Abstract
BackgroundA Demographic and Family Health Survey (ENDES, for Encuesta Demográfica y de Salud Familiar in Spanish) is carried out annually in Peru. Based on it, the anemia prevalence was 43.6% in 2016 and 43.8% in 2017 using the WHO cutoff value of 11 g/dL and the altitude-correction equation.ObjectiveTo assess factors contributing to anemia and to determine its prevalence in Peruvian children 6 to 35 months old.MethodsWe used the MEASURE DHS-based ENDES survey to obtain representative data for11364 children from 6 to 35 months old on hemoglobin and health determinants. To evaluate normal hemoglobin levels, we used the original WHO criterion of the 5th percentile in children without chronic malnutrition and then applied it to the overall population. Relationships between hemoglobin and altitude levels, usage of cleaning methods to sanitize water safe to drink, usage of solid fuels and poverty status were tested using methodology for complex survey data. Percentile curves were made for altitude intervals by plotting hemoglobin compared to age. The new anemia rates are presented in graphs by Peruvian political regions according to the degree of public health significance.ResultsHemoglobin increased as age and altitude of residence increased. Using the 5th percentile, anemia prevalence was 7.3% in 2016 and 2017. Children from low altitudes had higher anemia prevalence (8.5%) than those from high altitudes (1.2%, p<0.0001). In the rainforest area of Peru, anemia prevalence was highest (13.5%), while in the highlands it was lowest (3.3%, p<0.0001). With access to safe drinking water and without chronic malnutrition, anemia rates could be reduced in the rainforest by 45% and 33%, respectively.ConclusionAnemia prevalence in Peruvian children from 6 to 35 months old was 7.3% in 2016 and 2017.
Highlights
In 1959 the World Health Organization (WHO) issued the first guidelines for anemia, defining it as hemoglobin (Hb) levels under 10.8–11.5 g/dL for 0.6 to 4-year-old children without acknowledging the arbitrariness of such values [1]
While seemingly trivial, determining the factors contributing to anemia, and assessing the success of any preventive program depends on the ability to diagnose anemia itself
A correction formula has been implemented to more precisely assess hemoglobin levels for children residing at high altitude as compared with those living at sea level
Summary
In 1959 the World Health Organization (WHO) issued the first guidelines for anemia, defining it as hemoglobin (Hb) levels under 10.8–11.5 g/dL for 0.6 to 4-year-old children without acknowledging the arbitrariness of such values [1]. Intended to establish an easy and unique way to diagnose anemia while avoiding the altitude variability factor[6,7], this correction factor has been adopted by the Peruvian guidelines which follow the World Health Organization (WHO) standards. This correction factor has never been critically evaluated. The anemia prevalence was 43.6% in 2016 and 43.8% in 2017 using the WHO cutoff value of 11 g/dL and the altitudecorrection equation
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