Keywords
Iron Deficiency Anemia (IDA), Plant-based therapies, Phytochemicals, Hematological indices, East Africa
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Siida R, Fasogbon IV, Musyoka AM et al. Plant-based management of Iron Deficiency Anemia (IDA) in East Africa community: a systematic review [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:931 (https://doi.org/10.12688/f1000research.169163.1)
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Systematic Review
Plant-based management of Iron Deficiency Anemia (IDA) in East Africa community: a systematic review
[version 1; peer review: awaiting peer review]
PUBLISHED 16 Sep 2025
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Abstract
Corresponding author:
Angela Mumbua Musyoka
Competing interests:
No competing interests were disclosed.
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The author(s) declared that no grants were involved in supporting this work.
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© 2025 Siida R et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Siida R, Fasogbon IV, Musyoka AM et al. Plant-based management of Iron Deficiency Anemia (IDA) in East Africa community: a systematic review [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:931 (https://doi.org/10.12688/f1000research.169163.1)
First published: 16 Sep 2025, 14:931 (https://doi.org/10.12688/f1000research.169163.1)
Latest published: 16 Sep 2025, 14:931 (https://doi.org/10.12688/f1000research.169163.1)
Introduction
Anemia is a blood disorder characterized by decreased haemoglobin (Hb) concentration. It is defined as haemoglobin levels <13.0 g/dL in men and <12.0 g/dL in women.1 Other factors that can alter an individual Hb level include ethnicity and physiological status.2 Iron deficiency anemia (IDA) is one of the most common causes of anemia. It occurs when there is insufficient iron in the body to produce red blood cells, an important cellular component of blood for the distribution of oxygen to tissues. Sources of iron include protein-rich diets such as fish and meat.3 Studies have shown that IDA accounts for about 50% of anemia in children.4 Among other haematological disorders, anemia is one of the biggest causes of disability worldwide and a major public health concern.5 Recent statistics have shown a progressive increase in the prevalence of anemia in developed and developing countries in the past decade, especially in sub-Sahara Africa with children accounting for 61.4%.6,7
An estimate from the United Nations revealed that East Africa contributes about 7% of the world population and 21.4% of children in this population suffer from IDA, probably due to the socio-economic status of people living in this region.8 According to the 2016 Uganda Demographic and Health Survey (UDHS), the prevalence of iron deficiency anaemia increased from 23% in 2011 to 53% in women of reproductive age and 49% in children aged 6-59 months.9 In Kenya, 69% of children under 5 years old bear the brunt of iron deficiency anemia.10 Sunguya et al.11 reported that the prevalence of IDA among pregnant women in Tanzania has risen to 57% thus the need for immediate intervention.
Several pharmacological interventions have been employed in the management of IDA, especially in East Africa. There is increasing scientific evidence that interventions with medicinal plants have gained global attention in recent years.12 Plant sources are known to contain phytochemicals with proven pharmacological efficacies in disease conditions. These sources are relatively available and affordable in low and middle-income countries.
Given the discrepancies in recent published studies regarding plant-based management of IDA, we carried out a systematic review. This review aimed to assess different published studies on plant-based management of iron deficiency anaemia (IDA) in the East African community.
Materials and methods
A comprehensive literature search was systematically conducted across the Web of Science (WoS), Scopus, and PubMed databases on 17th July 2024. The search employed the following terms: Plant, management, “iron deficiency anemia”, and “East Africa.” Boolean operators (AND/OR/NOT), alternative terms, and various delimiters such as quotation marks, parentheses, wildcards, and asterisks (*) were utilized to create the search strategy outlined in Table 1, as reported by Fasogbon et al.13–15 The search was restricted to peer-reviewed articles published in English. The paper selection process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines16,17 and followed the inclusion and exclusion criteria presented in Table 2. The risk of bias was assessed as shown in Figure 5 (a-b).
Table 1. Search strategies.
Figure 1. PRISMA flow chart for study selection.
Figure 2. Biochemical techniques used for the extraction of the plants extracts.
Figure 3. Vitamin, mineral, and carbohydrates compositions of the plants used in the management of anemia.
Figure 4. Phytochemical constituents of the plants used in the management of anemia.
(a) A revised tool to assess the Quality in randomized trials (RoB 2).
(b) SYRCLE’s risk of bias tool for animal studies.
Figure 5. (a-b): Risk of bias analysis of the included articles.
