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.

A comprehensive literature search was systematically conducted across the Web of Science (WoS), Scopus, and PubMed databases on 17 ^th 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 guidelines ^{16, 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).

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 globin ⁶⁰ (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.

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.