Where is iron deficiency anemia most common?

December 21, 2025 •

5 min read

According to the World Health Organization (WHO), half a billion women and over 250 million children worldwide are affected by anemia, with iron deficiency being the most common cause. The prevalence of iron deficiency anemia is not uniform globally, with the highest burden concentrated in low- and middle-income countries.

Quick Summary

The highest prevalence of iron deficiency anemia is in developing nations, with Sub-Saharan Africa and South Asia experiencing the greatest burden. Key factors include poor nutrition, infectious diseases, and socioeconomic status, disproportionately affecting young children and women of reproductive age.

Key Points

Prevalence in Developing Countries: Iron deficiency anemia is most common in low- and middle-income countries, particularly in Sub-Saharan Africa and South Asia.
High-Risk Demographics: The condition disproportionately affects young children, pregnant women, and women of reproductive age due to higher iron requirements and blood loss.
Key Contributing Factors: Poor diet low in bioavailable iron, parasitic infections like malaria and hookworm, and high fertility rates are major drivers in high-prevalence areas.
Socioeconomic Links: Poverty and low educational attainment are consistently linked with a higher risk of iron deficiency anemia due to limited access to nutrition and healthcare.
Effective Interventions: Targeted prevention includes food fortification, iron supplementation for vulnerable groups, and controlling infectious diseases, all tailored to regional contexts.

Global Distribution of Iron Deficiency Anemia

Iron deficiency anemia (IDA) is a widespread nutritional problem, but its prevalence varies dramatically across different regions of the world, primarily impacting low- and middle-income countries. The geographic distribution is strongly influenced by a combination of nutritional, environmental, and socioeconomic factors.

Heavily Affected Regions

Sub-Saharan Africa: This region consistently shows some of the highest rates of anemia globally, with Western and Central sub-Saharan Africa reporting particularly high burdens. The prevalence is driven by severe dietary iron inadequacy, parasitic infections like malaria and hookworm, and overall poor health infrastructure. Malaria, for instance, leads to hemolytic anemia and inflammation that disrupts iron metabolism.
South Asia: Another major hotspot for IDA, with high prevalence rates, especially among women and children. Factors include dietary habits low in bioavailable iron, high rates of pregnancy and childbirth, and pervasive poverty. Countries like India have historically reported high rates, with surveys showing significant prevalence among adolescent girls and women of reproductive age.
Middle East and North Africa (MENA): Although some improvements have been observed, many countries in the MENA region still have a significant burden of iron deficiency. A key study highlighted Yemen and Sudan as having particularly high prevalence rates, linked to conflict, food insecurity, and low socioeconomic status.

Causes Specific to High-Prevalence Regions

In developing countries, the causes of IDA are often complex and interconnected, differing significantly from those in high-income nations. For instance, infectious diseases play a much larger role in these regions.

Dietary Factors: Diets in low-income settings are often low in bioavailable iron. Heme iron, found in meat, is more easily absorbed than non-heme iron from plant sources. Many diets in these regions rely heavily on plant-based foods, and absorption can be further hindered by consuming tea or coffee with meals.
Infectious Diseases: Parasitic infections are a major contributor. Hookworm, for example, causes chronic intestinal blood loss, and malaria leads to hemolysis and inflammation, both worsening iron status. In areas with endemic infectious diseases, the body's iron stores are sequestered away from pathogens, causing a functional iron deficiency.
Socioeconomic Status: Poverty and low educational status are consistently correlated with higher rates of anemia. These factors impact access to nutritious food, quality healthcare, and knowledge about proper nutrition and preventative measures.
High Fertility Rates: In many developing countries, high fertility rates, coupled with insufficient access to prenatal care and iron supplementation, place significant iron demands on women, further exacerbating the issue for them and their children.

Vulnerable Populations by Region

The burden of IDA is not distributed evenly across age groups and genders, with specific demographics facing higher risks globally.

Pregnant Women and Infants: These groups have increased iron requirements due to rapid growth and development. In low-income countries, inadequate maternal iron stores during pregnancy often result in insufficient iron being transferred to the fetus, impacting the newborn's iron status. Delayed umbilical cord clamping can help increase an infant's iron levels at birth.
Women of Reproductive Age: Menstrual blood loss is a common cause of iron deficiency among menstruating women, and in regions where nutritional intake is already poor, this risk is significantly elevated. The World Health Assembly has set a target to reduce anemia in women of reproductive age.
Young Children: Infants and toddlers have a high iron requirement relative to their body weight due to rapid growth. Infants born to mothers with iron deficiency are already at a disadvantage, and without sufficient dietary iron or supplementation, they are highly susceptible.

