Prevalence and Associated Risk Factors of Anaemia in Children Aged Six Months to Fifteen Years Admitted to University Teaching Hospital, Lusaka, Zambia
Keywords:
Anaemia, Prevalence, Risk factors, Zambia, Africa
Abstract
Background: Anaemia is a public health problem globally affecting 293.1 million children and 28.5% of these children are in the sub Saharan Africa. The aim of this study was to determine the prevalence of anaemia and the associated risk factors of anaemia in children aged 6 months to 15 years admitted to the University Teaching Hospital. There have been no studies done at University Teaching Hospital to establish the burden of anaemia in children. Methods: A cross sectional study was conducted from July 2016 to December 2016. 351 children were recruited through convenient sampling methods. Data collection sheet was used to collect socio demographic and anthropometry data. The prevalence, associated risk factors of anaemia, and morphological types of anaemia were determined after blood investigations were done. Data analysis was done using SPSS version 21.0. The association between predictors and outcome variables were measured by using by logistic regression and bivariate analysis. Ethical permission was obtained, consent from parents/guardians was taken and confidentiality was maintained. Results: A total of 351 children were studied. The mean age was 3 years (IOR 2-7 years). 45.9% were females and 54.1% were males (P=0.12). The mean cell volume was 74. 5fL.Malnourised children were 37.9% among those who were anaemic as compared to 33.7% in the non-anaemic group.7.4% children had positive malaria by rapid diagnostic test (RDT). 23.8% had a positive sickling test. The prevalence of anaemia was 161/351 (45.9%). Mild, moderate, severe anaemia was 47/161(29%), 86/161(53%) and 28/161(17%) respectively. The age group 6 months to 5 years was the most affected with 59% mildly, 69.8% moderately and 71.4% severely anaemic. On bivariate analysis malnutrition, HIV, malaria, age and sex were not associated with anaemia and there was no statistical difference. Logistic regression analysis revealed that presence of haemoglobin S was the only risk factor independently strongly associated with Anaemia (CI-0.2-0.7), p value-0.001. Conclusion: Anaemia is a health problem at University Teaching hospital and the under-five age group is the most affected. Predictors of mild, moderate and severe anaemia is sickle cell disease. Therefore, improving on early screening of sickle cell disease and investigating the role of iron deficiency anaemia are some of the strategies to be advocated.References
1. Benoist B, McLean E, Egll I, Cogswell M (2008) Worldwide prevalence of Anaemia 19932005: WHO
2. World Health Organization (2009). Global database on Anaemia: Public Health Nutrition, 12:444-454
3. Chatterjee A, Bosch RJ, Kupka R, Hunter DJ, Msamanga GI, Fawzi WW (2010) predictors and consequences of Anaemia among antiretroviral-naïve HIV-infected and HI uninfected children in Tanzania. Public health nutrition, 13:289-296.
4. WHO (2011): Haemoglobin Concentration for the diagnosis of Anaemia and assessment of severity:1-6
5. CDC (1989) Criteria for Anaemia in children and childbearing aged women, Morbidity and mortality weekly report,38(22):400-404
6. World Health Organization Report (2002). Reducing risks, promoting healthy life: 449-93
7. Obonyo C, Steyerber E, Oloo A, Habbema J. (1998). Blood transfusion for severe malaria related Anaemia in Africa: A decision analysis. Am J Trop med Hyg:525-530
8. Lawless J, Latham M, Stephenson L, Kinoti S. (1994). Iron supplementation improves appetite and growth in anaemic Kenyan primary school children. The J Nutrition 124:654
9. Brian BJ, Premji Z, Verhoeff F (2001). Iron deficiency Anaemia: Reexamining the nature and magnitude of the public Health Problem. An analysis of Anaemia and child mortality. World health,131:636-648
10. Brooker S, Akhwale W, Pullen R, Estambale B, Clarke SE, Snow RW, Hotez PJ. (2007). Epidemiology of plasmodium-helminth co infection in Africa: populations at risk, potential impact on Anaemia and prospects for combining control. Am J Trop MedHyg 77:88-98
11. Ekvall H. (2003). Malaria and Anaemia.Curr Opin Haematol 10:108-114
12. Ong’echa J, Keller C, Were T, Ouma C, Otieno R, et al. (2006) Parasitemia, anemia, and malarial anemia in infants and young children in a rural holoendemic plasmodium falciparum transmission area. Am J Trop Med Hyg 74: 376–385.
13. Kraemer K, Zimmermann M (2007) Nutritional anemia: Sight and Life Press Basel.
14. Schellenberg D, Schellenberg JR, Mushi A: The silent burden of Anaemia in Tanzania children, a community-based study. World Health Organ 2003, 81:581-590.
