Severe anemia in Malawian children|
Calis, Job C.J.; Phiri, Kamija S.; Faragher, E. Brian; Brabin, Bernard J.; Bates, Imelda; Cuevas, Luis E.; Haan, Rob J. de; Phiri, Ajib I.; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul J.M.; Lieshout, Lisette van; Beld, Marcel G.H.M; Teo, Yik Y.; Rockett, Kirk A.; Richardson, Anna; Kwiatkowski, Dominic P.; Molyneux, Malcolm E. & Hensbroek, Michaël Boele van
Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been
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.
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−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 B12 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.
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.