Global researchers hit ‘reset’ on anaemia reduction targets

Globally, almost one in four people lives with anaemia.

It’s a condition that Associate Professor Crystal Karakochuk has been studying for almost two decades. She recently joined a worldwide network of researchers who are reinvigorating efforts to reduce anaemia, taking a critical look at the underlying and, often complex, factors that influence it.

Dr. Karakochuk and a group of 48 researchers formed the Lancet Haematology Commission, led by the University of Melbourne’s Professor Sant-Rayn Pasricha. Earlier this year they published Getting back on track to meet global anaemia reduction.

“I was excited to receive an invitation to join the Commission, which included renowned anaemia experts from all across the world,” said Dr. Karakochuk, a Canada Research Chair (Tier 2) in Micronutrients and Human Health.

The Commission’s report was critical of the initial global target set by the World Health Assembly (the decision-making body of the World Health Organization) in 2012, that aimed to reduce global anaemia by 50% by 2030 – indicating a more realistic target should be in the range of 12-22%.

Anaemia is a condition where the number of red blood cells or the haemoglobin concentration within them is below normal. It affects people in developed nations, but it’s especially prevalent in lower-to-middle income countries, as well as in women, adolescent females, and children. It can increase the risk of serious problems during pregnancy (e.g., postpartum hemorrhage, small gestational-age infants), and can also affect quality of life by causing fatigue and weakness, headaches, and shortness of breath, among other symptoms.

Importantly, the Commission’s recommendations addressed issues that will impact the prevalence of anaemia in a country, such as the cost and methods of diagnosis, and steps needed to properly measure anaemia rates. Dr. Karakochuk stressed that a tailored approach is needed in each country to reduce anaemia.

“Each country should first focus on understanding the causes of anaemia in their population, and the proportion of the anaemia that appears to be amenable to nutrition interventions,” said Dr. Karakochuk. “Each country should really be setting at their own targets for anaemia reduction.”

“While anaemia is often caused due to a lack of iron in the diet, it could also be hereditary and in those cases, giving an iron supplement to someone could cause more harm than good. For instance, sickle cell anaemia is a serious genetic condition that can cause iron overload – and in these instances interventions other than iron supplements are needed.”

“While anaemia is often caused due to a lack of iron in the diet, it could also be hereditary and in those cases, giving an iron supplement to someone could cause more harm than good”

– Dr. Crystal Karakochuk

The Commission made 10 recommendations to reduce anaemia with the first one being to expand diagnostic testing to include infants, school-aged children, adolescents, and older people. It also made several recommendations aimed at closing knowledge gaps related to understanding the drivers and determinants of anaemia, to further researching interventions that are both nutrition-based (i.e., iron supplementation) and non-nutrition based. Non-nutrition-based interventions could include improving sanitation, delaying cord clamping of newborns in lower-income countries, and postpartum haemorrhage treatments.

Dr. Karakochuk has a track record of conducting notable anaemia research.

She is a member of ‘Team Anaemia’ – an international working group of anaemia experts led by the World Health Organization (WHO) and UNICEF. In 2024, they published ground-breaking findings in the global anaemia field, concluding that drawing capillary blood with a single-drop caused a high probability of random error in haemoglobin measurements as compared to blood collection through veins. These findings were used to shape the recently revised WHO global guidelines for the assessment of haemoglobin for population-level anaemia assessment. Now, Team Anaemia is operationalizing diagnostic testing and optimizing best practices for anaemia assessment.

Dr. Karakochuk also studies the efficacy of different forms and doses of prenatal micronutrients to improve maternal and infant health outcomes in Cambodia, as well as in Canada.

In Cambodia, she and her research team are examining the potential benefits of using multiple micronutrient supplements during pregnancy as a more holistic supplement compared to just iron and folate. This project is led in collaboration with the Cambodian Ministry of Health and Helen Keller International. Eight of Dr. Karakochuk’s trainees have had the opportunity to travel and work in Cambodia for various projects over the last decade as part of this long-standing collaboration.

In Canada, Dr. Karakochuk’s team is also examining different forms and doses of iron in prenatal vitamins, to inform optimal formulations for improving maternal and infant health outcomes.

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