Abstract
Scientific experts from nine countries gathered to share their views and experience around iron interventions in Africa. Inappropriate eating habits, infections and parasitism are responsible for significant prevalence of iron deficiency, but reliable and country-comparable prevalence estimates are lacking: improvements in biomarkers and cut-offs values adapted to context of use are needed. Benefits of iron interventions on growth and development are indisputable and outweigh risks, which exist in populations with a high infectious burden. Indeed, pathogen growth may increase with enhanced available iron, calling for caution and preventive measures where malaria or other infections are prevalent. Most African countries programmatically fortify flour and supplement pregnant women, while iron deficiency in young children is rather addressed at individual level. Coverage and efficacy could improve through increased access for target populations, raised awareness and lower cost. More bioavailable iron forms, helping to decrease iron dose, or prebiotics, which both may lower risk of infections are attractive opportunities for Africa. Fortifying specific food products could be a relevant route, adapted to local context and needs of population groups while providing education and training. More globally, partnerships involving various stakeholders are encouraged, that could tackle all aspects of the issue.
Highlights
A one-day workshop was convened in Marrakesh (Morocco) in October 2016 to discuss issues around iron interventions in Africa, with a focus on iron fortification
Affects more than 70% of young children and more than 45% of women in countries such as Côte d’Ivoire, The Gambia or Malawi
It was agreed that WHO guidelines should be followed for at least until evidence becomes available from current initiatives, such as the BRINDA project which aim at improving the interpretation of Iron deficiency (ID) biomarkers in various contexts of infection burden; several methods are being proposed, including a regression model taking inflammation into account, instead of using ferritin cut-off value [36]
Summary
A one-day workshop was convened in Marrakesh (Morocco) in October 2016 to discuss issues around iron interventions in Africa, with a focus on iron fortification. The worldwide prevalence of anemia has slightly decreased in the past 20 years, the situation still raises important concerns in Africa, especially in the Central and Western parts of the continent [2]. Experts from nine African countries (Algeria, Côte d’Ivoire, Egypt, Ghana, Kenya, Malawi, Morocco, South Africa and The Gambia) from academia or governmental bodies contributed their scientific, clinical or public health expertise and their field experience to share knowledge and visions regarding the current situation and the most appropriate ways to address the specificities of ID in Africa. The objective of the workshop was to provide a landscape analysis of the needs and concerns facing African countries and to exchange knowledge on best practices that are currently in place or could be initiated in the different areas. The words “anemia” and “iron deficiency” encompass anemia from all causes and iron deficiency from all causes, except when the wording “iron deficiency anemia” is used
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