Comparing hemoglobin distributions between population-based surveys matched by country and time

Abstract

Background: Valid measurement of hemoglobin is important for tracking and targeting interventions. This study compares hemoglobin distributions between surveys matched by country and time from The Demographic and Health Survey (DHS) Program and the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Methods: Four pairs of nationally representative surveys measuring hemoglobin using HemoCue® with capillary (DHS) or venous (BRINDA) blood were matched by country and time. Data included 17,719 children (6-59 months) and 21,594 nonpregnant women (15-49 y). Across paired surveys, we compared distributional statistics and anemia prevalence. Results: Surveys from three of the four countries showed substantial differences in anemia estimates (9 to 31 percentage point differences) which were consistently lower in BRINDA compared to DHS (2 to 31 points for children, 1 to 16 points for women). Conclusion: We identify substantial differences in anemia estimates from surveys of similar populations. Further work is needed to identify the cause of these differences to improve the robustness of anemia estimates for comparing populations and tracking improvements over time.

The co-occurrence of overweight/obesity and anaemia among adult women, adolescent girls and children living in fifty-two low- and middle-income countries

“…Although the difference is low (<1•5 percentage-points), presenting different estimates can cause confusion for governments, or policy and programme planners, and hinder appropriate monitoring of the DBM. Significant differences in Hb distributions across different surveys have been discussed previously and attributed to factors such as humidity, the HemoCue ® model used for data collection, or the use of different survey sampling procedures (40) . This may have had an influence in the prevalence of DBM; however, it is worth noting, that for Cambodia, our sample size is significantly higher (3799 v. 406), which may explain the difference in estimates from a 0•0 % (29) to a 1•4 % in our study.…”

Prevalence of Anaemia, Iron Deficiency, and Iron Deficiency Anaemia in Women of Reproductive Age and Children under 5 Years of Age in South Africa (1997–2021): A Systematic Review

“…In both surveys, haemoglobin concentrations were assessed with a portable hemoglobinometer (HemoCue 301). The results showed a significant difference in reported anaemia prevalence (61% vs. 30%) [ 49 ]. In view of the above, we suspect that the SADHS 2016 anaemia prevalence results may have been influenced by the blood sample type.…”

Examination of the Cameroon DHS data to investigate how water access and sanitation services are related to diarrhea and nutrition among infants and toddlers in rural households

“…Generally, children aged 6 months and older are tested for anemia through a finger prick, while in the case of infants aged younger than 6 months heel prick blood testing is done using standard testing systems. The test results are then adjusted for altitude before grouping children into the following anemia status categories: (i) no anemia (!11.0 g/dl), (ii) mild anemia (10-10.9 g/dl), (iii) moderate anemia (7-9.9 g/dl), and severe anemia (,7 g/dl) (Hruschka et al 2020). For this study, anemia status was dichotomized into: no anemia (!11.0 g/dl) or any anemia (,11.0 g/dl).…”