The Prevalence of Anaemia in Africa

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Anaemia is when haemoglobin (Hb) concentration and red blood cell (RBC) numbers are lower than expected and insufficient to meet the amount you need to function effectively. This means that the RBCs will not be able to carry enough oxygen. 

• Anaemia affects roughly one-third of the world’s population, with more than 60% of them in Africa
• It’s often a sign of nutritional deficiency and ill health
• Anaemia is also associated with death and disease in women and children.

Anaemia symptoms

Anaemia is subtle at the earliest. The body tries to compensate for the inadequacy initially, but symptoms may appear as the anaemia continues or worsens. The symptoms may include:

• Pale skin (pallor)
• Cold hands and feet
• Tiredness or weakness
• Dizziness, lightheadedness, or feeling like you are about to pass out
• Fast or unusual heartbeat
• Shortness of breath
• Headache 
• Pain
• Poor growth 

The severity of the symptoms depends on the level of anaemia, the persistence of the cause, and how well the body compensates for the inadequacy. 

What are the causes of anaemia in Africa

Anaemia occurs either because:

1. the body does not produce enough blood or
2. an excess number of red cells are destroyed, or
3. the body is losing blood at a faster rate than it produces

These three mechanisms result from many causes. The common causes of anaemia in Nigeria include 

• genetic conditions (e.g., thalassemia in parts of the Mediterranean, sickle cell in Africa)
• nutritional deficiencies other than iron deficiency (i.e., folic acid, vitamins A and B-12)
• factors related to reproduction (e.g., high fertility, obstetric complications, contraceptives)
• infections (e.g., HIV/AIDS, tuberculosis, diarrhoea) that increase requirements for iron and other micronutrients
• parasitic infections such as malaria and worm infestation

Malaria is a leading cause of anaemia in Sub-Saharan Africa, as is iron deficiency.

Risk factors

The following factors place you at increased risk of anaemia, they include:

• Nutritional deficiency: low intake of minerals and vitamins, such as iron, copper, vitamin B-12, and folate 
• Intestinal disorders: intestinal disorders such as Crohn’s disease and celiac disease affect the absorption of nutrients in your small intestine and increase your risk of developing anaemia
• Menstrual disorders: excess blood loss during menstruation is a risk factor
• Pregnancy: Increased energy and nutrient demands and fluid retention during pregnancy can lead to anaemia
• Chronic conditions: Chronic conditions like cancer or longstanding infections deplete your iron stores, while kidney failure can affect the release of the hormone that controls blood production. 

Chronic blood loss from an ulcer or other sources within the body can deplete the body's store of iron, leading to iron deficiency anaemia.

• Family history: inherited conditions, such as sickle cell anaemia, make you vulnerable to becoming anaemic due to increased destruction of red cells
• Old age: People over age 65 are at increased risk of anaemia

Other factors include blood diseases like haemophilia, autoimmune disorders, alcoholism, exposure to toxic chemicals like camphor, and the use of some medications can affect red blood cell production and lead to anaemia.

Diagnosis

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Diagnosis of anaemia is a combination of clinical presentation and laboratory

Laboratory tests for anaemia generally include the following:

• Packed cell volume (PCV) estimation: involves spinning your blood in a tube to see how much of it is red blood cells
• Complete blood count (CBC): also called full blood count, this test estimates the levels of individual components of your blood, including white blood cells, red blood cells, platelets, reticulocytes, haemoglobin, differential cells, etc.
• Peripheral blood smear: involves using a microscope to examine your blood for its colour, shape, size
• Haemoglobin estimation
• Serum iron estimation
• Serum bilirubin
• Haemoglobin electrophoresis
• Reticulocyte count
• Urinalysis
• Liver function tests
• Renal function test
• Bone marrow biopsy

Treatment

Treatment for anaemia depends on the cause or type of anaemia. Treatments for common forms of anaemia include:

• Iron-deficiency anaemia: iron supplements and dietary changes.
• Vitamin deficiency anaemia: vitamins and dietary supplements.
• Thalassemia: folic acid supplements, iron chelation, and, for some people, blood transfusions and bone marrow transplants.
• Anaemia of chronic disease: treatment of underlying disease.
• Aplastic anaemia: blood transfusion or bone marrow transplant.
• Sickle cell anaemia: oxygen therapy, pain relief medication, and intravenous fluids: antibiotics, folic acid supplements, blood transfusions, and hydroxyurea may be added.
• Haemolytic anaemia: treatment of the underlying cause

Prevention

Prevention can be achieved by enforcing individual/family and government policies.

On individual level

Iron deficiency and vitamin-deficiency anaemia can be prevented by consuming the right diet. Suchnutrient can be gotten from the following sources:

• Iron: from red meat, dark-green leafy vegetables, beans and lentils, dried-fruits and iron-fortified cereals.
• Folate/folic acid: from dark-green leafy vegetables, whole fruits or fruit juices, kidney beans, green peas, peanuts and fortified products such as bread, cereal, pasta, and rice.
• Vitamin B-12: sources include dairy products, meat, soy products and fortified cereal.
• Vitamin C: citrus fruits – whole or juiced, strawberries, peppers, broccoli, melons and tomatoes.

On Governmental level

The three major causes of anaemia (iron deficiency, malaria and helminth infections) can be addressed during contacts with vulnerable groups using a combination of key interventions, as needed.

Five Key Interventions

• Iron supplements targeted to at-risk groups
• Fortification of staple foods with iron and other micronutrients that cause anaemia for the general population 
• Supply of iron-fortified foods targeted to at-risk groups
• Prevent and treat malaria
• Use of insecticide-treated materials and bed nets to prevent anaemia
• Deworming (anthelmintics) in at-risk groups

Other important interventions to decrease anaemia:

• Expand immunization coverage
• Prevent and manage obstetric complications, particularly excessive bleeding
• Promote birth spacing through use of modern contraceptives and exclusive breastfeeding
• Promote use of contraceptives that decrease blood loss
• Improve water and sanitation facilities/practices

Conclusion

Anaemia is a huge problem in Africa, but it is manageable with interventions at the individual and government levels. The primary cause of anaemia in the continent include iron deficiency, malaria, and complications of pregnancy and delivery. These causes are controllable.