Iron Deficiency Diagnosis in Sub-Saharan Africa: Challenges, Barriers, and Opportunities.

Iron deficiency (ID) is the most common nutritional deficiency in sub-Saharan Africa (SSA). The burden of ID in SSA is further amplified by high rates of infectious diseases, hemoglobinopathies, and health system challenges. Early and accurate diagnosis of ID is necessary to reduce the clinical and public health impact of ID, particularly among vulnerable groups such as children and pregnant women. Identifying ID before the onset of anemia is especially important, as anemia represents a late manifestation of depleted iron stores. Achieving earlier detection in SSA requires improved geographic and financial access to iron status testing, as well as diagnostic approaches that are appropriate for local epidemiological contexts. This review evaluates current strategies for diagnosing ID in SSA and points out key limitations that reduce their effectiveness. We emphasize that the interpretation of commonly used iron biomarkers is frequently confounded by inflammation, malaria, and inherited blood disorders, leading to misclassification and underestimation of the actual disease burden in SSA. These biological challenges are also compounded by systemic barriers, including high testing costs, limited laboratory infrastructure, reliance on distant referral facilities, and gaps in awareness at both healthcare providers and community levels. We further argue that improving ID diagnosis in SSA will require a multifaceted approach that includes the adoption of affordable, context-appropriate diagnostic platforms and the development of regionally derived reference ranges and diagnostic decision frameworks. Such strategies would better reflect the physiological and environmental diversity across SSA and support more accurate identification of both ID with and without anemia. These efforts could provide a practical pathway toward improving early detection, guiding targeted interventions, and reducing the burden of ID across the region.