Ge Shiliang, Ali Saif, Haldane Victoria, Bekdache Carine, Tang Grace H, Sholzberg Michelle
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Br J Haematol. 2025 Feb;206(2):428-442. doi: 10.1111/bjh.19984. Epub 2025 Jan 6.
Approximately 1.92 billion people worldwide are anaemic, and iron deficiency is the most common cause. Iron deficiency anaemia (IDA) disproportionately affects women of reproductive age and remains under-addressed in low- to middle-income countries (LMICs). The primary objective of our scoping review is to evaluate the barriers and facilitators to IDA management in LMICs by using an intersectionality-enhanced implementation science lens adapted from the consolidated framework for implementation research and the theoretical domains framework. A total of 53 studies were identified. Contextual barriers included the deprioritization of IDA risk, unequal gender norms and stigma from the HIV/AIDS epidemic. Regional poverty, conflict and natural disasters led to supply chain barriers. Individual-level facilitators included partner support and antenatal care access while barriers included forgetfulness and having medical comorbidities. Successful interventions also utilized education initiatives to empower women in community decision-making. Moreover, community mobilization and the degree of community ownership determined the sustainability of IDA reduction strategies. IDA is not only a medical problem, but one that is rooted in the sociocultural and political context. Future approaches must recognize the resilience of LMIC communities and acknowledge the importance of knowledge translation rooted in community ownership and empowerment.
全球约有19.2亿人贫血，缺铁是最常见的原因。缺铁性贫血（IDA）对育龄妇女的影响尤为严重，在低收入和中等收入国家（LMICs）中，这一问题仍未得到充分解决。我们的范围审查的主要目标是，通过使用从实施研究综合框架和理论领域框架改编而来的、增强了交叉性的实施科学视角，评估低收入和中等收入国家缺铁性贫血管理的障碍和促进因素。共识别出53项研究。背景障碍包括对缺铁性贫血风险的优先级降低、不平等的性别规范以及来自艾滋病毒/艾滋病流行的污名化。地区贫困、冲突和自然灾害导致了供应链障碍。个人层面的促进因素包括伴侣支持和获得产前护理，而障碍包括健忘和患有合并症。成功的干预措施还利用教育举措，使妇女在社区决策中获得权力。此外，社区动员和社区所有权程度决定了缺铁性贫血减少策略的可持续性。缺铁性贫血不仅是一个医学问题，而且是一个植根于社会文化和政治背景的问题。未来的方法必须认识到低收入和中等收入国家社区的复原力，并承认植根于社区所有权和赋权的知识转化的重要性。
