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

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.