Anemia Is a Global Problem for Women and Girls. Cleaner Cooking Fuel May Be an Answer.

Anemia negatively impacts health, quality of life, school performance, and productivity around the world. Indoor air pollution may be an important but under-recognized contributor to the condition.

The most common cause of anemia is low iron in the body, usually from not getting enough iron in the diet. It can also develop because of folate and vitamin B12 deficiencies, heavy menstrual bleeding, and certain diseases. When someone is anemic, they do not produce enough healthy red blood cells to carry oxygen through the body.

Anemia can cause severe tiredness, weakness, and irregular heartbeat. If left untreated, it can cause heart problems, pregnancy complications, and developmental delays in children.

The Worldwide Impact of Anemia

Anyone can be anemic, but it mainly affects women and children. Over 30% of women and almost 40% of children under 5 years old globally have anemia, according to the World Health Organization. Children and pregnant and menstruating women have higher iron needs, making anemia more common in those groups.

In the U.S., an estimated 13% of females over 2 years old have anemia. It is most common in Black women and girls (almost four times as common as in white females).

The greatest anemia burden lies in low- and middle-income countries where iron consumption is lower. Infections are also more common in these countries. Infections lead to inflammation, which can make the body absorb less iron.

A Possible Solution: Controlling Household Air Pollution

The role of inflammation in anemia was a major focus of a new study from researchers at Emory University’s Rollins School of Public Health. The study, published in Nature Communications, investigated the effects of household air pollution on anemia. It looked at common indoor air pollutants and use of cleaner cooking fuels to see how they impacted hemoglobin, the protein in red blood cells that transports oxygen.

The researchers used data from the Household Air Pollution Intervention Network (HAPIN) study. HAPIN is a large randomized controlled trial studying how switching from biomass fuel (like wood or coal) to liquid petroleum gas for cooking affects health in Peru, Guatemala, India, and Rwanda.

“Previous observational studies had found an association between air pollution and anemia, but no intervention studies had been done to evaluate whether reducing exposure to air pollution would affect hemoglobin concentrations or the risk of anemia,” says Sheela Sinharoy, PhD, assistant professor of global health and the study’s lead author. “We wanted to see whether a cleaner cooking intervention that reduced exposures to air pollution could be an effective approach for reducing anemia in women of reproductive age.”

They found that women who switched to using liquid petroleum gas for cooking had higher hemoglobin levels than those using biomass fuel. This reveals that limiting indoor air pollution could help prevent anemia in low- and middle-income countries.

What This Means

“Because anemia is multi-factorial, we know that one single approach will never solve the whole problem,” says Sinharoy. “However, our results tell us that cleaner cooking interventions could be one component of a multi-sectoral anemia reduction strategy, alongside nutritional interventions and other environmental interventions like improved water, sanitation, and hygiene to reduce infections.”

Dietary changes to increase iron consumption remain the most effective way to treat anemia for individuals. But controlling household air pollution by cooking with cleaner fuel could be a great tool to prevent anemia across populations.

“We hope that our findings will provide additional scientific justification for programs and policies to reduce exposures to household air pollution among women of reproductive age,” says Sinharoy.