332 - Rates of Anemia in a Pediatric Clinic in Consuelo, a Rural Community in the Dominican Republic
Sunday, April 27, 2025
8:30am – 10:45am HST
Publication Number: 332.6374
Maria Dunn, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Marissa Olson, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Anabel Fernández, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Andrew P. Steenhoff, Children's Hospital Of Philadelphia & Univ Of Pennsylvania, Philadelphia, PA, United States; Ramona Cordero, Niños Primeros en Salud, Consuelo, San Pedro De Macoris, Dominican Republic; Angie Alvarez, Childrens Hospital of Philadelphia, San Pedro de Macorís, San Pedro De Macoris, Dominican Republic; Danuary Garcia, Niños primeros en salud, Consuelo, San Pedro De Macoris, Dominican Republic; Ivelisse Tavarez, Niños Primero en Salud, Consuelo, San Pedro De Macoris, Dominican Republic; Susannah Anderson, Temple University, Philadelphia, PA, United States; Francisca Vásquez Santana, Childrens Hospital of Philadelphia, San Pedro De Macoris (Zona Urbana), San Pedro De Macoris, Dominican Republic; Tatidelmi Garcia, AdventHealth for Children, San Pedro de macoris, San Pedro De Macoris, Dominican Republic
Global Health Program Coordinator Children's Hospital of Philadelphia Philadelphia, Pennsylvania, United States
Background: Childhood anemia is a common global problem that, when severe, adversely affects cognitive and motor development. The Niños Primeros en Salud (NPS) clinic in the rural town of Consuelo, Dominican Republic (DR), addresses this problem in two ways: 1) by screening children for anemia using hemoglobin (Hb) levels at least once between 6-12 months of age and 2) by discussing nutritious food options during both clinic and home visits, conducted by clinicians and community health promoters. In 2015 just 30% of children in this clinic were screened for anemia and rates of child anemia in those screened were 90% with 51% of anemic children receiving iron therapy. Following multiple community and clinic interventions, here we reassess these rates 8 years later. Objective: To evaluate the clinic's performance between 2022 to 2024 screening for, diagnosing, and treating iron deficiency anemia; and to describe the prevalence and severity of anemia in children attending a rural clinic in the Dominican Republic. Design/Methods: We reviewed patient medical records for children ages 6-15 months with at least one clinic visit between November 1, 2022 - January 31, 2024, to assess hemoglobin (Hb) screening, Hb and MCV levels and prescription of iron therapy in those diagnosed with anemia. Anemia was defined according to the World Health Organization (WHO) standards as Hb < 11g/dL. Mild, moderate, and severe anemia were defined as Hb 10-10.9, 7-9.9 and < 7 g/dL respectively. Results: Of 308 patients who met inclusion criteria, 176 (57%) had a Hb result in their medical record. See attached study flow diagram and table summarizing the cohort. Of the 176 with a Hb test, 68 (39%) had anemia (28% mild anemia, 11% moderate anemia, 0% severe anemia). Of 68 children with anemia, 44 (65%) had an MCV < 73 fL, indicating microcytosis. Among 26 wasted or stunted patients, 19% (5/26) had Hb < 11g/dL. Of all children diagnosed with anemia, 43/68 (63%) received iron therapy, 61% with mild anemia and 68% with moderate anemia.
Conclusion(s): Although Hb screening has gone up from 30% in 2015 to 57% in 2022-2024, over a third of children at the clinic were unscreened for iron deficiency anemia during the period of highest risk. Encouragingly, among those screened, anemia rates in children 9-15 months of age decreased from 90% in 2015 to 39% in 2022-2024. In children diagnosed with anemia, there was an increase in iron therapy from 51% to 63%. Despite improvements since 2015, there is room for additional progress in Hb screening, anemia prevention and anemia treatment in this community.