Comparison of Causes in Developed vs. Developing Regions


Feature	Developing Countries	Developed Countries
Primary Cause	Inadequate dietary intake, parasitic infections (malaria, hookworm), frequent childbirth.	Chronic blood loss (e.g., heavy periods, GI bleeding from ulcers), malabsorption issues (celiac disease, post-bariatric surgery), and specific dietary choices (veganism).
Influencing Factors	Poverty, poor sanitation, low education levels, concurrent infections.	Lifestyle, diet, underlying medical conditions, and less emphasis on iron-fortified staples.
At-Risk Groups	Young children, pregnant and postpartum women, women of reproductive age due to dietary deficiencies and infectious diseases.	Women with heavy menstrual bleeding, frequent blood donors, individuals with GI disorders, and pregnant women not receiving supplementation.
Interventions	Public health programs focusing on food fortification, deworming campaigns, malaria control, and maternal/child health support.	Screening for underlying causes like GI bleeding, dietary counseling, and targeted supplementation.

Conclusion

In summary, while iron deficiency anemia is a global public health problem, it is most common in low- and middle-income countries, particularly in Sub-Saharan Africa and South Asia. The reasons for this disparity are multifaceted, involving a combination of poor nutrition, high incidence of infectious diseases like malaria and hookworm, and significant socioeconomic challenges. The most vulnerable populations include women of reproductive age and young children, whose higher iron demands are often not met. While developed countries experience IDA, it is more commonly due to factors such as chronic blood loss or malabsorption issues, presenting a different set of challenges and requiring different interventions. Effective strategies must address the root causes specific to each region to reduce the global burden of this preventable condition.

Preventative Measures for High-Prevalence Regions

Food Fortification: Large-scale programs to fortify staple foods like wheat flour and oil with iron and other micronutrients are critical. In-home fortification with micronutrient powders can also be effective.
Dietary Improvements: Promoting the consumption of iron-rich foods, including bioavailable heme iron, and combining iron-rich foods with Vitamin C sources to enhance absorption is vital.
Targeted Supplementation: Providing iron and folic acid supplements to high-risk groups, such as pregnant women and young children, is a key strategy recommended by the WHO.
Infection Control: Implementing measures to prevent and treat infectious diseases like malaria and hookworm is crucial, as these contribute significantly to iron deficiency.
Improving Socioeconomic Conditions: Addressing underlying factors like poverty, access to education, and sanitation can help reduce the prevalence of IDA in the long term.

Addressing the Global Burden

While tackling IDA globally requires a multi-pronged approach tailored to regional contexts, focusing resources on the most vulnerable populations and highest-prevalence areas is essential. A combination of nutritional interventions, infectious disease control, and improved healthcare access is the most effective path forward. For more comprehensive insights into global health issues, authoritative sources like the World Health Organization (WHO) and the National Institutes of Health (NIH) provide valuable information and research data.

The Lancet: New study reveals global anemia cases remain persistently high among women and children

Frequently Asked Questions

While prevalence varies, countries with consistently high rates of anemia, driven largely by iron deficiency, include several in Sub-Saharan Africa. Studies from 2019 identified Zambia, Mali, and Burkina Faso as having the highest age-standardized point prevalence rates for anemia globally.

It is more common in certain regions due to a combination of factors, including inadequate dietary iron intake, a higher prevalence of infectious diseases that cause blood loss or inflammation (e.g., malaria, hookworm), and socioeconomic challenges like poverty and limited access to fortified foods or healthcare.

Yes, certain populations are more vulnerable. Young children, pregnant women, and menstruating women are at the highest risk due to their increased iron requirements or blood loss. In developing countries, high fertility rates further exacerbate the risk for women.

If left untreated, it can lead to serious health issues, including heart problems like an enlarged heart or heart failure. In pregnant women, it can cause premature birth or low birth weight, and in children, it can lead to developmental delays.

Malaria contributes to anemia in several ways, including causing hemolysis (the breakdown of red blood cells), which leads to the loss of hemoglobin and iron. The resulting inflammatory response also disrupts iron metabolism and absorption.

Diet alone is often insufficient, especially in regions with high disease burdens and poor nutritional access. While dietary improvements are important, many international health organizations also recommend fortified foods and iron supplementation for vulnerable groups to prevent deficiencies.

Effective interventions include food fortification programs, targeted iron and folic acid supplementation for high-risk groups, and public health campaigns to control parasitic infections and other diseases that worsen iron status.