Visualizing the toll of bad blood: It’s not just about preventing mother and child deaths

Women and children suffering from low iron - whether due to malnutrition or other causes - end up suffering from anemia, essentially cellular asphyxiation.

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

Mother and child, Ethiopia
Mother and child, Ethiopia
Flickr, subcomandanta

For many members of the global health community, the term “maternal and child health” translates into saving the lives of women and children.

But to fully realize the mission of improving the health of this population in particular, we have to think about more than just preventing death. What is one of the leading causes of disability worldwide? Women and children, particularly those who are poor, disproportionately suffer from a disease that causes substantial disability: Anemia.

Anemia, which literally (in Greek) means lack of blood, is about starving the body of oxygen. Red blood cells carry oxygen to cells in the human body thanks to a protein known as hemoglobin, which contains iron.

Women and children suffering from low iron – whether due to malnutrition or other causes – end up suffering from anemia, essentially cellular asphyxiation.

A new study reported that in 2010, anemia as a whole accounted for around 9% of years lived with disability worldwide, making it an even greater cause of disability than depression. Iron-deficiency anemia, the type of anemia that causes the most disability, is associated with lower cognitive performance, difficulty concentrating, low productivity, weakness, and fatigue. It often goes undiagnosed, unrecognized even as it quietly strangles.

This condition can negatively, permanently and severely, impact children’s development. Severe iron-deficiency anemia is associated with low birth weight, elevated risk of preterm labor, and increased rates of maternal and child death.

If we only focus on the causes that are killing women and children in developing countries, we fail to recognize anemia as a major threat to global health. The case of anemia drives home the importance of measuring healthy years lost from disability as well as early death, as done in the Global Burden of Disease study.

Globally, iron-deficiency anemia was the third-leading cause of disability in 2010, as shown in the screen grab below. The figure reveals how this disease tends to be a major driver of disability in the poorest regions. For example, iron-deficiency anemia was the top cause of disability in South Asia as well as in Central, East, and West sub-Saharan Africa. Check out the live visualization tool on the Institute for Health Metrics and Evaluation’s (IHME) website to explore the results for specific countries.

Ranking of leading 25 causes of years lived with disability by region, all ages, 2010

Bad Blood Anemia
IHME

In developing countries as a whole, iron-deficiency anemia was the fourth-highest cause of disability in females ages 15 to 49. In children under 5 years, it was the number one cause of disability. Watch the video below to visualize these trends.

Exploring rates of iron-deficiency anemia in children around the world reveals that countries stretching from Mauritania on the western coast of Africa to Eritrea on the eastern coast have the highest levels in the world (see screen grab below). The highest levels of iron-deficiency among females ages 15 to 49 are concentrated in Senegal, Mali, Benin, and India (see interactive map online).

Rates of iron-deficiency anemia in children under 5 years, 2010

Bad Blood anemia
UW, IHME

Yet another characteristic of iron-deficiency anemia is the starkly higher level of burden in females compared to males. As an example, the screen grab illustrates the years lost due to disability from iron-deficiency anemia in males and females in South Asia. The most straightforward explanation for iron deficiency might seem to be poor nutrition, but the issue is actually more complex.  Many women are iron-deficient as a result of having an underlying condition that requires them to consume high amounts of iron in order to remain healthy. Iron-deficiency anemia of this sort may stem from heavy or abnormal menstruation or other conditions that lead to blood loss.

I asked Dr. Nicholas Kassebaum, the lead author of the anemia study and an IHME faculty member, how the global health community could improve the health of people suffering from iron-deficiency anemia.

Nicholas Kassebaum
IHME

“It’s not as simple as giving out iron supplements,” said Kassebaum. “You have to identify the root cause of iron-deficiency anemia.”

If the underlying cause is not related to inadequate nutrition, he said, then simply giving extra iron supplements will not make the problem go away – and may even do harm. Experts argue about whether or not iron-deficiency anemia may play a protective role in some conditions, Kassebaum noted. One example he cited is malaria, where red blood cells spread the infection. If iron-deficiency anemia is part of the body’s defense mechanism against malaria, excessive iron supplementation may do more harm than good.

To reduce the healthy years lost to anemia worldwide, Kassebaum and colleagues call for greater surveillance and intervention among high-risk groups, especially women and children.

As with many global health issues, there is no silver bullet that can easily solve the problem. To address this major driver of disability in women and children, the global health community needs to help strengthen health systems’ ability to diagnose the disease and treat its underlying causes.

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