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close this bookGuidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anaemia (International Life Sciences Institute, 1998, 46 p.)
View the document(introduction...)
View the documentPreface
View the documentAcknowledgments
View the documentAbout INACG
View the documentBackground
View the documentPurpose of These Guidelines
View the documentOverview of Interventions for Controlling Iron Deficiency Anemia
View the documentSelecting and Prioritizing Interventions
View the documentGuidelines for Iron Supplementation to Prevent Iron Deficiency Anemia
View the documentGuidelines for Treatment or Referral of Severe Anemia in Primary Care Settings
View the documentFrom Guidelines to Programs
View the documentWhere to Go for More Help and Information
View the documentSelected Bibliography
View the documentAppendix A. Percentage and amount of iron in some commonly used iron compounds
View the documentAppendix B. Examples of materials used in iron supplementation programs
View the documentAppendix C. Addresses and World Wide Web sites for international agencies engaged in the control of iron deficiency anemia
View the documentAppendix D. Some sources of supplements and other supplies for iron supplementation programs


Iron deficiency is the most common form of malnutrition in the world, affecting more than 2 billion people globally. Iron deficiency anemia (inadequate amount of red blood cells caused by lack of iron) is highly prevalent in less-developed countries but also remains a problem in developed countries where other forms of malnutrition have already been virtually eliminated. Iron deficiency is not the only cause of anemia, but where anemia is prevalent, iron deficiency is usually the most common cause. The prevalence of anemia, defined by low hemoglobin or hematocrit, is commonly used to assess the severity of iron deficiency in a population (Table 1).

Table 1. Hemoglobin and hematocrit cutoffs used to define anemia in people living at sea level

Age or sex group

Hemoglobin below:

Hematocrit below:



Children 6 months to 5 years



Children 5-11 years



Children 12-13 years



Nonpregnant women



Pregnant women







Iron deficiency anemia is most prevalent and severe in young children (6-24 months) and women of reproductive age, but is often found in older children and adolescents and maybe found in adult men and the elderly. Iron deficiency anemia occurs when iron stores are exhausted and the supply of iron to the tissues is compromised. Iron deficiency anemia is a severe stage of iron deficiency in which hemoglobin (or hematocrit) falls below the above cutoffs. Iron deficiency anemia is defined as anemia with biochemical evidence of iron deficiency. Serum ferritin, transferrin saturation, transferrin receptor, and erythrocyte protoporphyrin are indicators used as biochemical evidence of iron deficiency.

Iron deficiency generally develops slowly and is not clinically apparent until anemia is severe even though functional consequences already exist. Where iron deficiency anemia is prevalent, effective control programs may yield benefits to human health as shown in Table 2.

Table 2. Benefits of effective control programs

Population group



· Improved behavioral and cognitive development

· Where severe anemia is common, improved child survival


· Improved cognitive development

· In girls, better iron stores for later pregnancies

Pregnant women and their infants

· Decreased low birth weight and perinatal mortality

· Where severe anemia is common, decreased maternal mortality and obstetrical complications

All individuals

· Improved fitness and work capacity

· Improved cognition