MENA Delphi consensus on iron deficiency anemia in infants and young children: screening, management, and prevention strategies

Iron deficiency anemia (IDA) is one of the most prevalent and consequential nutritional disorders affecting infants and young children globally, with profound implications for neuro development and long-term health. Despite its well-documented risks, IDA remains under diagnosed and under treated, particularly in the Middle East and North Africa (MENA) region, where prevalence ranges from 23.2% in the UAE to 72% in Jordan. To address gaps in screening, diagnosis, and management, a multidisciplinary panel of 14 pediatric experts from nine MENA countries convened to develop evidence-based consensus recommendations.

The methodology included a structured literature review, virtual consensus meetings, and iterative Delphi-style voting on 32 evidence-based statements across five domains: (1) prevalence and burden, (2) screening and diagnosis, (3) nutritional prevention, (4) treatment, and (5) public health strategies.

Key recommendations included universal screening at 9-12 months using hemoglobin, CRP, and ferritin; first-line oral iron therapy (3-6 mg/kg/day of elemental iron for 3-6 months); and avoidance of cow's milk before 12 months. The panel also developed a comprehensive algorithm to standardize diagnosis and management across the region. Major barriers identified were underutilized screening practices (85.71% agreement) and insufficient public awareness (92.86% emphasized tailored campaigns). Excessive and early cow's milk consumption was considered a key dietary contributor to IDA, with 84.6% agreement on its role due to low iron content and 69.2% agreement on its inhibitory effects on iron absorption and risk of gastrointestinal blood loss.

This consensus highlights critical interventions, including iron-rich complementary feeding, caregiver education, and referral for refractory cases. By aligning clinical practice with current evidence and regional realities, these consensus recommendations provide a structured framework to reduce the burden of IDA in MENA through early detection, standardized care, and collaborative public health strategies.