Prevalence and significance of anaemia in childhood bacterial meningitis: a secondary analysis of prospectively collected data from clinical trials in Finland, Latin America and Angola

Abstract

ObjectivesTo describe the prevalence and severity of anaemia and to examine its associations with outcome in children with bacterial meningitis (BM).DesignSecondary analysis of descriptive data from five randomised BM treatment trials.SettingHospitals in Finland, Latin America and Angola.ParticipantsConsecutive children from 2 months to 15 years of age admitted with BM and who had haemoglobin (Hb) measured on admission.Outcome measuresPrevalence and degree of anaemia using the WHO criteria, and their associations with recovery with sequelae or death.ResultsThe median Hb was 11.8 g/dL in Finland (N=341), 9.2 g/dL in Latin America (N=597) and 7.6 g/dL in Angola (N=1085). Of the children, 79% had anaemia, which was severe in 29%, moderate in 58% and mild in 13% of cases. Besides study area, having anaemia was independently associated with age <1 year, treatment delay >3 days, weight-for-age z-score <−3 and other than meningococcal aetiology. Irrespective of the study area, anaemia correlated with the markers of disease severity. In children with severe to moderate anaemia (vs mild or no anaemia), the risk ratio for death was 3.38 and for death or severe sequelae was 3.07.ConclusionAnaemia, mostly moderate, was common in children with BM, especially in Angola, in underweight children, among those with treatment delay, and in pneumococcal meningitis. Poor outcome was associated with anaemia in all three continents.Trial registration numberThe registration numbers of Angolan trials were ISRCTN62824827 and NCT01540838.

Combination of Hemoglobin-for-Age Z-Score and Plasma Hepcidin Identified as a Novel Predictor for Kawasaki Disease

“…Hemoglobin levels are decreased in FC [ 20 ], and anemia, mostly moderate, is a common presentation in children with bacterial meningitis, and it is also associated with poor outcomes [ 53 ]. Shi et al found that children in ICU with lower hemoglobin levels have higher mortality in severe community-acquired pneumonia [ 54 ].…”

The Effect of Blood Transfusion on the Survival of Children with Both Severe Anemia and Bacterial Meningitis

“…1,2 Moderate to severe anemia is a known complication in severe disease and triples the odds for death in childhood bacterial meningitis (BM). 1,2 The principal causes of anemia in sub-Saharan Africa, in order of importance, but often combined, include malaria, other parasitic infections, sickle cell disease, undernutrition, and inadequate iron intake. 3 Opposite to the other risks for adverse outcomes from BM, severe anemia is mitigable or reversable by blood transfusion.…”

“…In sub-Saharan Africa, anemia is highly prevalent in children. 1 , 2 Moderate to severe anemia is a known complication in severe disease and triples the odds for death in childhood bacterial meningitis (BM). 1 , 2 The principal causes of anemia in sub-Saharan Africa, in order of importance, but often combined, include malaria, other parasitic infections, sickle cell disease, undernutrition, and inadequate iron intake.…”