Results
Search results
The Web of Science database search produced 50 articles, Scopus yielded 212, and PubMed identified 30, bringing the total to 292 articles across the three databases. The search results from each database were then exported and imported into Rayyan, a platform specifically designed for systematic review processes, where they were screened based on the inclusion and exclusion criteria.18 On the platform, 78 duplicate articles were removed. The remaining 214 records were initially screened by evaluating their titles and abstracts, which led to the exclusion of 153 articles. Following a more detailed full-text review, an additional 30 articles were excluded for not meeting the inclusion criteria. In the end, 30 articles were included in the study after passing the eligibility criteria and quality assessment ( Figure 1).
Table 3 above outlines the mechanisms of action, effects on anemia-related parameters, plants used, plant parts studied, duration of treatment, and geographic origin of the studies.
Table 3. Mechanisms of action of the plant and parts used in the study.
| Mechanism of IDA treatment/Amelioration | Effect on parameters | Plant | Part of plant | Duration | Country | Reference |
|---|---|---|---|---|---|---|
| Not specified | Increase Hb and pcv, at 2g/dl and 4g/dl, MCV, MCH, MCHC and RCC insignificant at 2g/dl and significant at 4g/dl | Emblic myrobalan | Fruits | 60 days | Pakistan | 19 |
| Mixture of honey, dates, and amla (Indian gooseberry) | The combination of honey, dates, and amla boosts hemoglobin levels, increases RBC count, and reduces fatigue, contributing to improved overall vitality | Phyllanthus emblica, Indian gooseberry | Fruits | 3 months | India | 20 |
| Increased Hemoglobin Levels, increase in Vitamin C levels | significant increase in hemoglobin levels, mean levels of Vitamin l and iron level | Phyllanthus emblica, Cucurbita pepo,Saccharum officinarum | Amla fruit, Jaggery no part specified, Pumpkin leaves | 60 days | India | 21 |
| Reducing phytate boosts iron bioavailability, and adding Moringa oleifera leaves enhances absorption and nutrition | Not specified | Moringa oleifera | Leaves | 12 weeks | Switzerland | 22 |
| Increased iron intake from Hibiscus sabdariffa meals is supported by vitamin C enhancing absorption | Not specified | Microalgae/Schizochytrium spp | Not specific | xxxx | Ghana | 23 |
| Not specified | Lacto-ovo vegetarians and vegans had lower hemoglobin, erythrocyte, and hematocrit levels, with increased RDW, compared to omnivores | Hibiscus sabdariffa | Not specific | Spain | 24 | |
| Treatment of IDA in restoration of hematopoiesis by adding decoction of the plant’s aerial parts | Effect on erythrocytes (red blood cells), platelets and leukocytes (white blood cells) | Urtica chamaedroydes | Leaves, stems, and flowers | 34 days | Mexico | 25 |
| Through the proliferation of hematopoietic stem cells | Increase RBC, Hemoglobin, Hematocrit decreased μ-RBC, & MRBC), with no significant changes in Platelets | Angelica gigas | Roots and rhizomes | 7 days | South Korea | 26 |
| Not specified | Haemoglobin, packed cell volume and red blood cells | Sorghum bicolor | Aqueous Moench stem bark | 6 weeks | Nigeria | 27 |
| Not specified | RBC count, hemoglobin, and hematocrit | Ajwa Date | Fruits | Not specify | Indonesia | 28 |
| Iron Supplementation, Improved Iron Storage, and Prevention of Iron Deficiency | RBC count, hemoglobin, and hematocrit | Caulis | Caulis extract | 42 days | China | 29 |
| Iron Supplement Improved Iron Storage & Prevention of Iron Deficiency | Hemoglobin (Hgb), and Anemia Prevalence | Lentils | Seeds | 4 months | Bangladesh | 30 |
| Not specified | Hemoglobin, Ferritin, Erythrocyte | Flacourtia indica | Leaf | 3 months | India | 31 |
| Not specified | Hematocrit, MCV, MCH, MCHC, and RDW | Moringa oleifera | Ethanol Leaf extract | 3 weeks | Indonesia | 32 |
| Anti-oxidative action of chlorophyll is as a hydrogen donor to break the chain reaction, due to the porphyrin in its chemical structure | CSA increased the levels of Hb, serum iron and serum ferritin | Pearl millet (Pennisetum americanam) | Seeds | 30 days | India | 33 |
| Increase in iron bioavailability | Increased Hb,serum iron and serum ferritin levels | Telfairia occidentalis | Leaves and seeds | 10 days | United Kingdom | 34 |
| Not included | Iron and Hb determined | Mangifera indica L (mango) | Stem bark & leaves | 14 days | Nigeria | 35 |
