Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.
Bibliographical noteFunding Information:
This study was funded by the Bill & Melinda Gates Foundation. Co-authors employed by the Bill & Melinda Gates Foundation provided feedback on initial maps and drafts of this manuscript. Otherwise, the funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the final report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. R.A. received consultancy/ speaker fees from UCB, Sandoz, Abbvie, Zentiva, Teva, Laropharm, CEGEDIM, Angelini, Biessen Pharma, Hofigal, AstraZeneca and Stada. Dr. Bell reports grants from the Wellcome Trust Foundation, grants from the NIH, grants from the Environmental Protection Agency, personal fees from the University of Montana, other from the NIH and grants from the Yale Climate Change and Health Center, all outside of the submitted work. Dr. Gessner reports employment from Pfizer Vaccines, outside of the submitted work. Dr. Islam reports grants from the National Heart Foundation of Australia and grants from the NHMRC, outside of the submitted work. Dr. Jozwiak reports personal fees from Amgen, personal fees from Alab Laboratories, personal fees from Teva, personal fees from Synexus, personal fees from Boehringer Ingelheim and personal fees from Zentiva, outside of the submitted work. Dr. Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, outside of the submitted work. Dr. Mendoza reports employment as a program analyst in Population and Development at the United Nations Population Fund-UNFPA Country Office in Peru, which does not necessarily endorse this study. Dr. Pandi-Perumal reports non-financial support from Somnogen Canada and personal fees from royalties, outside of the submitted work. Dr. Postma reports grants and personal fees from MSD, grants and personal fees from GSK, grants and personal fees from Pfizer, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novavax, personal fees from Quintiles, grants from Bayer, grants and personal fees from BMS, grants and personal fees from Astra Zeneca, grants and personal fees from Sanofi, personal fees from Novartis, personal fees from Pharmerit, other from Health-Ecore, other from PAG, other from Asc Academics, grants and personal fees from IQVIA, grants from bioMérieux, grants from the WHO, grants from the European Union, grants and personal fees from Seqirus, grants from FIND, grants from Antilope and grants from DIKTI, LPDP, Budi, all outside of the submitted work. Dr. Rezahosseini reports grants from the Research Foundation of Rigshospitalet and grants from the A.P. Møller Fonden, outside of the submitted work. Dr. Shivarov reports salary from PRAHS, outside of the submitted work. Dr. Uddin reports as having worked as a visiting fellow at Deakin University Institute for Physical Activity and Nutrition (IPAN). IPAN paid for travel (including flights and transportation), accommodations and meals. E.Upadhyay is listed on two patents: ‘A system and method of reusable filters for anti-pollution mask’ (pending) and ‘A system and method for electricity generation through crop stubble by using microbial fuel cells’ (pending). Dr. Wu reports grants from the Ministry of Science and Technology in China, personal fees from HealthKeepers, grants from Suzhou Municipal Science and Technology Bureau and grants from Kunshan Government, outside of the submitted work. Dr. Zhu reports grants from UTHealth Innovation for Cancer Prevention Research Training Program Pre-doctoral Fellowship (Cancer Prevention and Research Institute of Texas, grant no. RP160015), during the conduct of the study.
This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation. Lucas Guimarães Abreu acknowledges support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) – Código de Financiamento 001, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (404710/2018-2 and 310797/2019-5), Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG) and Pró-Reitoria de Pesquisa (PRPq) of Universidade Federal de Minas Gerais. Olatunji Adetokunboh acknowledges the Department of Science and Innovation and National Research Foundation for its support. Syed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Alaa Badawi acknowledges support by the Public Health Agency of Canada. Josip Car acknowledges their post at Imperial College London, which is supported by the NIHR NW London Applied Research Collaboration. Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support, with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support by the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by the Wellcome Trust (grant no. 201900/Z/16/Z) as part of his International Intermediate Fellowship. Sagnik Dey acknowledges support from IIT Delhi for the Institute Chair position. Marcel Ausloos, Adrian Pana and Claudiu Herteliu are partially supported by a grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Claudiu Herteliu is partially supported by a grant co-funded by the European Fund for Regional Development through the Operational Program for Competitiveness, project ID P_40_382. Claudiu Herteliu and Adrian Pana are partially supported by a grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P2-2.1-SOL-2020-2-0351. Praveen Hoogar wholeheartedly thanks the Centre for Bio Cultural Studies (CBiCS), Directorate of Research, Manipal Academy of Higher Education (MAHE), Manipal. Sheikh Mohammed Shariful Islam is funded by a Fellowship from the National Heart Foundation of Australia and NHMRC. Oommen John is the recipient of an UIPA scholarship, UNSW, Sydney. Md. Nuruzzaman Khan acknowledges Jatiya Kabi Kazi Nazrul Islam University, Bangladesh. Yun Jin Kim acknowledges support by the Research Management Centre, Xiamen University Malaysia (grant no. XMUMRF/2020-C6/ITM/0004). Kewal Krishan acknowledges support by a DST PURSE grant and the UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Iván Landires is member of the Sistema Nacional de Investigación (SNI), which is supported by the Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), Panamá. Alberto Ortiz acknowledges their research, which is supported by FRIAT, ISCIIII FEDER funds RETIC REDINREN RD016/0009. George Patton acknowledges support from an NHMRC research fellowship. Maarten J. Postma reports various grants and honoraria from public and private partners and shareholdership in two health economics consultancies. Rajesh Kumar Rai received financial support from the West Bengal State Department of Health and Family Welfare, India (memo no. 114-P&B/ HFW-27011/114/2019-NHM SEC). Milena Santric-Milicevic acknowledges the support received from the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract no. 175087). Feng Sha acknowledges support from the Shenzhen Science and Technology Program (grant no. KQTD20190929172835662). Aziz Sheikh acknowledges Health Data Research UK. Adithi Shetty acknowledges Kasturba Medical College, Mangalore and Manipal Academy of Higher Education for the support and encouragement. B. Suresh Kumar Shetty acknowledges Kasturba Medical College, Mangalore and Manipal Academy of Higher Education, Manipal for the encouragement and support provided. Mohammad Reza Sobhiyeh acknowledges the clinical research development center of Imam Reza Hospital Kermanshah University of Medical Sciences for their wise advice. Riaz Uddin is supported by the Alfred Deakin Postdoctoral Research Fellowship. Charles Shey Wiysonge’s work is supported by the South African Medical Research Council. Sojib Bin Zaman received a scholarship from the Australian Government Research Training Program in support of his academic career. Yunquan Zhang was supported by the Key Research Center for Humanities and Social Sciences in Hubei Province (Hubei University of Medicine) (grant no. 2020ZD001).
© 2021, The Author(s).