Title

Anemia in low-income infants and preschoolers from Hartford, CT: The impact of a community-based assessment model

Date of Completion

January 2005

Keywords

Health Sciences, Nutrition|Health Sciences, Public Health

Degree

Ph.D.

Abstract

Iron-deficiency in young children has been tied to developmental delays and poor educational achievement. This research utilized a community-based model to address iron deficiency and anemia among low-income infants and preschool-aged children from Hartford, CT. ^ The first study assessed the influence of recent infection on the effectiveness of zinc protoprophyrin-to-heme ratio (ZPP) and low hemoglobin concentration (Hb) as screens for iron depletion in 180 low-income preschoolers. Approximately half had recent illness at enrollment, and 57.5% had a history of anemia. More than one-third were iron-depleted as measured by serum ferritin concentration. Secondary to the effect of illness on ferritin, positive predictive value of ZPP, but not low Hb, was significantly reduced. Screening with ZPP identified significantly more children with low iron stores than low Hb, particularly when children had not been recently ill. ^ The second study assessed a community-based outreach and education program aimed at early childhood iron-deficiency and anemia using a quasi-experimental, pre-post design. More than half of caretakers completing exit interviews reported acting in response to program participation. The proportion of children with abnormal screening tests decreased significantly among those children whose caretakers took action. No significant differences were found with respect to low iron stores. ^ The final study utilized review of children's medical records to examine associations between history of anemia, risk of overweight at 24 months of age, limitations in access to health care, and infant feeding practices. More frequent use of the emergency department and missing routine checkups between 2 weeks and 12 months of age significantly increased risk of anemia. Solid food <4 months of age, cow's milk <12 months of age, and human milk >6 months of age tended to increase risk of anemia. Solid food <4 months of age was significantly associated with increased risk of overweight. Evidence of both access issues and feeding issues was associated with a two- to four-fold increase in risk of anemia and overweight. ^ Iron-deficiency remains common among low-income children in Hartford. This research underscores the need for focused, community-based initiatives to prevent iron-deficiency in this and similar communities. ^