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. 2020 Mar 30;20(1):422.
doi: 10.1186/s12889-020-08537-4.

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

Daniel J Hruschka  1 , Anne M Williams  2   3 , Zuguo Mei  2 , Eva Leidman  2 , Parminder S Suchdev  2   4   5 , Melissa F Young  5 , Sorrel Namaste  6
Affiliations

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

Daniel J Hruschka et al. BMC Public Health. .

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 non-pregnant 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.

Keywords: Anemia; Biomarkers reflecting inflammation and nutritional determinants of Anemia; Blood collection; Data quality; Demographic and health surveys; Hemoglobin; Micronutrient surveys; Nutrition surveys.

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Conflict of interest statement

DJH acknowledges financial support from a USAID grant to The DHS Program. PSS is co-PI of the BRINDA project and receives salary support from Centers for Disease Control & Prevention. SN works on The DHS Program and the data collected under this program is a primary source of hemoglobin data in low and middle-income countries. In addition, SN was a former co-PI of the BRINDA project and continues to serve on the Steering Committee. AW, ZM, and EL declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Distributions of hemoglobin concentrations for 8 children’s and 6 women’s surveys (adjusted for altitude). Kernel density plots. Data sources: seven pairs of country surveys conducted between 2009 and 2016 from the Demographic and Health Surveys (DHS) and the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Total sample: 17,719 children and 21,594 women
Fig. 2
Fig. 2
Hemoglobin distributions by country and survey type: a children, b women. Kernel density plots. Data sources: four pairs of country surveys conducted between 2009 and 2016 from the Demographic and Health Surveys (DHS) and the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Hemoglobin concentrations adjusted for altitude
Fig. 3
Fig. 3
Proportion of any anemia by survey type and age for (a) children (6–59 months) and (b) women (15–49 years). Error bands are 95% CI. Data sources: six pairs of country surveys conducted between 2009 and 2016 from the Demographic and Health Surveys (DHS) and the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Hemoglobin concentrations adjusted for altitude
See this image and copyright information in PMC

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