Severe anemia in Malawian children



Calis, Job CJ, Phiri, Kamija S, Faragher, E Brian, Brabin, Bernard J, Bates, Imelda, Cuevas, Luis E, de Haan, Rob J, Phiri, Ajib I, Malange, Pelani, Khoka, Mirriam
et al (show 9 more authors) (2008) Severe anemia in Malawian children. NEW ENGLAND JOURNAL OF MEDICINE, 358 (9). pp. 888-899.

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Abstract

<h4>Background</h4>Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied.<h4>Methods</h4>We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool children without severe anemia in urban and rural settings in Malawi. Causal factors previously associated with severe anemia were studied. The data were examined by multivariate analysis and structural equation modeling.<h4>Results</h4>Bacteremia (adjusted odds ratio, 5.3; 95% confidence interval [CI], 2.6 to 10.9), malaria (adjusted odds ratio, 2.3; 95% CI, 1.6 to 3.3), hookworm (adjusted odds ratio, 4.8; 95% CI, 2.0 to 11.8), human immunodeficiency virus infection (adjusted odds ratio, 2.0; 95% CI, 1.0 to 3.8), the <i>G6PD</i><sup>-202/-376</sup> genetic disorder (adjusted odds ratio, 2.4; 95% CI, 1.3 to 4.4), vitamin A deficiency (adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.8), and vitamin B<sub>12</sub> deficiency (adjusted odds ratio, 2.2; 95% CI, 1.4 to 3.6) were associated with severe anemia. Folate deficiency, sickle cell disease, and laboratory signs of an abnormal inflammatory response were uncommon. Iron deficiency was not prevalent in case patients (adjusted odds ratio, 0.37; 95% CI, 0.22 to 0.60) and was negatively associated with bacteremia. Malaria was associated with severe anemia in the urban site (with seasonal transmission) but not in the rural site (where malaria was holoendemic). Seventy-six percent of hookworm infections were found in children under 2 years of age.<h4>Conclusions</h4>There are multiple causes of severe anemia in Malawian preschool children, but folate and iron deficiencies are not prominent among them. Even in the presence of malaria parasites, additional or alternative causes of severe anemia should be considered.

Item Type: Article
Uncontrolled Keywords: 3207 Medical Microbiology, 32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, Clinical Research, Nutrition, Infectious Diseases, Pediatric, Orphan Drug, Rare Diseases, Vector-Borne Diseases, Malaria, Hematology, 2.1 Biological and endogenous factors, 2 Aetiology, Infection, 3 Good Health and Well Being, Anemia, Anemia, Iron-Deficiency, Bacteremia, Case-Control Studies, Causality, Child, Preschool, Female, Glucosephosphate Dehydrogenase, HIV Infections, Hookworm Infections, Humans, Infant, Malaria, Malawi, Male, Multivariate Analysis, Nutrition Disorders, Odds Ratio, Severity of Illness Index
Depositing User: Symplectic Admin
Date Deposited: 15 Nov 2017 08:00
Last Modified: 22 Jun 2024 01:08
DOI: 10.1056/NEJMoa072727
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3012157