Population screening for anaemia in the inner city

Objective An evaluation of the effectiveness and acceptability of a screening programme for anaemia linked to routine child health surveillance.

Design A community-based study of the screening process with re-evaluation after treatment and again 9 months later, supported by a questionnaire study of the opinions of GPs, health visitors and parents.

Setting Child Health clinics and GP surgeries in an area of Birmingham with high levels of deprivation and ethnic minority groups.

Subjects All 625 children turning 21 months of age during a 2-month period who were resident in the study area.

Main outcome measures Attendance for screening, haemoglobin result, compliance with medication, and post-treatment haemoglobin.

Results Sixty-three per cent of the target population attended for blood screening. 46% of 365 children tested were anaemic (Hb < 110 g/L). The thumb-prick blood test was acceptable to children, parents and health visitors. Two months of iron therapy was effective in raising haemoglobin by a mean of 15.5 g/l, but one-third of cases were noncompliant with oral iron. At 30 months of age, haemoglobin tended to fall in those previously not anaemic at 21 months from a mean of 122.2 to 115.5 g/l, and 33% who had been successfully treated later relapsed.

Conclusions The effectiveness of the programme from the public health perspective was reduced by nonattendance. Nevertheless, it could identify and treat anaemic children successfully. Despite shortcomings, we feel that screening is a useful adjunct to ongoing primary prevention of anaemia.