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Malawi Medical Journal
College of Medicine, University of Malawi and Medical Association of Malawi
ISSN: 1995-7262
Vol. 28, No. 3, 2017, pp. 99-107
Bioline Code: mm16027
Full paper language: English
Document type: Reprinted Article
Document available free of charge

Malawi Medical Journal, Vol. 28, No. 3, 2017, pp. 99-107

 en 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

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−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.
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.

 
© Copyright 2016 - Malawi Medical Journal
Alternative site location: http://revista.uft.edu.br/index.php/jbb/index

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