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Severe anemia in Malawian children

Calis, J. C. J., Phiri, K. S., Faragher, Brian, Brabin, Bernard, Bates, Imelda ORCID: https://orcid.org/0000-0002-0862-8199, Cuevas, Luis ORCID: https://orcid.org/0000-0002-6581-0587, de Haan, R. J., Phiri, A. I., Malange, P., Khoka, M., Hulshof, P. J. M., van Lieshout, L., Beld, M. G. H. M., Teo, Y. Y., Rockett, K. A., Richardson, A., Kwiatkowski, D. P., Molyneux, Malcolm E and Boele van Hensbroek, Michael (2008) 'Severe anemia in Malawian children'. New England Journal of Medicine, Vol 358, Issue 9, pp. 888-899.

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Abstract

Background 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.
Methods 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.
Results 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 G6PD(sup -202/-376) 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) 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.
Conclusions 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: vitamin-a supplementation young-children severe malaria salmonella bacteremia plasmodium-falciparum ancylostoma-duodenale necator-americanus blood-transfusion northern ghana iron status
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WS Pediatrics > Diseases of Children and Adolescents > General Diseases > WS 200 General works
WS Pediatrics > WS 20 Research (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WD Disorders of Systemic, Metabolic or Environmental Origin, etc > Nutrition Disorders > WD 105 Deficiency diseases
WS Pediatrics > WS 100 General works
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 300 Hemic and lymphatic system
WH Hemic and Lymphatic Systems > WH 100 General works
Digital Object Identifer (DOI): https://doi.org/10.1056/NEJMoa072727
Depositing User: Users 43 not found.
Date Deposited: 24 Jun 2010 13:25
Last Modified: 23 Nov 2018 11:44
URI: http://archive.lstmed.ac.uk/id/eprint/745

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