15. Awash S, pande V.K. (1998). Cause specific mortality in under-fives in urban slums of Lucknow, North India.J Trop paediatrics 44:358-361
16. Job C, Calis M, Phiri S. (2008). Severe Anaemia in Malawian children Eng. J Med 2008;358.888-899
17. Newton RC, Warn PA, Winstanley AP, Marsh K. (1997). Severe Anaemia in children living in a malaria endemic area of Kenya. Trop med int health 1997;2 165-78
18. Ashiwini K, Mandar K, Rajnish J, Kalantri S, Ulhar J (2010). Accuracy and reliability of pallor for detecting Anaemia: A Hospital based diagnostic accuracy study. PLOS one 5(1): e8545
19. Stoltzfus R, Michele LD, Marco A, Keith PW, Hababuu MC, Lorenzo S, James T (1990) Clinical pallor is useful to detect severe Anaemia in populations where Anaemia is prevalent and severe Nutr 129(9):1675-81
20. Zucker JR, Lackritz EM, Ruebush TK, Hightower AW, Adungesi JE, Were JB, Metchock KB, Patrick E, Campbell CC (1996). Childhood mortality during and after hospitalization in western Kenya: effects of malaria treatment regimen. Am J. Trop.Med hyg 55:655-660
21. Daly Z. (2015). Prevalence of iron deficiency and correlate of mild, moderateanaemic infants 6 to 11 months; mbala, Northern Province. Zambia electronic thesis or dissertation, university of British Colombia.
22. Uma D, Bhabani SD, Mohan CR, Pramod KR (2003). Effect of iron supplement on mild to moderate anaemia. Britishjou of Nutr 90,541-550
23. Chatterjee A, Bosch RJ, Kupka R, Hunter DJ. Predictors and consequences of Anaemia among antiretroviral naïve HIV-infected and HIV-uninfected children in Tanzania.publi health nutrition 2010, 13:289-296.
24. Makubi AN, Mugushi F, Magesa PM, Roberts D. (2012) Risk factors for Anaemia among HIV infected children attending care and treatment clinic at muhimbili National Hospital in dar es salaam, Tanzania.Health2012,14:1-9
25. Ngesa O Mwambi (2014). Prevalence and risk factors of Anaemia among children aged 6 months and 14 years in Kenya. Plos one9(11): ell3726.cloi: 10.1371/journal.pon.0113756
26. Luo C, Mwela CM, Campbell J (1999). National baseline survey on prevalence and Aetiology of Anaemia in Zambia. Random cluster survey involving children, women and men
27. Vilamor E, Mbise R, Spieglman D, Ndossi Vitamin A Supplementation and other predictor of Anaemia among children from Dar es salaam, Tanzania. The American journal of tropical medicine and hygiene 2000,62:590-597
28. Crawley J (2004). Reducing the burden of Anaemia in infants and young children in malaria endemic countries of Africa: from evidence to action. Am J Trop Med Hyg 2004:71-:25-34
29. UN/ACC/SCN.4th Report on world nutrition situation ACC/SCN, Geneva,2000
30. Angus BJ, White NJ. (1997). Vivo removal of malaria parasite from red blood cells without their destruction in acute falciparum malaria blood: 90:2037-40
31. Phillis RE, Parvol G (1992). Anaemia of plasmodium falciparum malaria. Bailliers clini Haematol 1992; 5,315-30
32. Hilgar M (2012) Hematological manifestation in HIV infected children paediatric 191,119:547-549
33. Tovo AP, De martino M, Gabiano C, Cappello N, Loy A, D’Elia R, Plebani A, Zuccotti GV, Dallacasa P, Ferraris G. (1992) Prognostic factors and survival in children with perinatal HIV infection: lancet 1992:1249-1253
34. Coyle TE (1997) Hematologic complications of human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Med clin AM.81:449-470
35. Matt TT.et al. (2003) Micronutrient status of primary school girls in rural and urban areas of south Vietnam, asia.pac J clin nutr 12:178-185
36. Sinha N. (2008) Epidemiology correlates of nutritional Anaemia among children,6-35 months, in rural wardha, central India. Indian Jmed sc62:45-54
37. Mouneke V, Ibekur R etal. (2012) Factors associated with mortality in the under five children with Anaemia in Ebonyi, Nigeria. Indian paediatric 49:119-123
38. Villamer, E (2007) Vitamin A supplement and other predictors of Anaemia among children. Dar-es-salaam. American journal of tropical medicine and hygiene 2007,62:590-597
39. Magalhaels RJ, (2011) Mapping the risk of Anaemia in preschool age children: the contribution of malaria, helminth infection in west Africa.p20 med 2100<8: e1000 438
40. Owusu-Agyei S, Chandramohan D, Fryauff DJ, Koram KA, Binka FN, Nkrumah FK, Hoffman SL, Utz GC (2002) Characteristics of severe Anaemia and its association with malaria in young children of kassena nankana district of northern Ghana.AMJ trop med hyg 67:371-377
