ArticleBMC medicine2020
Estimating the burden of iron deficiency among African children.
Article in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 4 of them syntheses that pooled it.
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Who cites it
48 citing papers in PubMed, 4 syntheses or guidelines pooled it, 75 citations in OpenAlex.
- Prevalence and associated factors of anemia among newborns in Africa: a systematic review and meta-analysis.BMC pediatrics · 2025Pooled it
- Biochemical assessment of the nutritional status of infants, children and adolescents in South Africa (1997-2022): a systematic review.Public health nutrition · 2024Pooled it
- Iron Deficiency Is Associated With Reduced Levels of Plasmodium falciparum-specific Antibodies in African Children.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Pooled it
- Effects of iron intake on neurobehavioural outcomes in African children: a systematic review and meta-analysis of randomised controlled trials.Wellcome open research · 2021Pooled it
- Cohort profile: the Entebbe Mother and Baby Study (EMaBS).BMJ open · 2026Trial
- Hepcidin is low in children with moderate acute malnutrition and asymptomatic malaria: secondary analysis of a 2×2×3 factorial randomised trial in Burkina Faso.The British journal of nutrition · 2026Trial
- Iron Bioavailability from Infant Cereals Containing Whole Grains and Pulses: A Stable Isotope Study in Malawian Children.The Journal of nutrition · 2022Trial
- Measuring neurodevelopment in iron-deficient children in sub-Saharan Africa: A systematic review of evidence and gaps.Global epidemiology · 2026Article
- Dietary Intake of Essential Elements from African Foods Available in the UK Market.Foods (Basel, Switzerland) · 2026Article
- African-specific genetic loci determine iron status and risk of severe malaria and bacteremia in African children.Nature communications · 2026Article
- Iron Deficiency Diagnosis in Sub-Saharan Africa: Challenges, Barriers, and Opportunities.Anemia · 2026Review
- Impact of inflammation on anemia in children: a cross-sectional study.BMC pediatrics · 2025Article
- Boosting nutritional value: the role of iron fortification in meat and meat products.Biometals : an international journal on the role of metal ions in biology, biochemistry, and medicine · 2025Review
- Prevalence and Determinants of Iron Deficiency Anemia Among Children Under Five Years at Luwero General Hospital, Uganda.Journal of blood medicine · 2025Article
- Iron deficiency anaemia in mothers and infants with high inflammatory burden: Prevalence and profile in a South African birth cohort.PLOS global public health · 2025Article
- The current status of genetic biofortification in alleviating malnutrition in Africa.Journal, genetic engineering & biotechnology · 2024Review
- Current or recent malaria infection is associated with elevated inflammation-adjusted ferritin concentrations in pre-school children: a secondary analysis of the BRINDA database.The British journal of nutrition · 2024Article
- Micronutrient supplementation practices in relation to the World Health Organisation 2013 guidelines on management of severe acute malnutrition.Maternal & child nutrition · 2024Article
- Association between asymptomatic Plasmodium falciparum malaria infection, anaemia and mean corpuscular volume of school children in the Volta Region of Ghana.European journal of microbiology & immunology · 2024Article
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Authors and funding
22 authors at 8 institutions in 8 countries.
Funding
Abstract
backgroundIron deficiency (ID) is a major public health burden in African children and accurate prevalence estimates are important for effective nutritional interventions. However, ID may be incorrectly estimated in Africa because most measures of iron status are altered by inflammation and infections such as malaria. Through the current study, we have assessed different approaches to the prediction of iron status and estimated the burden of ID in African children.
methodsWe assayed iron and inflammatory biomarkers in 4853 children aged 0-8 years from Kenya, Uganda, Burkina Faso, South Africa, and The Gambia. We described iron status and its relationship with age, sex, inflammation, and malaria parasitemia. We defined ID using the WHO guideline (ferritin < 12 μg/L or < 30 μg/L in the presence of inflammation in children < 5 years old or < 15 μg/L in children ≥ 5 years old). We compared this with a recently proposed gold standard, which uses regression-correction for ferritin levels based on the relationship between ferritin levels, inflammatory markers, and malaria. We further investigated the utility of other iron biomarkers in predicting ID using the inflammation and malaria regression-corrected estimate as a gold standard.
resultsThe prevalence of ID was highest at 1 year of age and in male infants. Inflammation and malaria parasitemia were associated with all iron biomarkers, although transferrin saturation was least affected. Overall prevalence of WHO-defined ID was 34% compared to 52% using the inflammation and malaria regression-corrected estimate. This unidentified burden of ID increased with age and was highest in countries with high prevalence of inflammation and malaria, where up to a quarter of iron-deficient children were misclassified as iron replete. Transferrin saturation < 11% most closely predicted the prevalence of ID according to the regression-correction gold standard.
conclusionsThe prevalence of ID is underestimated in African children when defined using the WHO guidelines, especially in malaria-endemic populations, and the use of transferrin saturation may provide a more accurate approach. Further research is needed to identify the most accurate measures for determining the prevalence of ID in sub-Saharan Africa.
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