Investigation of Pediatric Anemia in the Commonwealth of the Northern Mariana Islands

  • Tiffany F. LinEmail author
  • James N. Huang
  • Haley L. Cash


Objective To report on the prevalence and etiology of pediatric anemia in the Commonwealth of the Northern Mariana Islands (CNMI). Method A retrospective chart review was conducted that included patients up to 19 years of age who presented for well child care and whose hemoglobin or hematocrit was checked in the CNMI from 2014 to 2015. Lab values, diagnoses and treatment plans, patient reported ethnicity, and follow-up results were collected from eligible patients. Results The records for 1483 pediatric patients who had 1584 well child visits were reviewed. The prevalence of anemia amongst all eligible patients was 8.0% (5.4–10.7). This included 292 9 to 18 months old patients, which is estimated to be 40% of the total pediatric population of CNMI in that age group. Among the 9 to 18 months old patients, the prevalence of anemia is 5.5% (2.6–8.4). Etiology of anemia was investigated and of the patients treated with iron, 55.2% had a documented response. The majority of those without documentation of improvement with iron were patients who were lost to follow-up. In addition, a total of 10 patients were found to have an alpha or beta thalassemia variant discovered initially by anemia screening or sibling tracing. Discussion In this United States Commonwealth, prevalence of anemia appears lower than prevalence reported for other independent Pacific Island nations and closer to that of the US. Thalassemia is documented within this population. Limitations to this data were use of a convenient sample that may be hampered by lack of presentation to well-child care. This study will guide future public health studies on anemia prevalence and can guide public health intervention decisions to improve pediatric care in the CNMI.


Pediatric anemia CNMI Pacific Island Anemia prevalence 



  1. Baker, R. D., & Greer, F. R. (2010). Clinical Report—Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics, 126, 1040–1050.CrossRefGoogle Scholar
  2. Dela Cruz, R. (2015). Assessing maternal and infant health in the Commonwealth of the Northern Mariana Islands. MPH Thesis, UCLA Fielding School of Public Health.Google Scholar
  3. Geltman, P. L., Hironaka, L. K., Mehta, S. D., et al. (2009). Iron supplementation of low-income infants: A randomized clinical trial of adherence with ferrous fumarate sprinkles versus ferrous sulfate drops. Journal of Pediatrics, 154, 738–743.CrossRefGoogle Scholar
  4. Gupta, R., Musallam, K. M., Taher, A. T., & Rivella, S. (2018). Ineffective erythropoiesis: Anemia and iron overload. Hematology/Oncology Clinics of North America, 32(2), 213–221.CrossRefGoogle Scholar
  5. Halterman, J. S., Kaczorowski, C., Aligne, A., Auinger, P., & Szilagyi, P. G. (2001). Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics, 107, 1381–1386.CrossRefGoogle Scholar
  6. Hughes, R. G., Sharp, D. S., Hughes, M. C., Akau’ola, S., Heinsbroek, P., Velayudhan, R., et al. (2004). Environmental influences on helminthiasis and nutritional status among Pacific schoolchildren. International Journal of Environmental Health Research, 14(3), 163–177.CrossRefGoogle Scholar
  7. Lin, T. F., Huang, J. N., & Cash, H. L. (2017). Comprehensive review of preschool age anemia in the Pacific Island jurisdictions. Hawaii Journal of Medicine and Public Health, 76(12), 331–336.Google Scholar
  8. Lozoff, B., Jimenez, E., Hagen, J., Mollen, E., & Wolf, A. W. K. (2000). Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics, 105, E51.CrossRefGoogle Scholar
  9. McDonagh, M., Blazina, I., Dana, T., et al. (2015) Routine iron supplementation and screening for iron deficiency anemia in children ages 6 to 24 months: A systematic review to update the U.S. Preventative Services Task Force recommendation. Evidence Syntheses, No. 122. Rockville, MD: Agency for Healthcare Research and Quality (US).
  10. Origa, R., Moi, P., Galanello, R., et al. (2013). Alpha-thalassemia. In R. A. Pagon, M. P. Adam, H. H. Ardinger, et al. (Eds), GeneReviews ®. Seattle, WA: University of Washington, Seattle. Updated Nov 21, 2013. Retrieved April 27, 2016, from
  11. Rahman, M., Abe, S. K., Rahman, S., et al. (2016). Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: Systemic review and meta-analysis. American Journal of Clinical Nutrition, 103, 495–504.CrossRefGoogle Scholar
  12. Snyder, R. E., Cunninghan, W., Nakazono, T. T., et al. (2016). Access to medical care reported by Asians and Pacific Islanders in a West Coast Physician Group Association. Medical Care Research and Review, 57, 195–215.Google Scholar
  13. US Department of Commerce. (2012). Northern Marianas Islands: 2010 Census summary report. Retrieved September 21, 2015, from
  14. Weiss, G., & Goodnough, L. T. (2005). Anemia of chronic disease. NEJM, 352, 1011–1023.CrossRefGoogle Scholar
  15. WHO. (2011). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. WHO/NMH/NHD/MNM/11.1. Geneva: World Health Organization. Retrieved October 30, 2017, from
  16. Yip, R. (1998). Recommendations to prevent and control iron deficiency in the United States. MMWR, 47, 1–36.Google Scholar
  17. Yip, R., Walsh, K. M., Goldfarb, M. G., & Binkin, N. J. (1987). Declining prevalence of anemia in childhood in a middle-class setting: A pediatric success story? Pediatrics, 80, 330–334.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Tiffany F. Lin
    • 1
    • 2
    • 3
    Email author
  • James N. Huang
    • 1
    • 2
  • Haley L. Cash
    • 4
  1. 1.UCSF Benioff Children’s HospitalSan FranciscoUSA
  2. 2.Department of PediatricsUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Commonwealth Healthcare CorporationSaipan, Northern Mariana IslandsUSA
  4. 4.Regional Epidemiology UnitPacific Island Health Officers AssociationHonoluluUSA

Personalised recommendations