Iron deficiency anemia among women and children in Saudi Arabia: A clinical burden analysis using laboratory surveillance and literature review (2014–2024)

Abstract: BACKGROUND: Iron deficiency anemia (IDA) represents a significant public health challenge worldwide, yet comprehensive epidemiological data from Saudi Arabia integrating clinical surveillance with population-based evidence remain limited. OBJECTIVES: This study aimed to quantify the clinical burden of IDA across demographic groups in Saudi Arabia using laboratory surveillance data, identify key risk factors through literature synthesis, analyze temporal trends from 1990 to 2024, and examine regional variations to inform Vision 2030 health priorities. MATERIALS AND METHODS: We conducted a two-stream study comprising: (1) a secondary analysis of laboratory-based surveillance data from Al Borg Diagnostics Laboratories, including 420,956 individuals tested between January 2014 and February 2024 across all 13 administrative regions, and (2) a narrative review of 14 peer-reviewed epidemiological studies supplemented with WHO Global Health Observatory and Global Burden of Disease Study 2021 data. Iron deficiency (ID) was defined as serum ferritin <30 ng/mL, while IDA was defined as hemoglobin below sex-specific thresholds with concurrent ID. Descriptive statistics and Chi-square tests were performed for laboratory data. Risk factors were extracted from multivariate analyses in reviewed studies. RESULTS: Laboratory surveillance findings: Among 420,956 individuals seeking diagnostic services, IDA prevalence was 19.8%, with nonanemic ID affecting an additional 23.7%, yielding a combined ID prevalence of 43.5%. Women constituted 93% of all iron-deficient cases. Significant regional variation was observed, ranging from 28% in Al-Jouf to 42% in the Makkah region ( P < 0.001). Among children <12 years tested (representing clinically suspected cases), 100% had anemia with 45% meeting IDA criteria, indicating extreme selection bias toward symptomatic presentations. Literature review findings: Population-based studies documented IDA prevalence of 49% among infants aged 6–24 months in primary care settings and 40% among women of reproductive age in community-based sampling. WHO national estimates indicated 43.7% prevalence in women of reproductive age and 45.5% in pregnant women. Key risk factors identified across studies included family history of IDA (adjusted odds ratio [OR] 2.91, 95% confidence interval [CI] 1.78–4.76), insufficient iron intake (OR 7.39, 95% CI 1.45–37.57), infrequent meat consumption (OR 1.54–7.70), and short birth intervals (OR 2.23, 95% CI 1.20–4.41). Global Burden of Disease 2021 data demonstrated a 44.5% decline in age-standardized disability burden from dietary ID between 1990 and 2021. CONCLUSIONS: IDA remains an important public health problem in Saudi Arabia, particularly affecting women of reproductive age and infants. The 93% female predominance in clinical samples and substantial regional disparities (28%–42%) necessitate targeted interventions aligned with Saudi Vision 2030 Quality of Life Program objectives, specifically key performance indicators for maternal and child health screening coverage and chronic disease prevention. Strengthening primary care screening, dietary education programs, and iron supplementation initiatives should be prioritized.