International Journal of Epidemiology, Vol 28, 82-89, Copyright © 1999 by International Epidemiological Association
JH Cohen and JD Haas
BACKGROUND: A maximum likelihood method of mixed distribution analysis
(MDA) is presented as a method to estimate the prevalence of iron
deficiency anaemia (IDA) in Costa Rican infants 12-23 months old. MDA
characterizes the parameters of the admixed distributions of iron deficient
anaemics and non-iron-deficient-anaemics (NA) from the frequency
distribution of haemoglobin concentration of the total sample population.
METHODS: Data collected by Lozoff et al. (1986) from 345 Costa Rican
infants 12-23 months old were used to estimate the parameters of the IDA
and NA haemoglobin distributions determined by MDA and the widely used
three-criteria model of iron deficiency. The estimates of the prevalence of
IDA by each of the methods were compared. The sensitivity and specificity
of MDA compared to diagnosis by the three-criteria method were assessed.
Simulations were carried out to assess the comparability of MDA and the
three-criteria method in low and high prevalence scenarios. RESULTS: The
mean and standard deviation (SD) of the NA haemoglobin distribution
determined by both methods was 12.1 +/- 1.0 g/dL. The IDA haemoglobin
distribution determined by MDA had a mean and SD of 10.2 +/- 1.3 g/dL while
the IDA distribution by the three-criteria method had a mean and SD of 10.4
+/- 1.3 g/dL. The prevalences of IDA as estimated by MDA and the three-
criteria method were 24% and 29%, respectively. The sensitivity and
specificity of MDA were 95% and 97%, respectively. The performance of MDA
was similar to the three-criteria method at a simulated high prevalence of
IDA and less similar at a low prevalence of IDA. CONCLUSIONS: Compared to
the reference three-criteria method MDA provides a more accurate estimate
of the true prevalence of IDA than the haemoglobin cutoff method in a
population of children aged 12-23 months with a moderate to high prevalence
of IDA. MDA is a less costly method for estimating the severity of IDA in
populations with moderate to high prevalences of IDA, and for assisting in
the design, monitoring and evaluation of iron intervention programmes.
ARTICLES
The comparison of mixed distribution analysis with a three-criteria model as a method for estimating the prevalence of iron deficiency anaemia in Costa Rican children aged 12-23 months
Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
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