New World Health Organization guideline on anemia cut-off points: implications for children aged 6-35 months in Peru

Abstract

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.