Effect of Ayurvedic Interventions on Iron Deficiency Anemia in India: A Systematic Review and Network Meta-Analysis.

Background: India bears a heavy burden of iron deficiency anemia (IDA), affecting nearly 50% of the population and contributing to adverse pregnancy outcomes, accounting for 20% of maternal deaths. While IDA continues to be a major health issue in India, there is a lack of comparative data on the efficacy of Ayurvedic treatments. This review aims to fill this evidence gap by systematically evaluating and ranking the efficacy of different Ayurvedic treatments for IDA using network meta-analysis (NMA). Methods: A systematic search was undertaken on May 1, 2024 using MEDLINE (via PubMed), Scopus, ScienceDirect, AYUSH Research Portal, and Google Scholar to locate randomized controlled trial (RCTs) evaluating interventions and their impact on hemoglobin (Hb) and serum ferritin. We conducted a random-effects NMA using a frequentist framework to estimate the mean difference (MD) and 95% confidence intervals (CIs) for the effects of interventions on outcomes, accounting for heterogeneity (I²). Results: Nineteen RCTs, comprising 2,121 individuals, assessed 26 different treatments for IDA and met the eligibility criteria. Results from the reference-based forest plots of the sensitivity analysis and corresponding P-scores revealed that both Sarva-Jvara-Hara-Lauha (SJHL) and Pippalyadi Yoga demonstrated statistically significant improvements in Hb levels, with MDs of 1.82 g/dL (95% CI: 0.66-2.98) and 1.45 g/dL (95% CI: 1.21-1.69), respectively. Among the interventions, Bibhitakadi Vatak demonstrated strong effectiveness in raising serum ferritin levels (MD: 3.87 ng/mL; 95% CI: -13.32-21.06). Conclusion: SJHL and Bibhitakadi Vatak were found to be the most effective strategies for treating IDA. Additional research is needed to substantiate these findings and assess their wider impact on public health. Trial Registration: PROSPERO registration number CRD42024541803.