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OBJECTIVE: To determine the most effective method for analysing haemoglobin concentrations in large surveys in remote areas, and to compare two methods (indirect cyanmethaemoglobin and HemoCue) with the conventional method (direct cyanmethaemoglobin). METHODS: Samples of venous and capillary blood from 121 mothers in Indonesia were compared using all three methods. FINDINGS: When the indirect cyanmethaemoglobin method was used the prevalence of anaemia was 31-38%. When the direct cyanmethaemoglobin or HemoCue method was used the prevalence was 14-18%. Indirect measurement of cyanmethaemoglobin had the highest coefficient of variation and the largest standard deviation of the difference between the first and second assessment of the same blood sample (10-12 g/l indirect measurement vs 4 g/l direct measurement). In comparison with direct cyanmethaemoglobin measurement of venous blood, HemoCue had the highest sensitivity (82.4%) and specificity (94.2%) when used for venous blood. CONCLUSIONS: Where field conditions and local resources allow it, haemoglobin concentration should be assessed with the direct cyanmethaemoglobin method, the gold standard. However, the HemoCue method can be used for surveys involving different laboratories or which are conducted in relatively remote areas. In very hot and humid climates, HemoCue microcuvettes should be discarded if not used within a few days of opening the container containing the cuvettes.

Iron deficiency anemia among young children is a large health problem. However, there is little information about the prevalence of anemia among young infants because it has been assumed that normal, breast-fed infants have adequate iron stores until 4-6 mo of age. We analyzed cross-sectional data from the HKI/GOI Nutrition and Health Surveillance System in rural Java, Indonesia from Sept. 1999 to Feb. 2001 for hemoglobin (Hb) of 3- to 5-mo-old breast-fed infants (n = 990) and related factors. The prevalence of Hb < 90 g/L was 13.4%, < 100 g/L, 37%, and < 110 g/L, 71%. Multiple logistic regression analysis revealed that normal birth weight infants (>2500 g) of anemic mothers (Hb < 120 g/L) had an odds ratio (OR) [95% confidence interval (CI)] of 1.81 [1.34-2.43] to have a low Hb (< 100 g/L) compared with infants of nonanemic mothers with a normal birth weight. Infants of nonanemic mothers but with low birth weight had an OR of 1.15 [0.61-2.16], and those with low birth weight and anemic mothers of 3.68 [1.69-8.02]. Other risk factors included stunting (OR 1.70 [0.97-2.95]), a young mother ( KEY WORDS: * anemia * infants * Indonesia * birth weight * maternal anemia * hemoglobin

Substantial efforts have been made in the past several decades to implement programs to reduce iron deficiency. Yet, compared with other micronutrients such as vitamin A and iodine, overall progress in reducing iron deficiency has been limited. Such limited progress is not attributed to a lack of scientific knowledge about the prevalence, causes or consequences of iron deficiency, but to limited implementation of effective interventions and ineffective communication tools. The challenge is to coordinate and balance research efforts more constructively with the implementation of practical and effective intervention programs. More attention must be paid to evaluating the operational feasibility of various intervention strategies to demonstrate their effectiveness under normal field conditions. Moreover, intervention efforts must be supported by substantially increased attention to communications to achieve effective advocacy for policy support and resource mobilization, foster partnerships and alliances, clarify priority target groups, including infants and young children, and support behavioral change. Through collaboration, researchers, program implementers and communicators can achieve substantial progress in reducing iron deficiency. J. Nutr. 132: 802S-805S, 2002. KEY WORDS: * iron deficiency * anemia * treatment interventions * communications strategies

