Campos-Sánchez Miguel, Cordero-Muñoz Luis, Velásquez-Hurtado Enrique, Baiocchi-Ureta Nelly, Miranda-Cuadros Marianella, Sánchez-Griñán María Inés, Valdivia-Miranda Walter
Universidad Peruana Cayetano Heredia, Lima, Perú.
Instituto Nacional de Salud, Lima, Perú.
Rev Peru Med Exp Salud Publica. 2025 Aug 25;42(2):115-125. doi: 10.17843/rpmesp.2025.422.14028.
Motivation for the study. In 2024, the World Health Organization modified the cut-off points that define anemia. The magnitude of the change in the prevalence of anemia in children aged 6-35 months in Peru, compared to the 2001 guideline, is unknown. Main findings. Between 2009 and 2023, we found significant and heterogeneous differences (a) nationally, (b) between and within regions, and (c) depending on the calculation technique (table or equation). Implications. The rationale for the 2024 guideline, while much better than that for the 2001 guideline, is not sufficient. The new guideline should be adopted with caution, both in individual care and population-related decisions.
OBJECTIVES.: To compare annual national and regional prevalence rates of anemia, using the 2001 guideline versus the new 2024 guideline in children aged 6 to 35 months residing in Peru between 2009 and 2023. To assess whether differences exist between guidelines vary by region, setting, or year.
MATERIALS AND METHODS.: Secondary analysis of the Demographic and Family Health Survey (continuous national random sample, stratified and clustered). Hemoglobin was measured in capillary blood using Hemocue. We applied an equation (and/or table) for altitude adjustment and a cutoff point for each guideline. We calculated 95% confidence intervals [95% CI]. Differences were evaluated according to region, setting, and/or year using a generalized linear model, calculating extremes and quartiles. Estimates and models were weighted.
RESULTS.: We analyzed 120,711 children. The difference in prevalence was -6.3 [-6.6 to -6.0], p<0.001, varying by region (p<0.001), region-year (p=0.004), and region-setting (p<0.001), between -40.6 and 11.0. The percentage of children whose diagnosis differed was 11.0 [10.7 to 11.2], (p<0.001), varying between 0.0 and 40.6. The difference between the table and the equation was -3.8 [-4.0 to -3.6].
CONCLUSIONS.: The prevalence differs with the new guideline (generally decreasing, but may increase), with variable differences according to region, setting, and year. The percentage with a different diagnosis also varies. These differences are of great importance for health, in some cases changing the problem from severe to moderate. The table calculation underestimates the equation calculation. Literature supports the direction of the correction, but not its magnitude.
Motivation for the study. In 2024, the World Health Organization modified the cut-off points that define anemia. The magnitude of the change in the prevalence of anemia in children aged 6-35 months in Peru, compared to the 2001 guideline, is unknown. Main findings. Between 2009 and 2023, we found significant and heterogeneous differences (a) nationally, (b) between and within regions, and (c) depending on the calculation technique (table or equation). Implications. The rationale for the 2024 guideline, while much better than that for the 2001 guideline, is not sufficient. The new guideline should be adopted with caution, both in individual care and population-related decisions.
研究动机。2024年，世界卫生组织修改了定义贫血的临界值。与2001年指南相比，秘鲁6至35个月儿童贫血患病率的变化幅度尚不清楚。主要发现。2009年至2023年期间，我们发现（a）全国范围内、（b）不同地区之间以及地区内部、（c）取决于计算技术（表格或公式）存在显著且异质性的差异。启示。2024年指南的基本原理虽然比2001年指南好得多，但并不充分。在个体护理和与人群相关的决策中，应谨慎采用新指南。
比较2009年至2023年期间居住在秘鲁的6至35个月儿童，使用2001年指南与新的2024年指南时全国和各地区贫血的年度患病率。评估不同指南之间的差异是否因地区、环境或年份而异。
对人口与家庭健康调查进行二次分析（全国连续随机抽样，分层且聚类）。使用Hemocue测量毛细血管血中的血红蛋白。我们对每个指南应用了一个用于海拔调整的公式（和/或表格）以及一个临界值。我们计算了95%置信区间[95%CI]。使用广义线性模型根据地区、环境和/或年份评估差异，计算极值和四分位数。估计值和模型进行了加权。
我们分析了120,711名儿童。患病率差异为-6.3[-6.6至-6.0]，p<0.001，因地区（p<0.001）、地区-年份（p=0.004）和地区-环境（p<0.001）而异，在-40.6至11.0之间。诊断不同的儿童百分比为11.0[10.7至11.2]，（p<0.001），在0.0至40.6之间变化。表格与公式之间的差异为-3.8[-4.0至-3.6]。
新指南下患病率有所不同（总体呈下降趋势，但可能上升），因地区、环境和年份而异。诊断不同的百分比也有所不同。这些差异对健康非常重要，在某些情况下会将问题从严重变为中度。表格计算低估了公式计算。文献支持校正的方向，但不支持其幅度。
研究动机。2024年，世界卫生组织修改了定义贫血的临界值。与2001年指南相比，秘鲁6至35个月儿童贫血患病率的变化幅度尚不清楚。主要发现。2009年至2023年期间，我们发现（a）全国范围内、（b）不同地区之间以及地区内部、（c）取决于计算技术（表格或公式）存在显著且异质性的差异。启示。2024年指南的基本原理虽然比2001年指南好得多，但并不充分。在个体护理和与人群相关的决策中，应谨慎采用新指南。
