Behind the small and cheerful bodies of children lies a bitter truth that is not always visible to the eye. It is none other than a body that may be lacking oxygen. Not because of breathing difficulties, but because the level of hemoglobin in their blood is too low. Yes, that’s anemia. A silent disease that continues to stalk the future generation, especially in developing countries.

 

This condition is influenced by tiny, invisible parasites that also play their part—intestinal worms. In medical terms, they are known as Soil-Transmitted Helminths (STH). This dangerous combination has long been suspected as a deadly duo that reinforces each other. But is it a fact or a mere assumption?

 

A recent study published by Rahayu Lubis and her research team from Universitas Sumatera Utara titled “Impact of Soil-Transmitted Helminths Infections on Anemia Burden: A Global Analysis of Children Under Five and Reproductive-Age Women” challenges this long-held notion. The team, consisting of Rahayu Lubis, Fauzi Budi Satria, Rasmaliah Rasmaliah, Jemadi Jemadi, Siti Khadijah Nasution, and Rafdzah Ahmad Zaki, conducted a large-scale study involving 187 countries over five years (2015–2019). The researchers delved deeper into the question: do soil-transmitted worm infections directly contribute to the surge in anemia cases? Especially among the two most vulnerable groups—children under five and women of reproductive age.

 

The approach used in this study not only highlights health aspects. It also touches the core of social and economic problems. This study brings us to a more complex reality. Yes, worm infections have indeed been significantly reduced in the past five years, thanks to massive campaigns involving mass drug administration, improved sanitation, and hygiene education.

 

But ironically, anemia prevalence does not show a proportional downward trend. Anemia is not merely a disease; it reflects the fragility of daily life support systems. When the body lacks iron, the consequences are not limited to fatigue or a pale face. In children, anemia can hinder brain development, disrupt behavioral growth, and even steal their future. For women of reproductive age, anemia means high-risk pregnancies, dangerous childbirth, and prolonged fatigue that undermines productivity and quality of life.

 

“All this time, we have been too focused on worms as the main cause of anemia, when in fact, there are much deeper factors: development disparities,” said Rahayu Lubis, framing the paradigm shift that occurred in this study. The researchers no longer see microorganisms as the main enemy, but also policies, poverty, and unequal access to basic resources.

 

The study also reveals something surprising: worm infections do have a statistical relationship with anemia in children. But when examined further, by considering other factors such as the Human Development Index (HDI), access to clean water, and national health service coverage (UHC), the influence of worm infections on anemia becomes blurred—it is no longer dominant. For women, the findings are even more striking: there is no significant relationship between worm infections and their anemia.

 

So, who is the real culprit?

This is where the real story begins. Anemia turns out to be more closely related to poverty, lack of access, and development disparities. In countries with low HDI, children are far more likely to suffer from anemia. Countries whose populations struggle to obtain safe drinking water and proper sanitation also report significantly higher rates of anemia. Even in places with minimal health service coverage, women are trapped in a cycle of anemia without ever knowing the cause.

 

“Anemia is not just about iron deficiency or infection. It is a reflection of who has access and who does not, who is protected by the state and who is left to struggle alone,” said Rahayu with a firm yet reflective tone.

 

Imagine a young mother in a remote village. She might not know what iron is. She might never have had a blood test during her pregnancy. She drinks from the same river used by livestock. She may often feel dizzy but considers it normal. Meanwhile, her child, who runs around every day, appears healthy on the outside but is actually oxygen-deprived. In that cycle, anemia emerges and persists—not just as a disease, but as an intergenerational legacy.

 

The study also emphasizes the importance of effective governance. Countries with good governance are better able to reduce anemia rates. Because in issues like this, the government’s stance toward the underprivileged is not just a matter of budget—it is a matter of life and death, about whether a child can grow optimally or not.

 

“We want to show that improving health infrastructure will not be enough if it is not accompanied by social improvements. Clean water, sanitation, women’s education—these are the determining factors of whether anemia will persist or not,” said Rahayu.

 

Interestingly, although many previous studies cited a direct link between worm infections and anemia, this study presents a new narrative. The difference, according to the researchers, may stem from the ecological method used in this study. So, it’s not that worm infections are unimportant, but on a global scale, the causes of anemia are far more multidimensional and go beyond parasitic infections.

 

The biggest lesson from this research is that health cannot be viewed solely from a medical perspective. It is the product of a complex social system, where clean water, education, income, and women's rights are all part of the diagnosis. When we talk about reducing anemia, we cannot simply talk about iron capsules or deworming medication. We must talk about infrastructure, education, and social justice.

 

This study, published in BMC Public Health, concludes with a powerful message: stop viewing anemia and neglected diseases like worm infections solely as health issues. They are part of a larger narrative about unequal human development. If we want to end anemia, we must build more than just health clinics. We must build hope, systems, and cross-sectoral commitment.

 

The true purpose of research is not merely to find the connection between two diseases. It is to awaken our awareness that behind the statistics, lives are at stake. There are children growing up without enough oxygen in their blood. There are women giving birth in a weakened state. And there is a world that still needs to learn that eradicating anemia is a matter of delivering justice, not just medicine.