Estimating the changing disease burden attributable to iron deficiency in South Africa, 2000, 2006 and 2012
DOI:
https://doi.org/10.7196/SAMJ.2022.v112i8b.16485Keywords:
iron deficiencyAbstract
Background. Worldwide, iron deficiency, and consequent iron-deficiency anaemia, remains the most common nutritional disorder. Iron-deficiency anaemia mostly affects young children and women of reproductive age, especially in Asia and Africa. Iron deficiency may contribute to disability directly or indirectly as a risk factor for other causes of death, and may rarely contribute to death.
Objectives. To estimate the changing burden of disease attributable to iron deficiency in males and females (all ages) for the years 2000, 2006 and 2012 in South Africa (SA).
Methods. The comparative risk assessment methodology developed by the World Health Organization (WHO) and the Global Burden of Diseases, Injuries, and Risk Factors Studies was used to estimate the burden attributable to iron deficiency in SA for the years 2000, 2006 and 2012. We attributed 100% of the estimated iron-deficiency anaemia burden across all age groups by sex to iron deficiency. For maternal conditions, the attributable burden to iron deficiency was calculated using the counterfactual method and applied to all women of reproductive age. The population attributable fraction calculated for these selected health outcomes was then applied to local burden estimates from the Second SA National Burden of Disease Study (SANBD2). Age-standardised rates were calculated using WHO world standard population weights and SA mid-year population estimates.
Results. There was a slight decrease in the prevalence of iron-deficiency anaemia in women of reproductive age from ~11.9% in 2000 to 10.0% in 2012, although the prevalence of anaemia fluctuated over time (25.5% - 33.2%), with a peak in 2006. There has been a gradual decline in the number of deaths from maternal conditions attributable to iron deficiency in SA between 2000 (351 deaths (95% uncertainty interval (UI) 248 - 436)) and 2012 (307 deaths (95% UI 118 - 470)), with a peak in 2006 (452 deaths (95% UI 301 - 589)). Furthermore, our analysis showed a 26% decrease between 2000 and 2012 in the age-standardised burden rates from maternal conditions (truncated to 15 - 49 years) attributable to iron deficiency. Between 2000 and 2012, the age-standardised disability-adjusted life year (DALY) rate from iron-deficiency anaemia attributable to iron deficiency markedly decreased by 33% in males, and increased by 3% in females of all ages. Approximately 1.1 - 1.4% of all DALYs in SA from 2000 to 2012 were attributable to iron deficiency.
Conclusion. Iron-deficiency anaemia prevalence can be markedly reduced if iron deficiency is eliminated. Hence it is essential to encourage, reappraise and strengthen the measures that have been put in place to address iron deficiency, especially in women of reproductive age and children.
References
Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anaemia. In: Ezzati M, Lopez D, Rodgers A, Murray CJL, eds. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Vol. 1. Geneva: World Health Organization, 2004;163-208.
World Health Organization. The Global Burden of Disease: 2004 update. Geneva: WHO, 2008.
PetryN,OlofinI,HurrellRF,etal.Theproportionofanemiaassociated with iron deficiency in low, medium, and high human development index countries: A systematic analysis of national surveys. Nutrients 2016;8(11):693. https://doi.org/10.3390/nu8110693
StoltzfusRJ,DreyfussML.Guidelinesfortheuseofironsupplements to prevent and treat iron deficiency anemia, 1998. https://www.who. int/nutrition/publications/micronutrients/guidelines_for_Iron_ supplementation.pdf ?ua=1 (accessed 12 October 2020).
KassebaumNJ,JasrasariaR,NaghaviM,etal.Asystematicanalysis of global anemia burden from 1990 to 2010. Blood 2014;123(5):615- 624. https://doi.org/10.1182/blood-2013-06-508325
World Health Organization. Nutrition: Micronutrient deficiency: Iron deficiency anaemia. Geneva: WHO, 2015. http://www.who. int/nutrition/topics/ida/en/ (accessed 12 October 2020).
WorldHealthOrganization.Globalhealthrisks:Moralityandburden of disease attributable to selected major risks. Geneva: WHO, 2009. 8. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology,
and etiology in low- and middle-income countries. Ann N Y Acad
Sci 2019;1450(1):15-31. https://doi.org/10.1111/nyas.14092
World Health Organization. Global Health Observatory data repository: Anaemia in children <5 years by region. Geneva: WHO, 2016. http://apps.who.int/gho/data/view.main.
ANEMIACHILDRENv? lang=en (accessed 15 January 2020). 10. World Health Organization. Global Health Observatory data repository: Prevalence of anaemia in women. Geneva: WHO, 2016. http://apps.who.int/gho/data/view.main (accessed 4 January 2021). 11. Black RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition: Global and regional exposures and health consequences. Lancet 2008;371(9608):243-260. https://doi.
org/10.1016/S0140-6736(07)61690-0
World Health Organization. The World Health Report 2002: Reducing risks, promoting healthy life. Geneva: WHO, 2002.
Miller JL. Iron deficiency anemia: A common and curable disease.