| Effects of both iron and phytochemicals of the extract induced boost RBC indices in the iron deficient rats | Increased Hb, concentration, PCV volume; RBC, MCV, & WBC | Plant based diet | Not specified | Not specify | Indonesia | 36 |
| Not specified | Increased Hb, concentration, PCV volume; RBC, MCV, & WBC | Angelica sinensis | Dry roots of A. sinensis (Polysaccharide) | 14 days | China | 37 |
| ASP inhibit hepcidin expression in vivo by stimulating erythropoietin secretion and interrupting two other major pathways of hepcidin regulation | Improves on haematological factors | Punica granatum L (Pomegranate) | Fruits | 5 hours | India | 38 |
| Increased iron bioavailability in the presence of PJ and Other organic acids, sugars and polyphenols present in PJ might as well have a role in modulation of iron bioavailability | Pomegranate Juice Improves Iron Uptake and Assimilation in Caco-2 Cells. PJ Enhances Iron Uptake and Assimilation in HepG2 Cells | Moon dal washed (MDW), red lentils (RL), chickpeas (CP), green lentils whole (GLW), and yellow split peas (YSP) | Legume seed | Not specified | Canada | 39 |
| Increased hepcidin mRNA correlates with bioavailable iron, while reduced DMT1 and TfR1 reflect decreased iron uptake | Iron extracted from defatted microalgae seemed to be effective in alleviating moderate anemia | Defatted Nannochloropsis oceanica (DGM) (defatted microalgae) | Whole plant | 10 weeks | United stated | 40 |
| The macro and micronutrient content in Moringa powder is thought to work synergistically to increase Hb levels in research subjects significantly | Supplement (P2) increased hemoglobin level | Moringa (Moringa oleifera) | Leaves (capsules) | 60 days | Indonesia | 41 |
| ASP significantly down-regulates JAK1 expression, similar to its effect on phospho-JAK1, while rhEPO has a stronger inhibitory effect on JAK1 and its phosphorylation | Increased, RBC, platelets, hematocrit, MCV, MCH & MCHC | Angelica sinensis | Polysaccharides from Angelica sinensis | 16 days | China | 42 |
| The increase in hemoglobin and erythrocytes in this study is attributed to the presence of iron found in moringa leaves | Increase in hemoglobin and erythrocyte levels | Moringa tree (Moringa oleifera) | Leaves | 15 days | Indonesia | 43 |
| The mechanism of antioxidative action of chlorophyll is as a hydrogen donor to break the chain reaction, due to the porphyrin in its chemical structure | CSA increased the levels of Hb, serum iron and serum ferritin | Sauropus androgynus (L) Merr (katuk) | Leaves | 37 days | Indonesia | 44 |
| Increase in iron bioavailability | Increased Hb, serum iron and serum ferritin levels | Low-Phytic Acid Beans and Biofortified Beans | Seeds | 14 days (double meal) | Rwanda | 45 |
Mechanisms of action and impact on anemia parameters
Various plants and plant-based combinations have been studied for their roles in increasing hemoglobin levels, red blood cell counts, hematocrit, and other indices of blood health. From the table above, some plants show mechanisms related to enhanced iron absorption or bioavailability, antioxidant action, or stimulation of hematopoiesis. Examples are Moringa oleifera, Angelica gigas, and Telfairia occidentalis. Some other plants, such as Emblic myrobalan and Phyllanthus emblica, have significantly improved hematological parameters after specific durations.
Plant parts and study locations
Commonly used plant parts include fruits, leaves, roots, seeds, and bark. The studies span multiple countries, including India, Pakistan, Indonesia, China, Nigeria, Rwanda, and Ghana, highlighting the global interest in plant-based anemia management. Some studies explored combinations of plant products, such as honey, dates, and amla, which showed synergistic effects in boosting Hb levels and alleviating fatigue.
Duration of intervention and phytochemical contributions
Treatment durations vary widely, from as short as 5 hours (Punica granatum) to a few weeks (Moringa oleifera), and several months (lentils). These variations emphasize the need to standardize treatment protocols for better comparison and effectiveness. From the table, specific phytocompounds, such as chlorophyll, polyphenols, and vitamin C, contribute to increased iron bioavailability and hematological improvements.
Key: Macro-erythrocytes (MRBC), Micro-erythrocytes (μRBC), PCV, packed cell, RBC, red blood, MCV: mean corpuscular volume, WBc, MCH, mean corpuscular hemoglobin MCHC.
