TITLE:
Definition of Altitude-Adjusted Anaemia Thresholds in the Democratic Republic of Congo: According to WHO 2024 Recommendations
AUTHORS:
Antoine Lufimbo Katawandja, Jimmy Yuma Ilemba, Antoine Sadiki Kishabongo, Philippe Katchunga Bianga
KEYWORDS:
Haemoglobin Thresholds, Altitude, Anaemia, DRC
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.8,
August
13,
2026
ABSTRACT: Problem: In 2025, the World Health Organisation (WHO) revised the haemoglobin thresholds defining anaemia by incorporating more representative global data and contextual adjustments based on age, gender, pregnancy, altitude, smoking, infections and genetics. The objective of this study is to define the thresholds for anemia based on altitude in the major cities of the Democratic Republic of Congo (DRC) using these latest WHO recommendations. Method: We grouped the 26 provinces of the DRC into four regions according to altitude: Region A between 1 and 499 meters, Region B between 500 and 999 meters, Region C between 1000 and 1499 meters, and Region D between 1500 and 1999 meters. Then, considering the new WHO recommendations, we established haemoglobin thresholds for each region to define anaemia, considering age, sex, pregnancy status and altitude. Results: The results show that Region A comprised 9 provinces (34.6%) and did not require any adjustment to the haemoglobin threshold. Region B comprised 12 provinces (46.1%) and required a +0.4 g/dl adjustment to the haemoglobin threshold. Region C comprised 2 provinces (7.6%) and required an adjustment of +0.8 g/dl to the haemoglobin threshold. Finally, Region D comprised 3 provinces (11.5%) and required an adjustment of +1.1 g/dl to the haemoglobin threshold. Conclusion: This study shows that adjusting the haemoglobin threshold defining anaemia according to altitude improves the accuracy of anaemia diagnosis and avoids errors associated with the uniform application of thresholds. Therefore, rigorous implementation of these adjustments is essential for the effective management of populations at risk of anaemia, particularly in very high-altitude regions of the DRC.