Prevalence of anemia among James Bay Cree infants of northern Quebec

Background: Anemia is common among First Nation infants in Canada, often as a result of iron deficiency, which places them at risk for psychomotor imp airment. Prevalence data are unavailable, and the risk factors are unknown. This study assessed the prevalence of anemia and associated risk factors a mong 9-month-old Cree infants in northern Quebec. Methods: Between January 1995 and October 1998, 6 of 9 Cree villages in the lames Bay region adopted a screening protocol for anemia in 9-month-old in fants. Cross-sectional data were obtained from medical charts. The data for babies of very low birth weight and those with fever or infection were exc luded. Among the 386 babies whose hemoglobin concentration was known, the t ype of milk consumed at the time of screening was known for 354. Associatio ns between hemoglobin concentration and mean cell volume at 9 months, and m ilk type and weight gain since birth were analysed. Results: The mean hemoglobin concentration of the 386 infants was 114.1 (st andard deviation [SD] 10.6) g/L. The prevalence of anemia was 31.9% (95% co nfidence interval [CI] 27.2%-36.7%) with a hemoglobin cutoff value of 110 g /L, 17.6% (95% CI 13.9%-21.7%) with a cutoff value of 105 g/L, and 7.8% (95 % CI 5.3%-10.9%) with a cutoff value of 100 g/L. Babies exclusively fed for mula at 9 months had a higher mean hemoglobin concentration (118.5 [SD 9.9] g/L) than those exclusively fed breast milk (109.9 [SD 10.0] g/L), cow's m ilk (112.5 [SD 10.1] g/L) or more than one type of milk (112.0 [SD 10.8] g/ L) (p < 0.05). Compared with formula, the odds ratio (OR) for anemia was 7. 9 (95% CI 3.4-18.2) for breast milk, 5.0 (95% CI 2.0-12.7) for cow's milk a nd 5.2 (95% CI 1.9-14.6) for mixed milks, infants fed formula and those fed cow's milk had significantly greater weight gains since birth, by 724 g an d 624 g respectively, than breast-fed infants (p < 0.05). When milk type wa s controlled for, weight gain since birth was significantly associated with the presence of microcytic erythrocytes (OR comparing highest tertile of w eight gain to lowest tertile 2.9, 95% ci 1.2-6.6). Interpretation: iron-deficiency anemia is highly prevalent among James Bay Cree infants. Measures to increase iron intake are required.