within the country. It is called upon all stakeholders to implement those strategies within their jurisdiction to achieve the goal of reducing the rate of anemia in children and women in Nepal.
Iron fortification of appropriate food items in combination with iron supplements in specific population groups has proven to be efficient and sustainable all over the world. Our initial efforts should be directed to the specific risk groups for iron deficiency anemia, i.e. children under the age of five, adolescent females, women of reproductive age, pregnant women, and postpartum lactating mothers.

(Professor Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)