Objective. To examine whether there is a continuation of the decline in prevalence of anemia among low-income infants and children 6.0 to 59.9 months old from the early 1980s to the mid-1990s. Study Design. Cross-sectional trend analysis of data from the Centers for Disease Control and Prevention&apos;s Pediatric Nutrition Surveillance System from the 5 states (Colorado, New Mexico, Oklahoma, Utah, and Vermont) that have been using the same laboratory method for anemia screening since 1984 or earlier. Results. The overall prevalence of anemia decreased substantially in each state from the early 1980s to the mid-1990s as follows: Colorado by 52%; New Mexico by 75%; Oklahoma by 67%; Utah by 57%; and Vermont by 48%. In each state, the prevalence of anemia declined for children of different age groups, birth weights, genders, type of pediatric care visit (screening or follow-up), and most race/ethnic groups. Conclusions. The decline in the prevalence of anemia initially observed in the 1980s continued well into the 1990s. This decline is likely attributable to better iron nutrition related to greater usage of iron-fortified products and possibly better iron bioavailability in some of the food products. Pediatrics 2001;107:677-682; anemia, low-income children, breast feeding, iron-fortified formula, iron-fortified cereal., ABBREVIATIONS. WIC, Special Supplemental Nutrition Program for Women, Infants, and Children; NHANES, National Health and Nutrition Examination Survey; PedNSS, Pediatric Nutrition Surveillance System; CDC, Centers for Disease Control and Prevention. [...]

The study was designed to determine whether population-specific hemoglobin cut-off values for detection of iron deficiency are needed for Indonesia by comparing the hemoglobin distribution of healthy young Indonesians with that of an American population. This was a cross-sectional study in 203 males and 170 females recruited through a convenience sampling procedure. Hemoglobin, iron biochemistry tests and key infection indicators that can influence iron metabolism were analyzed. The hemoglobin distributions, based on individuals without evidence of clear iron deficiency and infectious process, were compared with the National Health and Nutrition Survey (NHANES) II population of the United States. Twenty percent of the Indonesian females had iron deficiency, but no male subjects were iron deficient. The mean hemoglobin of Indonesian males was similar to the American reference population at 152 g/L with comparable hemoglobin distribution. The mean hemoglobin of the Indonesian females was 2 g/L lower than that of the American reference population, which may be the result of incomplete exclusion of subjects with milder form of iron deficiency. When the WHO cutoff (Hb < 120 g/L) was applied to female subjects, the sensitivity of 34.2% and specificity of 89.4% were more comparable to the test performance for white American women, in contrast to those of the lower cut-off. On the basis of the finding of hemoglobin distribution of men and the test performance of anemia (Hb < 120 g/L) for detecting iron deficiency for women, it is concluded that there is no need to develop different cut-off points for anemia as a tool for iron-deficiency screening in this population. KEY WORDS: hemoglobin; anemia; iron deficiency; humans; screening

The current international growth reference, the National Center for Health Statistics (NCHS) reference, is widely used to compare the nutritional status of populations and to assess the growth of individual children throughout the world. Recently, concerns were raised regarding the adequacy of this reference for assessing the growth of breast-fed infants. We used the NCHS reference to evaluate infant growth in one of the most developed areas of Brazil. Infants who were exclusively or predominantly breast-fed for the first 4-6 mo, and partially breastfed thereafter, grew more rapidly than the NCHS reference in weight and length during the first 3 too, but appeared to falter thereafter. The average growth of all infants, regardless of feeding pattern, was faster than the NCHS reference until [approximately]6 mo, after which their growth became slower than that of the NCHS sample. To substantiate this finding, the NCHS growth curves were then compared with growth data of breast-fed infants in developed countries from pooled published studies, formula-fed North American and European infants and predominantly bottle-fed U.S. infants monitored by the Centers for Disease Control and Prevention (CDC) Pediatric Surveillance System. In all three cases, weights showed the same pattern as the Brazilian infants - higher than NCHS in the early months but an apparent decline thereafter. The pattern for length gain was similar but less marked. Breastfed infants showed more pronounced declines than those who were predominantly bottle-fed. These findings suggest that the infancy portion of the NCHS reference does not adequately reflect the growth of either breastfed or artificially fed infants. This probably results from characteristics of the original sample and from inadequate curve-fitting procedures. The development of an improved international growth reference that reflects the normal infant growth pattern is indicated. KEY WORDS: breast-feeding; bottle-feeding; infant nutrition; humans

