Sys Rev Pharm 2020; 11(5): 383 401 A multifaceted review journal in the field of pharmacy E-ISSN 0976-2779 P-ISSN 0975-8453 383 Systematic Review Pharmacy Vol 11, Issue 5, 2020 The Challenges in Eradication of Iron Deficiency Anemia in Developing Countries Yasinta Rakanita 1,2 , Rano K. Sinuraya 1,3 , Eka W. Suradji 4 , Auliya A. Suwantika 1,3 , Mas Rizky A. A. Syamsunarno 5 , Rizky Abdulah 1,3 1 Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Indonesia. 2 Pelita Mas College of Pharmaceutical Science, Palu, Indonesia 3 Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Indonesia. 4 Teluk Bintuni Hospital, Teluk Bintuni Regency, West Papua Province, Indonesia. 5 Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Indonesia. Corresponding Author: Rano K. Sinuraya, MPH. Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM. 21, Jatinangor 45363, Indonesia, Email: r.k.sinuraya@unpad.ac.id Article History: Submitted: 25.02.2020 Revised: 16.04.2020 Accepted: 07.05.2020 ABSTRACT Anemia causes losses of billions of dollars annually in terms of productivity among working women of the reproductive age; it affects both their cognitive and physical performance. In developing countries where many manual labor jobs exist, an iron supplementation program is the first choice for eradicating anemia. However, this program cannot sufficiently meet reduction targets, and this created a polemic among health experts. The purpose of this study was to explore how iron deficiency anemia may be eradicated in developing countries. The results showed that the main challenges for iron anemia deficiency eradication are as follows: low adherence, infection, hidden symptoms, comorbidities from other non- communicable diseases, micronutrient deficiencies, and lack of program monitoring. In terms of low adherence, the side effects of iron supplements become a major factor in taking medication. Conversely, parasites and worms cause most of the high infection cases. Poor access to facilities of healthcare centers are becoming the main factor for the absence of anemia eradication program evaluation in remote areas of developing countries. Therefore, breakthroughs are expected to be developed to reduce anemia significantly. These include increasing patient visits to a healthcare center, diagnosing anemia accurately and intensively, prioritizing infection control, fortifying food, and monitoring iron side effects. Keywords: Anemia, developing country, iron deficiency, women of reproductive age Correspondence: Rano K. Sinuraya Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, University Padjadjaran, JI. Raya Bandung Sumedang K.M. 21, Jatinangor 45363, Indonesia E-mail: r.k.sinuraya@unpad.ac.id DOI: 10.31838/srp.2020.5.55 @Advanced Scientific Research. All rights reserved INTRODUCTION Generally, in the global context, anemia is becoming a public health burden. In 2015, the World Health Organization (WHO) reported that no country succeeded in the Sustainable Development Goals target of anemia reduction. An approximate annual average rate of 5.2% per year occurred from 2012 to 2025. The WHO released a guideline goal was to reduce the prevalence of anemia by 50% by 2025 (1). However, the requires targeted handling. The baseline prevalence data in 2012 indicates that it requires continuous monitoring every year (2). Anemia demonstrates a variety of causes. One of the most common cause is due to a lack of the ability of red blood cells to perform their function to transport oxygen and carbon dioxide in the body (3). Red blood cells contain hemoglobin, composed of heme and globin. In general, the shortage of iron, which is the main raw material for manufacturing hemoglobin, mostly causes anemia (4). The metabolism of iron absorption, distribution, and excretion, as well as role in a human body, can be explained through the field of pharmacology (5). Previous studies already discovered the underlying causes of developing anemia. Such causes include the following: blood loss (i.e., hemorrhage, ) (6), increased demand for blood (i.e., in pregnancy) (7), decreased or low production of red blood cells (8), and hemolysis of red blood cells (i.e., in infection) (9). However, the prevalence of anemia prevalence can be a more complex problem, depending on the economic level (10), education level (11, 12), and culture of certain geographical regions (13). In developing countries with limited resources, these issues may produce more significant effects. The purpose of this study was to conduct a literature review on the challenges of iron supplementation for eradicating iron deficiency anemia in developing countries, especially for women of reproductive age (15 49 years of age) (14). Anemia prevalence in developing countries Anemia is becoming an important issue in developing countries where high anemia incidence rates exist and heavy manual labor occurs. Their cognitive and physical productivity losses are even higher (15). Due to anemia, a developing country loses around $0.232 per capita or 0.057% of its gross domestic product (GDP). Furthermore, South Asian countries experience a $4.2 billion loss in physical productivity. Median total losses (physical and cognitive) are $16.78 per capita, which is 4.05% of the present GDP (16-18). Countries with an anemia prevalence rate of more than 40%, especially among women reproductive of age between the ages of 15 and 49 years old, demonstrate a severe public health burden to provide for healthcare facilities and iron supplementation programs (19). Epidemiological studies about the causes of anemia, especially among pregnant women, are required because of the risk of congenital disabilities and maternal mortality. The anemia cases with prevalence rates of 20% 39.9% are categorized as moderate anemia. Meanwhile, 5% to 19.9% is categorized as mild anemia (20). This classification will help many countries to prioritize their target (21, 22). Anemia is closely related to cognitive development and national productivity (23-25). In