41. Brabin B, Premji Z, Verhoeff (2001) An analysis of anaemia and child mortality. The JNutri 131:6365-6485
42. Akhwale WS, Obonyo C, Lum JK, Kaneko A, Eto H, Bjorkman A, kobayakawa T (2004) Anaemia and malaria at different altitudes in west highlands of Kenya acta trop 91:167-175
43. Magalhaes R, Clements A (2011) Mapping the risk of anaemia in preschool age children, the contribution of malnutrition, malaria and helminth infections in west Africa plos med 8: el000438
44. Bukele G, Wondimagegn A, Yaregal A, Lealem G (2014) Anaemia and associated factors among school age children, southern ethopia.BMC Haematology 14:13
45. Mohammad SE, Awad EE, Ahmed AM, Abbas A (2014) prevalence of anaemia among schools(khalawi) in central Sudan, a cross sectional study. Pan afrc.med journal
46. Ughasoro MI, Emodi I, Ibe BC (2011) prevalence of moderate and severe anaemia in Children under five at university of Nigeria Teaching Hospital, Enugu, south east Nigeria. Paediatric research, PR 2011 714
47. Simbauranga RH, Kamugisha E, Hokororo A, Kidenya BR, Makani J (2015) prevalence and factors associated with severe anaemia among under five children hospitalized at Bugando Medical Center, Mwanza, Tanzania. BMC Haematology 2015 15:13
48. Kuziga F, Yeka A (2017) prevalence and factors associated with Anaemia among children aged 6 to 59 months in Namuluna District, Uganda. A cross sectional study.BMC paediatrics ISSN:1471-2431.
49. Brian SE, Alan AS, Gregory DH (2002) A prospective cross-sectional study of Anaemia and peripheral iron status in HIV infected children in cape town, south Africa. BMC infectious disease 2002:2-3
50. Rosemary F, Eliane SC, Ana Paula CP (2010) Prevalence of Anaemia in under 5 children in a children’s Hospital in Recife, Brazil. Rev Bras Hematol Hemoter 2011:33(2):100-104
51. Quinto L, Aponte JJ, Menedez C, Navia MM, Thompson R, Alonso PL (2006) Relationship between Hemoglobin and Hematocrit in the definition of anaemia. Trop Med inter Health 2006 aug;11(8) 1295-302
52. Qasem A, Friel J (2015) An Overview of Iron in term breastfed infants. Clinical medicine insights Paediatrics 2015:9 79-84
53. Osazuwa F (2011) A significant association between intestinal infection and Anaemia burden in children in rural communities of Edo state, Nigerian Am J Med sci.2011;3(1):30-34
54. Samson A, Ogbenna A (2016) Morphologic evaluation of Anaemia. I. Biomed (Aligarh)8:322; doi 10.4172/0974 8369,1000322
2. World Health Organization (2009). Global database on Anaemia: Public Health Nutrition, 12:444-454
3. Chatterjee A, Bosch RJ, Kupka R, Hunter DJ, Msamanga GI, Fawzi WW (2010) predictors and consequences of Anaemia among antiretroviral-naïve HIV-infected and HI uninfected children in Tanzania. Public health nutrition, 13:289-296.
4. WHO (2011): Haemoglobin Concentration for the diagnosis of Anaemia and assessment of severity:1-6
5. CDC (1989) Criteria for Anaemia in children and childbearing aged women, Morbidity and mortality weekly report,38(22):400-404
6. World Health Organization Report (2002). Reducing risks, promoting healthy life: 449-93
7. Obonyo C, Steyerber E, Oloo A, Habbema J. (1998). Blood transfusion for severe malaria related Anaemia in Africa: A decision analysis. Am J Trop med Hyg:525-530
8. Lawless J, Latham M, Stephenson L, Kinoti S. (1994). Iron supplementation improves appetite and growth in anaemic Kenyan primary school children. The J Nutrition 124:654
9. Brian BJ, Premji Z, Verhoeff F (2001). Iron deficiency Anaemia: Reexamining the nature and magnitude of the public Health Problem. An analysis of Anaemia and child mortality. World health,131:636-648
10. Brooker S, Akhwale W, Pullen R, Estambale B, Clarke SE, Snow RW, Hotez PJ. (2007). Epidemiology of plasmodium-helminth co infection in Africa: populations at risk, potential impact on Anaemia and prospects for combining control. Am J Trop MedHyg 77:88-98
11. Ekvall H. (2003). Malaria and Anaemia.Curr Opin Haematol 10:108-114
12. Ong’echa J, Keller C, Were T, Ouma C, Otieno R, et al. (2006) Parasitemia, anemia, and malarial anemia in infants and young children in a rural holoendemic plasmodium falciparum transmission area. Am J Trop Med Hyg 74: 376–385.