A nutrition survey was performed in 1990 among children 6 through 35 mo of age living in Palestinian refugee camps in Syria, Jordan, the West Bank, Gaza Strip and Lebanon. Overall, 67% [95% confidence interval (CI): 66, 68] were anemic (hemoglobin KEY WORDS: anemia; hemoglobin; iron deficiency; refugees; humans

Objectives. Although more fetal deaths than neonatal deaths occur, routinely collected fetal death data are seldom used for perinatal epidemiologic research because of data quality concerns. We developed a strategy for identifying and correcting errors in birthweight and gestational age in fetal death records. Methods. Using data from Georgia for 1989 and 1990, we detected singleton fetal death records having improbable or missing birthweight or gestational age by comparing these values with referent values. To verify the questionable values, we contacted 100 reporting hospitals in 1992. Results. In 817 of 2226 records, values were either improbable (60.1%) or missing (39.9%). We were able to contact the hospitals to verify data for 716 (88%) of these records. Verification resulted in corrections to 405 (57%) records, and 48% of unreported birthweights were obtained. Conclusions. Many errors in recorded gestational age and birthweight were identified by this method. Rather than deleting or imputing problem data for analyses, researchers should consider efforts to verify them. Efforts to improve this information should include improved reporting, strict quality assurance, and procedures for routine verification and correction of records. (Am J Public Health. 1997:87:1323-1327)

Chronic gastrointestinal infection with the bacterium Helicobacter pylori may be responsible for the chronic iron deficiency seen in many Alaska natives. Researchers studying the Yupik eskimos found that many had anemia even though their diet is rich in iron. In a detailed study of 140 adults, 90% had blood in their stool. Among 70 who had endoscopy, 97% had evidence of severe Helicobacter pylori infection that caused ulcers and hemorrhages. They also had evidence of gastritis, which is an inflammation of the stomach. This could account for their gastrointestinal bleeding., Objective.--To confirm prevalent iron deficiency among Yupik Eskimos living in Alaska and to explore the frequency of and potential lesions accounting for occult gastrointestinal bleeding. Design.--Descriptive survey. Setting.--Rural Arctic community. Subjects.--A total of 140 adult volunteers from 3 villages in the Yukon-Kuskokwim Delta region of western Alaska. Main Outcome Measures.--Daily iron intake, hematologic and biochemical indexes of iron status, fecal hemoglobin levels, stool parasites, and endoscopic findings. Results.--While dietary iron intake by Yupiks was similar to that of a reference population, iron deficiency prevalence was increased 13-fold in Yupik men and 4-fold in Yupik women. Fecal hemoglobin levels were elevated in 90% of subjects contrasted with only 4% of a reference group; median levels were 5.9 and 0.5 mg of hemoglobin per gram of stool, respectively. Among 70 Yupik subjects with elevated fecal hemoglobin levels who had endoscopy performed, 68. (97%) had an abnormal gastric appearance consisting of erythema, mucosal thickening, diffuse mucosal hemorrhages, erosions, or ulcerations. Gastric biopsies revealed chronic active gastritis with associated Helicobacter pylori in 68 (99%) of 69. No other hemorrhagic gastrointestinal disease was detected. Conclusions.--Based on this study sample, occult gastrointestinal bleeding appears to be pervasive in the Yupik population and likely underlies the prevalent iron deficiency. An atypical hemorrhagic gastritis associated with H pylori infection is present almost universally and may represent the bleeding source. JAMA. 1997;277:1135-1139

To define more fully the nature of a persistently high prevalence of iron deficiency anemia observed among Alaska Native children, we examined dietary iron intake, hemoglobin concentrations, and storage iron (serum ferritin) based on multiple cross-sectional surveys of Alaska Natives between 1983 and 1989. Approximately 30 to 50% of the children studied INDEXING KEY WORDS: Alaska Natives, iron deficiency, anemia, fecal occult blood, humans

The U.S. military will continue to play a significant role in international humanitarian relief efforts. Investigators used their personal experiences, interviews, and a literature review to examine U.S. military relief operations, including the benefits and limitations, and suggestions for future improvements. They describe the Kurdish crisis that followed the Persian Gulf War, the Bangladesh cyclone of 1991, and the famine and internal conflict in Somalia in 1992. For each scenario, the relief efforts of the U.S. military are detailed. Some advantages of using military forces to provide emergency aid include the provision of security, effective transport of supplies and personnel, and coordination of activities. Military efforts are somewhat constrained by their emphasis on combat support rather than the provision of humanitarian aid. Four recommendations for ensuring effective, efficient future relief missions are provided.

