The Risk of Anemia in Pediatric Immigrant and Refugee Populations and its Association with Immigration Status: A Systematic Review & Meta-Analysis

Abstract

Introduction: This systematic review aimed to assess the prevalence of anemia among refugee, immigrant, and asylum-seeking children, with a focus on identifying regional differences, types of anemia, and the impact of immigration status. Methods: A comprehensive literature search was conducted across multiple databases, identifying 46 eligible studies from an initial pool of 3,642 records. Study designs included cross-sectional, retrospective, cohort, and mixed methods approaches, with participants aged 0.5 to 18 years old. Data on anemia prevalence, diagnostic criteria, anthropometric measures, and comorbidities were extracted and analyzed. Results: The pooled prevalence of anemia was 28% (95% CI: 23-32%) across 52 studies, with significant heterogeneity (I² = 99%). Among children aged ≤6 years, anemia prevalence was 37% (95% CI: 30-43%), while for those >6 years, it was 22% (95% CI: 17-26%). Refugees and asylum seekers had a higher anemia prevalence (29%, 95% CI: 24-34%) compared to immigrant populations (18%, 95% CI: 7-29%). The most common type of anemia was iron deficiency, ranging from 4% to 64.9%, with microcytic anemia observed in 58.5% of cases. Stunting, wasting, and comorbidities such as malnutrition, infections, and parasitic diseases were also prevalent. Conclusion: Tailored programs should address both nutritional deficiencies and comorbidities, with a focus on improving access to healthcare, enhancing education about anemia prevention, and ensuring culturally appropriate care. Policymakers must consider immigration status and regional disparities to develop comprehensive strategies that mitigate health risks and promote the long-term well-being of marginalized communities.