13. Kraemer K, Zimmermann M (2007) Nutritional anemia: Sight and Life Press Basel.
14. Schellenberg D, Schellenberg JR, Mushi A: The silent burden of Anaemia in Tanzania children, a community-based study. World Health Organ 2003, 81:581-590.
15. Awash S, pande V.K. (1998). Cause specific mortality in under-fives in urban slums of Lucknow, North India.J Trop paediatrics 44:358-361
16. Job C, Calis M, Phiri S. (2008). Severe Anaemia in Malawian children Eng. J Med 2008;358.888-899
17. Newton RC, Warn PA, Winstanley AP, Marsh K. (1997). Severe Anaemia in children living in a malaria endemic area of Kenya. Trop med int health 1997;2 165-78
18. Ashiwini K, Mandar K, Rajnish J, Kalantri S, Ulhar J (2010). Accuracy and reliability of pallor for detecting Anaemia: A Hospital based diagnostic accuracy study. PLOS one 5(1): e8545
19. Stoltzfus R, Michele LD, Marco A, Keith PW, Hababuu MC, Lorenzo S, James T (1990) Clinical pallor is useful to detect severe Anaemia in populations where Anaemia is prevalent and severe Nutr 129(9):1675-81
20. Zucker JR, Lackritz EM, Ruebush TK, Hightower AW, Adungesi JE, Were JB, Metchock KB, Patrick E, Campbell CC (1996). Childhood mortality during and after hospitalization in western Kenya: effects of malaria treatment regimen. Am J. Trop.Med hyg 55:655-660
21. Daly Z. (2015). Prevalence of iron deficiency and correlate of mild, moderateanaemic infants 6 to 11 months; mbala, Northern Province. Zambia electronic thesis or dissertation, university of British Colombia.
22. Uma D, Bhabani SD, Mohan CR, Pramod KR (2003). Effect of iron supplement on mild to moderate anaemia. Britishjou of Nutr 90,541-550
23. Chatterjee A, Bosch RJ, Kupka R, Hunter DJ. Predictors and consequences of Anaemia among antiretroviral naïve HIV-infected and HIV-uninfected children in Tanzania.publi health nutrition 2010, 13:289-296.
24. Makubi AN, Mugushi F, Magesa PM, Roberts D. (2012) Risk factors for Anaemia among HIV infected children attending care and treatment clinic at muhimbili National Hospital in dar es salaam, Tanzania.Health2012,14:1-9
25. Ngesa O Mwambi (2014). Prevalence and risk factors of Anaemia among children aged 6 months and 14 years in Kenya. Plos one9(11): ell3726.cloi: 10.1371/journal.pon.0113756
26. Luo C, Mwela CM, Campbell J (1999). National baseline survey on prevalence and Aetiology of Anaemia in Zambia. Random cluster survey involving children, women and men
27. Vilamor E, Mbise R, Spieglman D, Ndossi Vitamin A Supplementation and other predictor of Anaemia among children from Dar es salaam, Tanzania. The American journal of tropical medicine and hygiene 2000,62:590-597
28. Crawley J (2004). Reducing the burden of Anaemia in infants and young children in malaria endemic countries of Africa: from evidence to action. Am J Trop Med Hyg 2004:71-:25-34
29. UN/ACC/SCN.4th Report on world nutrition situation ACC/SCN, Geneva,2000
30. Angus BJ, White NJ. (1997). Vivo removal of malaria parasite from red blood cells without their destruction in acute falciparum malaria blood: 90:2037-40
31. Phillis RE, Parvol G (1992). Anaemia of plasmodium falciparum malaria. Bailliers clini Haematol 1992; 5,315-30
32. Hilgar M (2012) Hematological manifestation in HIV infected children paediatric 191,119:547-549
33. Tovo AP, De martino M, Gabiano C, Cappello N, Loy A, D’Elia R, Plebani A, Zuccotti GV, Dallacasa P, Ferraris G. (1992) Prognostic factors and survival in children with perinatal HIV infection: lancet 1992:1249-1253
34. Coyle TE (1997) Hematologic complications of human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Med clin AM.81:449-470
35. Matt TT.et al. (2003) Micronutrient status of primary school girls in rural and urban areas of south Vietnam, asia.pac J clin nutr 12:178-185
36. Sinha N. (2008) Epidemiology correlates of nutritional Anaemia among children,6-35 months, in rural wardha, central India. Indian Jmed sc62:45-54