Those who perform emergency studies of populations should use standard measurement techniques and must devote greater attention to the documentation of methods and results. Researchers reviewed 23 surveys of Somalians that recorded rates of malnutrition and death as well as the most common causes of death and disease. Investigators identified profound differences in the groups under study and the sampling techniques that were used. Although all surveys collected data on nutrition or health, only six reported on the major areas of concern: death, disease, and nutritional condition. The 16 studies that contained statistics on deaths were inconsistent in measurements, formulas for rate calculation, and results. Studies on disease occurrence used subjects of varying age groups. There was no information on diseases in children who were five years of age or over. Recommendations to standardize studies of disease, death, and nutritional conditions are provided., Objectives. - To evaluate the various survey methods used in Somalia between 1991 and early 1993 while assessing documentation of mortality and malnutrition rates and common causes of morbidity and mortality. Data Sources. - Twenty-three population surveys were identified from the Center for Public Health Surveillance for Somalia, the United Nations Children&apos;s Fund, and other humanitarian organizations. Study Selection. - Only surveys with defined populations and apparently systematic methodology that focused on mortality, morbidity, and/or nutritional status were included. Results. - Extensive methodological differences were found among the 23 surveys. Target populations and sampling strategies varied widely. Twelve studies were considered not reproducible. Of the 16 studies assessing mortality, only eight assessed cause of death. Use of units of measurement and inclusion of denominators in rate calculations were inconsistent. None of the studies provided confidence intervals around the point estimates of the rates. Of the 11 studies providing information on morbidity, none provided case definitions. And in the 16 studies reporting nutritional status, a variety of measurement methods and definitions of malnutrition were used. Three studies presented information based on mid-upper-arm circumference measurements, and 10 presented weight-for-height data below 70% and 80% of the reference median; only four studies presented zscores. Conclusions. - While the results of some studies may have influenced policy and program management decisions, their effects may have been limited by failure to adequately document results and by differences among studies in objectives, design, parameters measured, methods of measurement, definitions, and analysis methods. We recommend that agencies conducting population studies in emergency situations define clear study objectives, use standard sampling and data collection methods, and ensure precise written documentation of study objectives, (JAMA. 1994;272:371-376)

Iron deficiency is a common nutritional disorder in developing countries and contibutes significantly to reduced work productivity and economic output as well as to increased morbidity and mortality. There are well established biochemical tests for assessing iron status in developed countries. However, cost and interference from infectious conditions make it difficult to assess iron status in many developing country settings. Examination of the hemoglobin distribution in the population and assessment of the hemoglobin response to supplementation are alternative approaches to defining iron status and the nature of anemia. Prevention and control of iron deficiency requires the combined approach of dietary improvement, fortification of a common staple food when feasible, and appropriate iron supplementation for infants and pregnant women. In all these intervention activities, operational research is needed to improve effectiveness. In addition, controlling iron deficiency requires coordination with other nutrition and primary health care programs as part of an integrated approach to improved health and nutrition of the population. J. Nutr. 124: 1479S--1490S, 1994.