Cold Spring Harb Perspect Med 2013;3(7):a011866. https://doi.
org/10.1101/cshperspect.a011866
VolberdingPA,LevineAM,DieterichD,MildvanD,MitsuyasuR, Saag M. Anemia in HIV infection: Clinical impact and evidence- based management strategies. Clin Infect Dis 2004;38(10):1454- 1463. https://doi.org/10.1086/383031
Burke RM, Leon JS, Suchdev PS. Identification, prevention and treatment of iron deficiency during the first 1 000 days. Nutrients 2014;6:4093-4114. https://doi.org/10.3390/nu6104093
GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990 - 2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1923-1994. https://doi.org/10.1016/S0140- 6736(18)32225-6
Nojilana B, Norman R, Dhansay MA, Labadarios D, van Stuijvenberg ME, Bradshaw D. Estimating the burden of disease attributable to iron deficiency anaemia in South Africa in 2000. S Afr Med J 2007;97(8):741-746.
Ezzati M, Lopez AD, Rodgers A, vander Hoorn S, Murray CJ, Group CRAC. Selected major risk factors and global and regional burden of disease. Lancet 2002;360(9343):1347-1360. https://doi. org/10.1016/S0140-6736(02)11403-6
Vos T, Barber R, Bell B, et al. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990 - 2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;386(9995):743-800. https://doi.org/10.1016/S0140-6736(15)60692-4
Labadarios D, Swart R, Maunder EMW, et al. The National Food Consumption Survey: Fortification Baseline (NFCS-FB), South Africa 2005. SA J Clin Nutr 2008:21(3)(Suppl 2):S245-S300. http://www. sajcn.co.za/index.php/SAJCN/article/view/286 (accessed 4 January 2021).
Shisana O, Labadarios D, Rehle T, et al. The South African National Health and Nutrition Examination Survey, 2012: SANHANES-1:The health and nutritional status of the nation. Pretoria: HSRC Press, 2014.
National Department of Health, Statistics South Africa, South African Medical Research Council, ICF. South Africa Demographic and Health Survey 2016. Pretoria, South Africa, and Rockville, Maryland, USA: NDoH, Stats SA, SAMRC, and ICF, 2019.
Pillay-van Wyk V, Msemburi W, Laubscher R, et al. Mortality trends and differentials in South Africa from 1997 to 2012: Second National Burden of Disease study. Lancet Glob Health 2016;4(9):e642-e653. https://doi.org/10.1016/S2214-109X(16)30113-9
Barendregt JJ. The effect size in uncertainty analysis. Value Health 2010;13(4):388-391. https://doi: 10.1111/j.1524-4733.2009.00686.x
Institute for Health Metrics and Evaluation: Global Health Data Exchange (GHDx); GBD 2019. University of Washington, 2020. http://ghdx.healthdata.org/gbd-results-tool (accessed 20 November 2020).
Ahmad OB, Boschi Pinto C, Lopez AD. Age standardisation of rates: A new WHO standard. GPE Discussion Paper Series: No 31. 2001:10-12. https://www.who.int/healthinfo/paper31.pdf (accessed 4 January 2021).
Dorrington R. Alternative South African mid-year estimates, 2013. Cape Town: Centre for Actuarial Research, University of Cape Town, 2013. https://www.commerce.uct.ac.za/Research_Units/CARE/ Monographs/Monographs/Mono13.pdf (accessed 4 January 2021).
Sibeko LN, Dhansay MA, Charlton KE, Johns T, van Stuijvenberg ME, Gray-Donald K. Full-term, peri- urban South African infants under 6 months of age are at risk for early-onset anaemia. Public Health Nutrition 2004;7(6):813-820. https://doi.org/10.1079/phn2004612
National Department of Health, South Africa. Saving Mothers 2014 - 2016: Seventh triennial report on confidential enquiries into maternal deaths in South Africa: Short report. 2018. Pretoria: NDoH, 2018. 30. Bradshaw D, Pillay-van Wyk V, Neethling I, et al. 2nd Second Comparative Risk Assessment for South
Africa (SACRA2) highlights need for health promotion and strengthened surveillance. S Afr Med J
;112(8b):556-570. https://doi.org/10.7196/SAMJ.2022.v112i8b.16648
National Department of Health. Guidelines for maternity care in South Africa. 4th ed. Pretoria: NDoH, 2016.
World Health Organization. WHO antenatal care recommendations for a positive pregnancy experience. Nutritional interventions update: Multiple micronutrient supplements during pregnancy. Geneva: WHO, 2020.
World Health Organization. Guideline: Daily iron supplementation in infants and children. Geneva: WHO, 2016.
ThejpalR.Irondeficiencyinchildren.SAfrMedJ2015;105(7):607.https://doi.org/10.7196/SAMJnew.7781 35. JacobsonD.Preventionandtreatmentofirondeficiencyanaemiainchildren.CME2008;26(5):242-244. 36. Moraleda C, Rabinovich NR, Menéndez C. Are infants less than 6 months of age a neglected group for
anemia prevention in low-income countries? Am J Trop Med Hyg 2018;98(3):647-649. https://doi.
org/10.4269/ajtmh.17-0487
McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2013;7:CD004074.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 O F Awotiwon, A Cois, R Pacella, E B Turawa, M A Dhansay, L Stuijvenberg, D Labadarios, R A Roomaney, I Neethling, B Nojilana, N Abdelatif, D Bradshaw, V Pillay-van Wyk
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
