Current Trends Declining Anemia Prevalence among Children
Enrolled in Public Nutrition and Health Programs -- Selected
States, 1975-1985
The Pediatric Nutrition Surveillance System (PNSS) was
established
by CDC in 1974 to monitor the growth and hematologic status of
children from low-income families participating in such programs as
the Special Supplemental Food Program for Women, Infants, and
Children
(WIC)*; Early Periodic Screening, Detection, and Treatment; and
publicly funded maternal- and child-health clinics. The
hematologic
data collected since 1975 from the states participating in PNSS
have
demonstrated a steady decline in the prevalence of childhood anemia
(1,2).
The number of states participating in the surveillance system
has
increased from five in 1974 to 34 in 1986. Since this changing
composition could have influenced the observed anemia trend, data
from
six states (Arizona, Louisiana, Kentucky, Montana, Oregon, and
Tennessee) that have consistently participated in the PNSS since
1975
were analyzed. In these analyses, the following age-specific
hemoglobin (Hgb) and hematocrit (Hct) levels were used as cutpoints
to
define anemia: age 6-23 months, Hgb less than 10.3 gm/dl or Hct
less
than 31%; age 24-59 months, Hgb less than 10.6 gm/dl or Hct less
than
32%; age 60-83 months, Hgb less than 11.0 gm/dl or Hct less than
33%.
These cutpoints, which are 0.6 gm/dl Hgb or 2% Hct lower than the
commonly used clinical criteria (3), were chosen to avoid inclusion
of
children with borderline anemia.
Between 1975 and 1985, data on 1,680,740 Hgb or Hct
measurements
obtained from 499,759 children aged 6 months to 5 years were
reported
from the six states. The majority (83%) of these measurements were
from children participating in WIC programs. Overall, the
prevalence
of anemia declined from 7.8% in 1975 to 2.9% in 1985 (Figure 1).
Age-specific analysis using 6-month age intervals demonstrated that
the decline occurred among all age groups. In general, anemia
prevalences were lower among children seen at follow-up visits than
among children of the same age seen for initial visits, although
both
prevalences declined over the decade.
Reported by Office of Nutrition Svcs, Arizona Dept of Health Svcs;
Nutrition Br, Dept of Health Svcs, Div of Maternal and Child
Health,
Kentucky Cabinet of Human Resources; Nutrition Section, Office of
Preventive and Public Health Svcs, Louisiana Dept of Health and
Human
Resources; Nutrition/WIC, Clinical Programs Bureau, Health Sciences
and Medical Facilities Div, Montana State Dept of Health and
Environmental Sciences; WIC Program, Oregon State Health Div;
Nutrition and Supplemental Food Programs, Tennessee Dept of Health
and
Environment; Div of Nutrition, Center for Health Promotion and
Education, CDC.
Editorial Note
Editorial Note: The prevalence of anemia among children from
lower-income families residing in the six selected states with
consistent participation in the PNSS declined by 60% between 1975
and
1985. Because of the magnitude and consistency of the decline, and
the relatively constant family income criteria used for enrollment
in
WIC and other public health programs, the decrease in anemia is
unlikely to be related to changes in the socioeconomic background
of
children included in the PNSS. Instead, the changes are probably
related to improvements in iron nutrition during infancy and early
childhood, which have resulted in lower levels of iron deficiency
anemia, the most common form of childhood anemia in the United
States
(4). In view of the decline in anemia prevalence noted at initial
screening visits, at least some of the decline appears independent
of
participation in public health programs. However, the even lower
prevalence of anemia observed at follow-up visits suggests that WIC
and other public programs also play a role in the decrease of
anemia
prevalence (5).
References
Trowbridge FL. Malnutrition in industrialized North America.
In: Malnutrition: determinants and consequences. New York:
Alan R. Liss, 1984:45-58.
Committee on Nutrition American Academy of Pediatrics.
Pediatric
nutrition handbook. 2nd ed. Elk Grove Village, Illinois:
American Academy of Pediatrics, 1985.
Dallman PR, Yip R, Johnson C. Prevalence and causes of anemia
in
the United States, 1976 to 1980. Am J Clin Nutr
1984;39:437-45.
Vazquez-Seoane P, Windom R, Pearson HA. Disappearance of
iron-deficiency anemia in a high-risk infant population given
supplemental iron. N Engl J Med 1985;313:1239-40.
*The WIC program, designed to provide nutrition education and
specific
foods to children up to age 5, lactating mothers, and pregnant and
postpartum women, is closely associated with health-care delivery
services.
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