Beyond the Diet: Why Does Cambodia Have Iron Deficiency?

November 12, 2025 •

3 min read

Despite significant progress, a 2014 survey showed that over 40% of women of reproductive age in Cambodia were anemic, a severe public health problem. While low dietary iron is often assumed to be the cause, research reveals a more complex picture answering why does Cambodia have iron deficiency and widespread anemia.

Quick Summary

The high prevalence of anemia in Cambodia is multi-faceted, stemming from genetic hemoglobin disorders, parasitic infections like hookworm, and inflammation, not solely from iron deficiency, especially in adults. Dietary factors contribute but do not fully explain the issue.

Key Points

Genetic Factors: Inherited blood disorders like Hemoglobin E and thalassemia are major causes of anemia in Cambodia, often independent of iron status.
Not Just Iron Deficiency: While dietary iron intake is a concern, recent studies show that iron deficiency itself is not the primary cause for the high prevalence of anemia in many Cambodian adults.
Infections: Parasitic infections, especially hookworm, are a significant contributor to anemia through chronic blood loss and inflammation.
Multiple Deficiencies: Other nutritional issues, including zinc and folic acid deficiencies, also play a role in the prevalence of anemia.
Targeted Interventions Needed: Blanket iron supplementation is often ineffective and potentially harmful; a comprehensive strategy addressing genetic, infectious, and multiple nutrient issues is necessary.

The Complex Etiology of Anemia in Cambodia

For many years, the high rates of anemia in Cambodia were assumed to be a direct result of dietary iron deficiency, particularly due to a rice-based diet low in heme iron from animal sources. While inadequate dietary iron is certainly a contributing factor, recent studies have shown that it is not the sole or even primary cause for a large portion of the population, especially adults. Instead, a complex interplay of genetic, infectious, and nutritional factors are at play, necessitating a more comprehensive approach to public health interventions.

The Major Role of Genetic Hemoglobin Disorders

One of the most significant and often overlooked causes of anemia in Cambodia is the high prevalence of inherited blood disorders known as hemoglobinopathies. Hemoglobin E, affecting over half the population, and various forms of thalassemia are common genetic mutations that impair hemoglobin production, directly causing anemia regardless of iron intake. These genetic conditions can also complicate the diagnosis of iron deficiency anemia (IDA) using traditional markers, as they may be elevated.

Infections and Systemic Inflammation

Parasitic infections and other diseases contribute significantly to anemia in Cambodia. Hookworm infection, in particular, leads to chronic blood loss and depletes iron stores. Malaria and other common infections cause inflammation, which further impacts iron metabolism and can make diagnostic indicators unreliable.

Dietary Habits and Other Nutrient Deficiencies

Dietary factors contribute, especially in vulnerable groups. The traditional rice-based diet is low in bioavailable iron, and consumption of iron-rich animal foods is limited. Phytates in foods like rice also hinder iron absorption. Furthermore, anemia is often linked to deficiencies in other micronutrients like zinc and folic acid, not just iron.

Targeted Solutions vs. Blanket Interventions

Effective interventions must address the multi-faceted nature of the problem. Simple iron supplementation has shown limited impact because it doesn't address the underlying genetic and infectious causes. In some cases, providing extra iron can even be harmful to individuals with non-iron deficiency anemia.

Causes of Anemia in Cambodia: ID vs. Non-ID Factors


Factor	Contribution to Anemia	Impact on Iron Deficiency
Dietary Lack of Iron	Contributes, especially in iron-poor diets	Direct cause of iron deficiency anemia (IDA)
Genetic Hemoglobinopathies	Widespread primary cause of anemia	Can lead to high ferritin, complicating IDA diagnosis
Parasitic Infections	Significant contributor via blood loss	Increases iron loss, exacerbating or causing IDA
Systemic Inflammation	Contributes to anemia of chronic disease	Affects iron metabolism and diagnostic markers
Zinc and Folate Deficiency	Contributing nutritional factors	Zinc deficiency is linked to childhood anemia
Socioeconomic Status	Poorer households have higher anemia rates	Limits access to varied, iron-rich foods

Targeted and Sustainable Interventions

Effective interventions require a comprehensive strategy that addresses multiple determinants of anemia.

Broadened Micronutrient Strategies: Supplementation or fortification should include zinc and folic acid alongside iron. Programs like iron-fortified fish sauce show potential.
Combating Infections: Deworming programs are vital to reduce parasitic infections. Improved sanitation also helps.
Nutritional Education: Promoting diverse diets and educating on food preparation can improve nutrient intake and absorption.
Integrated Healthcare: Screening for hemoglobin disorders in antenatal care helps with proper diagnosis and prevents potentially harmful blanket iron supplementation.
Addressing Socioeconomic Factors: Reducing poverty and food insecurity is fundamental to improving nutrition and reducing anemia.

Conclusion: Shifting Focus for a Healthier Cambodia

The high prevalence of anemia in Cambodia is a serious public health challenge with a complex and multi-factorial etiology. The simple assumption that it is solely caused by iron deficiency has been challenged by recent scientific evidence, which highlights the crucial role of genetic hemoglobin disorders, endemic infections, and other nutritional shortfalls. For effective and sustainable interventions, public health policy must shift from a narrow focus on iron to a broader, integrated approach that addresses all major drivers of anemia. Moving forward requires a greater understanding of local disease prevalence and a shift towards targeted strategies. Learn more about ongoing research into this complex issue at the National Institutes of Health website.

Note: This article is for informational purposes only and does not constitute medical advice. Consult with a healthcare professional for diagnosis and treatment of anemia or iron deficiency.

Frequently Asked Questions

Yes, anemia remains a significant public health problem in Cambodia, affecting high proportions of the population, particularly women of reproductive age and young children.

The high prevalence of anemia in Cambodia cannot be attributed to a single cause. It is driven by a combination of factors, including genetic hemoglobin disorders, parasitic infections, and various micronutrient deficiencies.

The traditional Cambodian diet is often low in iron-rich animal foods and high in phytates from rice, which inhibit iron absorption. While this is a concern, dietary iron deficiency is not the sole cause of anemia.

Genetic hemoglobin disorders like Hemoglobin E and thalassemias are very common in Cambodia and cause anemia by interfering with the body's ability to produce normal, healthy red blood cells. This is a key factor separate from iron levels.

For many people in Cambodia, anemia is not caused by a simple iron deficiency. Since genetic and infectious factors are major contributors, providing only iron supplements may be ineffective and, in some cases of hemoglobinopathy, could lead to iron overload.

Parasitic infections like hookworm are common and contribute significantly to anemia by causing chronic blood loss and impairing nutrient absorption. Other infections can also cause inflammation that affects iron metabolism.

Effective interventions involve a multi-pronged strategy, including deworming programs, promoting a diverse diet, fortification with multiple micronutrients (like zinc and folic acid), and improving overall public health infrastructure.