Knowledge Gaps in Understanding the Etiology of Anemia in Indonesian Adolescents.

Kesso Gabrielle Van Zutphen,Klaus Kraemer,Alida Melse-Boonstra

doi:10.1177/0379572120979241

Kesso Gabrielle Van Zutphen, Klaus Kraemer + Show 1 more

Open Access

https://doi.org/10.1177/0379572120979241

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Abstract

Background:Anemia is a public health problem among adolescents in Indonesia. Strategies to prevent or treat anemia should be tailored to local conditions, taking into account its specific etiology and prevalence in a given setting and population group.Objective:This review aims to (1) identify and synthesize the current knowledge on the etiology of anemia among adolescents in Indonesia, (2) reveal knowledge gaps in this area, and (3) suggest directions for future research and programmatic work.Methods:We systematically searched PubMed, Web of Science, Scopus, Medline, and WorldCat databases for peer-reviewed journal articles to identify which etiological factors were related to anemia among Indonesian adolescents. Research papers were reviewed and included in the review according to inclusion criteria.Results:Of 13 studies, 8 showed that anemia was associated with iron deficiency; 4 are suggestive of vitamin A deficiency; and 2 of folic acid deficiency. Five studies underscore different etiological determinants for anemia, such as malaria, protein and energy malnutrition, vitamin B2 deficiency, calcium, and vitamin C deficiency. Based on these findings, we developed a framework on knowledge gaps on the etiology of anemia among adolescents in Indonesia, divided in 3 levels of knowledge: (1) significant knowledge gaps, (2) knowledge gaps, and (3) established knowledge.Conclusions:The knowledge gaps around the etiology of anemia among Indonesian adolescents are significant. Our framework emphasizes the need for further research across all etiological factors, namely inadequate nutritional intake and absorption, genetic hemoglobin disorders, infection and inflammation, and menstrual disorders.

Highlights

According to the 2013 Indonesian National Basic Health Research Survey, approximately 23% and 12%, respectively, of 13- to 18-year-old girls and boys are affected by anemia,[1] thereby classifying anemia as a moderate public health problem among adolescents in Indonesia
In addition to issues with the coverage of and compliance with iron folic acid (IFA) supplementation programs, an important reason for the apparent failure to reduce the prevalence of anemia is that many programs are designed with the assumption that the only cause of anemia is iron deficiency (ID).[2]
ID is the most common nutritional deficiency leading to anemia, deficiencies in folate, vitamin B12, and vitamin A and B6, C, D, E, riboflavin, copper, and zinc can all contribute to anemia

Summary

Introduction

According to the 2013 Indonesian National Basic Health Research Survey, approximately 23% and 12%, respectively, of 13- to 18-year-old girls and boys are affected by anemia,[1] thereby classifying anemia as a moderate public health problem among adolescents in Indonesia. Anemia can be classified into 3 processes, namely decreased erythrocyte production, increased erythrocyte destruction, and increased erythrocyte loss. These processes are broadly determined by nutrition, infectious disease, genetics, and heavy menstrual beeding. Five studies underscore different etiological determinants for anemia, such as malaria, protein and energy malnutrition, vitamin B2 deficiency, calcium, and vitamin C deficiency. Based on these findings, we developed a framework on knowledge gaps on the etiology of anemia among adolescents in Indonesia, divided in 3 levels of knowledge: (1) significant knowledge gaps, (2) knowledge gaps, and (3) established knowledge. Our framework emphasizes the need for further research across all etiological factors, namely inadequate nutritional intake and absorption, genetic hemoglobin disorders, infection and inflammation, and menstrual disorders

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