Current Issues in Healthcare: Simple Solutions Can Be Effective

Sometimes the easiest solutions are those which may most desperately need to be implemented.  This became apparent to me recently when one new article in Blood (1) led me to another recent one (2) on the high prevalence of iron deficiency anemia in lower income regions, and how a simple, cost-effective first step may change the lives of many patients.

To start with, what is iron deficiency anemia?  Anemia – having a deficiency of red blood cells or hemoglobin – is one of the most common maladies worldwide, and iron deficiency anemia is just that – anemia caused by the body not having enough iron.  General symptoms of any type of anemia include fatigue, weakness, and difficulty concentrating, among others.  As a result, patients with chronic anemia may have poor work performance, experience difficulty holding onto a job, and potentially have to deal with a myriad of complications that can lead to overall health challenges  and compounding medical bills.

As mentioned, iron deficiency anemia has a high prevalence in lower-income regions, something that was known and is now even more soundly demonstrated by Kassebaum et al.  There are several potential causes for iron deficiency anemia including poor iron absorption due to an underlying condition such as Celiac disease or simply a diet poor in iron-rich foods.  One of the first lines of therapy is also incredibly simple and relatively easy to implement in lower income regions with poor resources: iron supplementation, either through iron-fortified foods or via nutritional supplements (2). This approach isn’t perfect and isn’t without risks, but (particularly for iron supplements) it is relatively inexpensive (3) and can be supported at multiple different levels of the healthcare system – private, state-run, or NGO.  The exact regimen also needs to be worked out – supplementation vs. fortification, constant vs. intermittent. This isn’t a long-term solution – Pasricha et al lay out a plausible model for long-term anemia control (2), but greater emphasis on making iron supplements available in these regions could be of great benefit.  If you want to learn more, I highly recommend the articles cited below.

So, would increased availability of iron supplementation solve the problem of iron deficiency anemia in low income regions?  Not completely; the causes of anemias are often complex.   Better screening should be implemented at the same time as any therapy to ensure a proper match between diagnosis and treatment (i.e., there are some patients for whom iron supplementation may actually be harmful if they are misdiagnosed).  Thankfully, the rate of iron deficiency anemia is already decreasing somewhat, but it is still quite high, indicating a burden on people who can least afford it.  And when barriers are many and complex (see Pasricha et al Figure 1, for example), sometimes simple solutions are the best that can realistically be asked for.  What it takes is cooperation between people ‘on the ground’ in underprivileged regions and those who can provide the needed resources.  For patients with true iron deficiency anemia, relatively inexpensive supplementation/fortification programs could be a good short-term start before long-term solutions can be implemented.

Steve Mason, Ph.D., is the Senior Editor of Biological Sciences of Cancer InCytes Magazine.  The opinions expressed in this article are those of the author and do not necessarily reflect any company or organization.

References

1. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615-624. Available at http://bloodjournal.hematologylibrary.org/content/123/5/615.full.

2. Pasricha S-R, Drakesmith H, Black J, et al. Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013;121(14):2607-2717. Available at http://bloodjournal.hematologylibrary.org/content/121/14/2607.long.

3. Ruiz-Arguelles, GR. Iron deficiency anemia in low- and middle-income countries. Blood. 2013;122(13):2289. Available at http://bloodjournal.hematologylibrary.org/content/122/13/2289.extract.

 

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