37. Mouneke V, Ibekur R etal. (2012) Factors associated with mortality in the under five children with Anaemia in Ebonyi, Nigeria. Indian paediatric 49:119-123
38. Villamer, E (2007) Vitamin A supplement and other predictors of Anaemia among children. Dar-es-salaam. American journal of tropical medicine and hygiene 2007,62:590-597
39. Magalhaels RJ, (2011) Mapping the risk of Anaemia in preschool age children: the contribution of malaria, helminth infection in west Africa.p20 med 2100<8: e1000 438
40. Owusu-Agyei S, Chandramohan D, Fryauff DJ, Koram KA, Binka FN, Nkrumah FK, Hoffman SL, Utz GC (2002) Characteristics of severe Anaemia and its association with malaria in young children of kassena nankana district of northern Ghana.AMJ trop med hyg 67:371-377
41. Brabin B, Premji Z, Verhoeff (2001) An analysis of anaemia and child mortality. The JNutri 131:6365-6485
42. Akhwale WS, Obonyo C, Lum JK, Kaneko A, Eto H, Bjorkman A, kobayakawa T (2004) Anaemia and malaria at different altitudes in west highlands of Kenya acta trop 91:167-175
43. Magalhaes R, Clements A (2011) Mapping the risk of anaemia in preschool age children, the contribution of malnutrition, malaria and helminth infections in west Africa plos med 8: el000438
44. Bukele G, Wondimagegn A, Yaregal A, Lealem G (2014) Anaemia and associated factors among school age children, southern ethopia.BMC Haematology 14:13
45. Mohammad SE, Awad EE, Ahmed AM, Abbas A (2014) prevalence of anaemia among schools(khalawi) in central Sudan, a cross sectional study. Pan afrc.med journal
46. Ughasoro MI, Emodi I, Ibe BC (2011) prevalence of moderate and severe anaemia in Children under five at university of Nigeria Teaching Hospital, Enugu, south east Nigeria. Paediatric research, PR 2011 714
47. Simbauranga RH, Kamugisha E, Hokororo A, Kidenya BR, Makani J (2015) prevalence and factors associated with severe anaemia among under five children hospitalized at Bugando Medical Center, Mwanza, Tanzania. BMC Haematology 2015 15:13
48. Kuziga F, Yeka A (2017) prevalence and factors associated with Anaemia among children aged 6 to 59 months in Namuluna District, Uganda. A cross sectional study.BMC paediatrics ISSN:1471-2431.
49. Brian SE, Alan AS, Gregory DH (2002) A prospective cross-sectional study of Anaemia and peripheral iron status in HIV infected children in cape town, south Africa. BMC infectious disease 2002:2-3
50. Rosemary F, Eliane SC, Ana Paula CP (2010) Prevalence of Anaemia in under 5 children in a children’s Hospital in Recife, Brazil. Rev Bras Hematol Hemoter 2011:33(2):100-104
51. Quinto L, Aponte JJ, Menedez C, Navia MM, Thompson R, Alonso PL (2006) Relationship between Hemoglobin and Hematocrit in the definition of anaemia. Trop Med inter Health 2006 aug;11(8) 1295-302
52. Qasem A, Friel J (2015) An Overview of Iron in term breastfed infants. Clinical medicine insights Paediatrics 2015:9 79-84
53. Osazuwa F (2011) A significant association between intestinal infection and Anaemia burden in children in rural communities of Edo state, Nigerian Am J Med sci.2011;3(1):30-34
54. Samson A, Ogbenna A (2016) Morphologic evaluation of Anaemia. I. Biomed (Aligarh)8:322; doi 10.4172/0974 8369,1000322
Published
2020-03-31
How to Cite
1.
Inambao M, Mulenga V. Prevalence and Associated Risk Factors of Anaemia in Children Aged Six Months to Fifteen Years Admitted to University Teaching Hospital, Lusaka, Zambia. Journal of Agricultural and Biomedical Sciences [Internet]. 31Mar.2020 [cited 21Nov.2024];4(1):10-1. Available from: https://alumni.unza.zm/index.php/JABS/article/view/351
Section
Biomedical Sciences
Copyright: ©️ JABS. Articles in this journal are distributed under the terms of the Creative Commons Attribution License Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.