Abstract
BackgroundIn 2005, Clalit Health Services (CHS), the largest health maintenance organization in Israel, initiated an intervention program aimed at reducing the prevalence rate of infantile anemia (IA). This study evaluated the progress made during the intervention (2005–2014) and its yield 5 years after it ended (2019).MethodsThe CHS database was retrospectively reviewed twice yearly from 2005 to 2014 for repetitive samples of children aged 9 to 18 months regarding the previous half-year interval, and a single sample in 2019. Data were collected on gender, ethnicity (Jewish/non-Jewish), socioeconomic class (SEC; low/intermediate/high), hemoglobin testing (yes/no), and hemoglobin level (if tested). Excluded were infants with documented or suspected hemoglobinopathy.ResultsAt study initiation, the rate of performance of hemoglobin testing was 54.7%, and the IA prevalence rate was 7.8%. The performance rate was lower in the Jewish than the non-Jewish subpopulation. The low-SEC subpopulation had a similar hemoglobin testing rate to the high-SEC subpopulation but double the IA prevalence rate. Overall, by the end of the intervention (2014), the performance rate increased to 87.5%, and the AI prevalence rate decreased to 3.4%. In 2019, there was little change in the performance rate from the end of the intervention (88%) and the IA prevalence was further reduced to 2.7%. The non-Jewish and low-SEC subpopulations showed the most improvement which was maintained and even bettered 5 years after the intervention ended.ConclusionsThe 10-year IA intervention program introduced by CHS in 2005 led to a reduction in IA prevalence rate to about 3.5% in all sub-populations evaluated. By program end, the results in the weaker subpopulations, which had the highest prevalence of IA at baseline, were not inferior to those in the stronger subpopulations. We recommended to the Israel Ministry of Health to adopt the intervention countrywide, and we challenge other countries to consider similar interventions.
Highlights
Anemia currently affects 24.8% of the world’s population, with the highest prevalence in the preschool age group
The performance rate was significantly lower at the initiation than at the end of the intervention (54.7% vs 87.5%)
Our findings strongly suggest that the implementation of a well-designed intervention program accompanied by monitoring measures, combined with an organizational focus and treatment guidelines, effectively reduced the prevalence rate of infantile anemia (IA) in the target population
Summary
Anemia currently affects 24.8% of the world’s population, with the highest prevalence in the preschool age group. In 2002, iron-deficiency anemia (IDA) was included among the important contributing factors to the global burden of disease [1]. The rapid growth characteristic of children in their first year of life places them at risk of infantile IDA (IIDA) owing to their increasing need for iron and a lack of dietary iron sources. Factors exacerbating this risk include maternal anemia during pregnancy, prematurity, low birth weight, introduction of cow’s milk or exclusive breastfeeding after 6 months, low socioeconomic class (SEC), and birth to newly immigrated parents [6,7,8]. This study evaluated the progress made during the intervention (2005–2014) and its yield 5 years after it ended (2019)
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