These four papers together outline the new ecological approach to reducing anemia. Understanding the ecology of anemia—the biology of nutrients interacting with physical, economic, social, behavioral, demographic, and environmental factors—is key to implementing context-specific interventions to reduce anemia.
- Exploring the anemia ecology: By conflating impaired iron physiology with iron deficiency, we have limited our ability to address anemia comprehensively. This overview presents a framework for how practitioners can use the biology of anemia, alongside methods for assessing prevalence and its causes, to devise context-specific interventions.
- Biology of anemia: Researchers have made recent progress in understanding the biological mechanisms underlying anemia. To be successful public health interventions need to consider common causes of anemia and their interactions, including iron deficiency (functional and absolute), deficiencies of other micronutrients, infection, inflammation, and genetic conditions.
- Improving anemia assessment: Assessment of anemia is based on hemoglobin concentrations and cutoffs that correspond to specific age ranges, sex, and physiological status. To understand which interventions would be most successful in this context, we need to know the real prevalence of anemia, as well as the non-nutritional (e.g., due to infection, inflammation, blood loss, or genetic disorders) and nutrition-specific (e.g., due to micronutrient deficiencies) causes of anemia.
- Interventions to address the challenge: Depending on whether the causes are nutritional or otherwise, solutions range from increasing dietary diversity, biofortification, food fortification, and supplementation to delayed cord clamping, as well as prevention and treatment for malaria and helminths and other parasitic diseases and infections. Practitioners must tailor these interventions to the local context, the cause, and the population group(s) affected.