A cross-sectional study was conducted in inner-city clinics, in children aged 9-30 months having routine anemia screening as part of a scheduled visit. Parents completed a questionnaire and children had venous blood sampling for complete blood count and ferritin. Anemia was defined as Hb < 11.0 g/dl. Iron deficiency (ID) was defined as ferritin < 10 mg/l or MCV < 70fl and RDW > 14.5%. Children were categorized into one of four groups: iron sufficient not anemic (ISNA), iron sufficient anemic (ISA), iron deficient not anemic (IDNA), iron deficient anemic (IDA). The questionnaire consisted of 15 dietary items in domains of infant diet, intake of solid food, intake of beverages and participation in the WIC program together with 14 historical items in domains of birth history, recent illness, chronic medical conditions, history of anemia and maternal history. Analysis was performed on individual items, domains and combinations of selected items. RESULTS: Of the 282 study subjects, the prevalence of anemia (35%), IDNA (7%) and IDA (8%) did not vary significantly by age. Among individual historical and dietary questions, maternal history of anemia and drinking more than two glasses of juice per day identified the highest proportion of children with IDA, 50% sensitivity (95% CL 16,81) and 77% sensitivity (54,89) respectively. However, because specificities for these questions were only 60% (55,65) and 22% (17,27), respectively, their positive predictive values were only 9% (6,13) and 8% (4,17). Domains of questions with the highest sensitivity for IDA were beverage intake, 91% (68,99) and intake of solid food, 91% (68,99). However, specificities of the domains were 14% (10,18) and 29% (24,35) respectively, yielding positive predictive values of only 8% and 10%. The dietary items used by Boutry and Needlman were 95% (77,99) sensitive but only 15% (11,19) specific for IDA. The CDC recommendations for health and dietary screening were 73% (56,92) sensitive and 29% (24,35) specific for IDA. The individual questions, domains of questions and inter-domain groups of questions had similar sensitivity, specificity and predictive value for anemia and ID (IDA + IDNA).
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