Causes of anemia in rural Sylhet, Bangladesh

Anemia, defined as low hemoglobin concentration in the blood, affects an approximately 500 million non-pregnant women, over 30 million pregnant women, and almost 300 million children around the globe. The World Health Organization estimates that over 50% of anemia is due to iron deficiency and recommends universal iron supplementation in segments of the population where anemia prevalence exceeds 40%.

However, anemia can have many causes, both nutritional (e.g., due to deficiencies in vitamin A, folate or vitamin B-12) and non-nutritional. The latter includes infectious diseases (e.g., malaria, soil-transmitted helminths, tuberculosis), inherited blood disorders (e.g., sickle cell disease, thalassemias); chronic conditions (e.g., advanced kidney diseases, some cancers); or a combination of these factors. In Bangladesh, high anemia prevalence concurrent with low or no iron deficiency has been reported, calling into question whether iron is the primary driver of anemia in this setting.

Furthermore, typical diets in Bangladesh are iron-poor, predicting a high prevalence of iron deficiency, especially among women and children. Recent studies have proposed that high groundwater iron levels may be bioavailable, resulting in reduced iron deficiency in this population. However, the primary causes of anemia in this population remain unclear.

This project aims to:

  • Examine the influence of groundwater iron on anemia and iron deficiency in rural Bangaldesh
  • Examine the etiology of anemia among women and children in rural Bangladesh, considering nutritional and non-nutritional factors

Project team:


  • Thrasher Research Fund
  • Alexander von Humboldt postdoctoral fellowship (2016-2018)
  • Federal Ministry of Education and Research (BMBF) for FAARM

Publications and presentations:

Wendt, A., Brintrup, J., Waid, J. L., Kader, A., Lambrecht, N., & Gabrysch, S. (2023). Thalassemia and hemoglobinopathy prevalence in a community-based sample in Sylhet, Bangladesh. Orphanet Journal of Rare Diseases, 18, 192, 

Wendt, A., Waid, J., Müller-Hauser, A., Kyei, N., Sobhan, S., & Gabrysch, S. (2020). Do Hemoglobin Concentration and Anemia Prevalence Differ Between Capillary and Venous Blood and Between Analysis Methods? Current Developments in Nutrition, 4(Supplement_2), 922-922, doi:10.1093/cdn/nzaa053_127.

Wendt, A. S., Waid, J. L., & Gabrysch, S. (2019). Dietary Factors Moderate the Relation between Groundwater Iron and Anemia in Women and Children in Rural Bangladesh. Curr Dev Nutr, 3(10), nzz093, doi:10.1093/cdn/nzz093.

Wendt, A., Waid, J., & Gabrysch, S. (2019). Etiology of Anemia Among Women and Children in Rural Bangladesh: An Assessment of Nutritional and Non-nutritional Factors (P10-115-19). Current Developments in Nutrition, 3(Supplement_1), doi:10.1093/cdn/nzz034.P10-115-19.