A public-health-oriented program might have helped lower the mortality rate of Kurdish refugee children in 1991. Though the Kurdish refugees on the Turkey-Iraq border benefited from relatively quick intervention, children five years old and younger accounted for 2/3 of all deaths during the crisis and in the refugee camps. Children shorter than 110 centimeters at Zakho Camp 1 in northern Iraq were selected at random for evaluation for signs of malnutrition. The height and weight of 816 children from 323 families were measured. Acute malnutrition, as determined by low weight for the height of the children, was most prevalent in children under two years old. It appeared to be a consequence of diarrhea. The mortality survey found that a total of 301 refugees died during the eight-week period studied from the beginning of the crisis. Children who were younger than one year had the highest mortality rate at 64 deaths per 1,000 each month. Children who are younger than two years should receive special attention from relief programs. These children would benefit from a disease-prevention program., Objective.--To determine the extent, major causes, and contributory factors of high rates of morbidity and mortality among children at mountain camps along the Turkey-Iraq border during the 1991 Kurdish refugee crisis. Design.--A cross-sectional rapid nutrition survey among children and a retrospective mortality survey covering a 2-month period from the onset of the crisis. Population Studied.--Households of Kurdish refugees at resettlement camp 1 near Zakho in northern Iraq. Main Outcome Measures.--Prevalence of wasting (low weight-for-height) and mean weight-for-height status, prevalence of diarrhea, and crude and age-specific mortality rates. Results.--Weight-for-height measurements indicated that children under 2 years of age had suffered significant (P

Participants in a November 1991 workshop concluded that coordinated strategies for controlling malnutrition due to iodine, iron, vitamin A and other micronutrients deficiencies are technically feasible and should be given consideration in planning control efforts. Coordinated surveys involving clinical, biochemical and dietary assessment of multiple micronutrients are feasible. Multiple fortification is also possible using such vehicles as salt, processed rice or sugar. Supplementation efforts can be integrated with existing health care programs. Food-based strategies are also effective. The best examples have been community-based and have included a strong nutrition and health education component designed to change food consumption patterns, improve food preservation and preparation practices, and link income-generating activities with food production activities. Successful coordinated efforts will require a strong political commitment and a supportive infrastructure. Specific recommendations include the formation of national coordinating bodies for micronutrient deficiency control, establishment of a micronutrient information network and expansion of technical exchange and training. J. Nutr. 123: 775-787, 1993.

A study was done on the relationship of iron nutrition on the hemoglobin differences between blacks and whites basing on reports which show that blacks have lower hemoglobin values than whites. Evaluation of dietary iron intake among black and white test populations show that despite the lower hemoglobin values in blacks, there is a higher value for ferritin compared to whites. These findings suggest that the difference in hemoglobin concentration involves other factors beside dietary iron intake.

Southeast Asian children who emigrate to the US have been found to be small for their age when they arrive in this country, but data from the Pediatric Nutrition Surveillance System of the Centers for Disease Control (CDC) show that their growth rates increase significantly thereafter. In 28,725 Asian children from low-income families surveyed by the CDC between 1978 and 1989, the percentage of children identified as low birth weight at delivery dropped from 15.5% to 8.5%. The percentage of children who were small or underweight for their age also dropped during this time period. By 1989, the percentage of Asian children who were small or underweight for their age approached that of other low-income minority children. It may not be necessary to develop special standards to assess the growth of Southeast Asian immigrant children.

Using Linked Program and Birth Records to Evaluate Coverage and Targeting in Tennessee's WIC Program PUBLIC HEALTH PROGRAMS in the United States are intended to serve low-income families who are […]

Anemia is a condition of inadequate hemoglobin, due either to defects in hemoglobin formation or a reduced number of red blood cells. Cigarette smoking is known to cause an increase in the level of hemoglobin, apparently as a response to the tight chemical bond that becomes established between carbon monoxide (a by-product of tobacco smoking) and hemoglobin. The effects of smoking on the measured level of hemoglobin were analyze among 2,250 males and 2,454 women between 18 and 44 years of age. Smoking history, hemoglobin level and socioeconomic status of all individuals were known. There was no significant difference in hemoglobin levels between individuals who had never smoked and those who had given up the habit. However, cigarette smoking was found to cause elevated hemoglobin in both men and women. The underestimation of anemia in smokers as the result of the elevation of hemoglobin was seen as significant. The compensation values presented in this article should be applied to the hemoglobin values of all smokers in order to detect possible anemia. (Consumer Summary produced by Reliance Medical Information, Inc.)