Biochemical techniques used for the extraction of the plants extracts
Figure 2 presents the biochemical techniques used for the extraction of plant extracts studied in the systematic review. The chart highlights that a significant portion of the studies utilized HPLC, which accounts for the largest percentage (17.65%). HPGC, GSMC, and phytate assay follow as the second most common method (11.76%). Common solvents of extraction are water (aqueous), ethanol, methanol, and hexane. The aqueous method is favored due to its simplicity, cost-effectiveness, and suitability for water-soluble polar compounds like flavonoids and polyphenols.46 Ethanol is widely used for its ability to extract both polar and non-polar compounds, making it versatile for isolating a range of bioactive phytochemicals.47 The choice of extraction method influences the types of bioactive compounds isolated and their subsequent effectiveness in treating iron deficiency anemia. For example, while aqueous extraction might favor compounds with direct iron bioavailability enhancement properties, ethanolic and methanolic methods may yield a wider variety of bioactives, including those with antioxidant and hematopoietic properties. The prevalence of aqueous and ethanolic extractions indicates a preference for techniques that are more feasible in low-resource settings, aligning with the focus on plant-based therapies in developing regions.46
Vitamin, mineral, and carbohydrates compositions of the plants used in the management of anemia
Figure 3 illustrates the vitamin and mineral compositions of the plants used in the management of anemia. Iron (36%) is the most prominent mineral highlighted, reflecting its direct role in addressing iron deficiency anemia (IDA). This is expected since IDA arises from insufficient iron required for hemoglobin synthesis. Vitamin C (20%) appears frequently as a vital nutrient. Its role in enhancing iron absorption, particularly from plant-based sources (non-heme iron), highlights its importance in these therapies. Vitamin A (12%) was the second most abundant vitamin. Vitamin A is noted for its antioxidant potential48 which contributes to hematopoiesis. Folic acid (4%) is also notable in the chart, as it supports red blood cell formation, highlighting its relevance in anemia management. The chart in Figure 3 highlights the multidimensional approach of plant-based management, where the synergy of vitamins and minerals aids not only in addressing iron deficiency but also in improving general nutritional status and hematopoiesis. Notably, plants with high iron content combined with vitamin C are particularly effective, as vitamin C mitigates inhibitors of iron absorption, such as phytates and tannins.49
Phytochemical constituents of the plants used in the management of anemia
Figure 4 provides the summary of the phytochemical constituents of the plants used in the management of anemia, highlighting the compounds responsible for therapeutic effects. The phytochemical constituents’ range was: Flavonoids>Saponins>Phenolic Compounds> Alkaloids>Others.
Flavonoids (26%) dominate the chart. Flavonoids are known for their antioxidant properties and ability to enhance iron bioavailability. They can chelate free iron, reducing oxidative stress while also protecting erythrocytes from damage.50 Saponins (11%) are bioactive compounds that may stimulate erythropoiesis (red blood cell production) and improve gut health, aiding in the absorption of iron and other nutrients.49 Phenolic compounds (10%) contribute to antioxidant activity, protecting red blood cells from oxidative damage and supporting the overall health of hematopoietic cells. They also enhance the bioavailability of iron in some situations.51 Alkaloids (10%) are associated with hematopoietic activity and may stimulate red blood cell production, making them valuable in combating anemia. Others are steroids, terpenes, tannins, and glycosides, which are potentially beneficial in synergistic interactions with the primary phytochemicals. The high presence of flavonoids and phenolic compounds suggests a focus on protecting red blood cells and hematopoietic tissues from oxidative stress, a common challenge in anemia. While tannins can inhibit non-heme iron absorption, their interaction with other phytochemicals (e.g., flavonoids and phenolics) may mitigate this effect. Thus, the combined presence of diverse phytochemicals points to the potential for synergistic effects, where compounds work together to enhance therapeutic efficacy, including improving gut health, reducing inflammation, and stimulating red blood cell production.
Discussion
After eligibility screening, only 30 studies from the 292 results of the first literature search were included in the qualitative analysis. Furthermore, there is still a significant amount of information lacking, as seen by the yearly trend of ethnobotanical research on plants used to treat anemia. Since its start, few anemia-related ethnobotanical investigations have been done in East Africa. On the other hand, we have the most ethnobotanical research locally documented in East Africa. Africa has a rich cultural heritage, but there are still more areas to investigate to close the knowledge gap. There is a large probability that other plants utilized for anemia still need to be documented within the African region.
