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Current Trends Declining Anemia Prevalence among Children Enrolled in Public Nutrition and Health Programs -- Selected States, 1975-1985

The Pediatric Nutrition Surveillance System (PNSS) was established by CDC in 1974 to monitor the growth and hematologic status of children from low-income families participating in such programs as the Special Supplemental Food Program for Women, Infants, and Children (WIC)*; Early Periodic Screening, Detection, and Treatment; and publicly funded maternal- and child-health clinics. The hematologic data collected since 1975 from the states participating in PNSS have demonstrated a steady decline in the prevalence of childhood anemia (1,2).

The number of states participating in the surveillance system has increased from five in 1974 to 34 in 1986. Since this changing composition could have influenced the observed anemia trend, data from six states (Arizona, Louisiana, Kentucky, Montana, Oregon, and Tennessee) that have consistently participated in the PNSS since 1975 were analyzed. In these analyses, the following age-specific hemoglobin (Hgb) and hematocrit (Hct) levels were used as cutpoints to define anemia: age 6-23 months, Hgb less than 10.3 gm/dl or Hct less than 31%; age 24-59 months, Hgb less than 10.6 gm/dl or Hct less than 32%; age 60-83 months, Hgb less than 11.0 gm/dl or Hct less than 33%. These cutpoints, which are 0.6 gm/dl Hgb or 2% Hct lower than the commonly used clinical criteria (3), were chosen to avoid inclusion of children with borderline anemia.

Between 1975 and 1985, data on 1,680,740 Hgb or Hct measurements obtained from 499,759 children aged 6 months to 5 years were reported from the six states. The majority (83%) of these measurements were from children participating in WIC programs. Overall, the prevalence of anemia declined from 7.8% in 1975 to 2.9% in 1985 (Figure 1). Age-specific analysis using 6-month age intervals demonstrated that the decline occurred among all age groups. In general, anemia prevalences were lower among children seen at follow-up visits than among children of the same age seen for initial visits, although both prevalences declined over the decade. Reported by Office of Nutrition Svcs, Arizona Dept of Health Svcs; Nutrition Br, Dept of Health Svcs, Div of Maternal and Child Health, Kentucky Cabinet of Human Resources; Nutrition Section, Office of Preventive and Public Health Svcs, Louisiana Dept of Health and Human Resources; Nutrition/WIC, Clinical Programs Bureau, Health Sciences and Medical Facilities Div, Montana State Dept of Health and Environmental Sciences; WIC Program, Oregon State Health Div; Nutrition and Supplemental Food Programs, Tennessee Dept of Health and Environment; Div of Nutrition, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: The prevalence of anemia among children from lower-income families residing in the six selected states with consistent participation in the PNSS declined by 60% between 1975 and 1985. Because of the magnitude and consistency of the decline, and the relatively constant family income criteria used for enrollment in WIC and other public health programs, the decrease in anemia is unlikely to be related to changes in the socioeconomic background of children included in the PNSS. Instead, the changes are probably related to improvements in iron nutrition during infancy and early childhood, which have resulted in lower levels of iron deficiency anemia, the most common form of childhood anemia in the United States (4). In view of the decline in anemia prevalence noted at initial screening visits, at least some of the decline appears independent of participation in public health programs. However, the even lower prevalence of anemia observed at follow-up visits suggests that WIC and other public programs also play a role in the decrease of anemia prevalence (5).


  1. Trowbridge FL. Malnutrition in industrialized North America. In: Malnutrition: determinants and consequences. New York: Alan R. Liss, 1984:45-58.

  2. CDC. 1983 annual summary of pediatric nutrition surveillance system. Atlanta, Georgia: Centers for Disease Control, 1985. HHS publication no. (CDC) 85-8295.

  3. Committee on Nutrition American Academy of Pediatrics. Pediatric nutrition handbook. 2nd ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 1985.

  4. Dallman PR, Yip R, Johnson C. Prevalence and causes of anemia in the United States, 1976 to 1980. Am J Clin Nutr 1984;39:437-45.

  5. Vazquez-Seoane P, Windom R, Pearson HA. Disappearance of iron-deficiency anemia in a high-risk infant population given supplemental iron. N Engl J Med 1985;313:1239-40. *The WIC program, designed to provide nutrition education and specific foods to children up to age 5, lactating mothers, and pregnant and postpartum women, is closely associated with health-care delivery services.

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