Iron deficiency anemia (IDA) is a condition where the body lacks sufficient iron to produce hemoglobin, a protein in red blood cells that transports oxygen. The pharmacological benefits of bioactive chemicals found in traditionally used plants on iron deficiency anemia have been shown in several research.52 Hematological indices, including hemoglobin, hematocrit, red blood cell (RBC), mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH), were used to assess the anti-anemic activity of the plants under study, in particular Telfairia occidentalis. In an experimental study conducted on albino rats, it was found that the ethanol leaf extract of Telfairia occidentalis induced regeneration of RBC, hematocrit, hemoglobin, MCV, and MCH (Cotoraci et al., 2021). Furthermore, Telfairia occidentalis leaf raised PCV levels in a trial on antisickling in sickle cell anemia patients.53
According to another study, the main nutrient for spinal cord hematopoiesis is the particular iron found in moringa leaves.54 Similarly, Moringa leaves’ protein and amino acid content function as hematopoietic growth agents. High levels of protein and amino acids, which are essential for controlling blood cell differentiation and proliferation, were reported in its leaves. Additionally, the body absorbs iron more readily due to the vitamin C in Moringa leaf extract and other plants.55 Its potential effects on the expression of liver hepcidin mRNA expression are suggested by the finding that dietary iron from plants was more effective than ferric citrate in curing iron deficiency in male Wistar rats in a study conducted.52,56
The biochemical techniques used for the extraction of plants in this review revealed that HPLC and GSMC form the bulk of the percentage of techniques used. The choice of a quick and accurate technique to measure the quantity of iron in plant tissues and fluids is a major technological challenge for assessing iron insufficiency in plants. As a precise instrument, HPLC can be used to separate complicated biological samples or synthetic chemicals, analyze organic molecules, confirm medicine authenticity, provide quantitative data, monitor the course of disease therapy, and discover contaminants and degradants in raw materials and final products.57 This makes HPLC the most reliable method for the extraction of plant products used in the treatment and management of IDA. Studies have also shown that the iron status of plants under normal growth conditions can be accurately and simply analyzed utilizing an HPLC-based technique.58
Among the number of vitamins and minerals identified in works of literature used for this review, Iron constitutes about 36%. IDA can be seen in conditions such as hemorrhage, prolonged menstruation, hookworm infections, and inadequate consumption iron-rich diet.59 However, other disease conditions can also prevent iron from being absorbed into the body. Heme (Iron) is a key component of hemoglobin, the oxygen-carrying protein that gives the red blood cell its reddish color. The binding affinity of iron to the protein globin enhances erythropoiesis and the oxygen-carrying capacity in red blood cells. IDA occurs when there is insufficient iron to bind with globin60 (Obeagu and Obeagu, 2025). Medicinal plants within East Africa have been proven to increase red cell production due to their high iron content.
Phytochemicals present in these plants reveal their anti-inflammatory and antioxidant properties in the management and treatment of IDA within countries in East Africa. A study has shown that flavonoids can control iron absorption and homeostasis, so they may be useful in the treatment of IDA.61 Additionally, flavonoids can be utilized to improve red blood cell indices in conjunction with iron supplementation. Also, by controlling the expression and activity of proteins that govern iron uptake and metabolism, flavonoids can have an impact on iron homeostasis and regulate red blood cell production.62 Tannin and saponins are active ingredients of secondary metabolites that are recognized to provide several health benefits, including their antioxidant and antibacterial properties.63 These properties can also prevent disease conditions that can result in IDA and improve red blood cell indices.
Conclusion
Thirty screened ethnobotanical articles that documented the use of medicinal plants for the treatment of IDA within the East African region were collected for this systematic review. An increase in traditional medicine research has noted for decades. However, more scientific investigation is required for medicinal plants that are used for treatment and management of iron deficiency anemia. Ethnobotanical research on IDA is still lacking in some East African regions. The different methods of extraction, minerals and vitamins as well phytochemicals of medicinal plants used to treat IDA in East Africa was demonstrated by this systematic review. To ascertain and confirm the safety and effectiveness of these medicinal plants in treating IDA in the general population, pharmacological and toxicological research is still required. Our current review will direct future researchers to examine unexplored medicinal plants in detail and evaluate their characteristics, focusing on human toxicity and safety.
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Siida R, Fasogbon IV, Musyoka AM et al. Plant-based management of Iron Deficiency Anemia (IDA) in East Africa community: a systematic review [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:931 (https://doi.org/10.12688/f1000research.169163.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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