Risk factors for presentation to hospital with severe anaemia in Tanzanian children: a case–control study

Abstract

SummaryIn malaria endemic areas anaemia is a usually silent condition that nevertheless places a considerable burden on health services. Cases of severe anaemia often require hospitalization and blood transfusions. The objective of this study was to assess risk factors for admission with anaemia to facilitate the design of anaemia control programmes. We conducted a prospective case-control study of children aged 2-59 months admitted to a district hospital in southern Tanzania. There were 216 cases of severe anaemia [packed cell volume (PCV) < 25%] and 234 age-matched controls (PCV ‡ 25%). Most cases [55.6% (n ¼ 120)] were < 1 year of age. Anaemia was significantly associated with the educational level of parents, type of accommodation, health-seeking behaviour, the child's nutritional status and recent and current medical history. Of these, the single most important factor was Plasmodium falciparum parasitaemia [OR 4.3, 95% confidence interval (CI) 2.9-6.5, P < 0.001]. Multivariate analysis showed that increased recent health expenditure [OR 2.2 (95% CI 1.3-3.9), P ¼ 0.005], malnutrition [OR 2.4 (95%CI 1.3-4.3), P < 0.001], living > 10 km from the hospital [OR 3.0 (95% CI 1.9-4.9), P < 0.001], a history of previous blood transfusion [OR 3.8 (95% CI 1.7-9.1), P < 0.001] and P. falciparum parasitaemia 3), P < 0.001] were independently related to risk of being admitted with anaemia. These findings are considered in terms of the pathophysiological pathway leading to anaemia. The concentration of anaemia in infants and problems of access to health services and adequate case management underline the need for targeted preventive strategies for anaemia control.

The effects of co-infection with human parvovirus B19 and Plasmodium falciparum on type and degree of anaemia in Ghanaian children

“…In a more recent study from Ifakara, Tanzania, however, a larger range of risk factors for hospitalisation for anaemia were listed. These included, malnutrition, Plasmodium falciparum (P. falciparum) infection, living>10 km from the hospital, a history of previous blood transfusion and increased recent health expenditure [19] .…”

“…Elution of viral DNA was done with 50 μL of elution buffer according to the manufacturer's instructions. 19 DNA was detected using a modified form of an in-house semi-nested PCR described earlier [71] . The semi-nested PCR targeted the C-terminal part of the VP1u region with a product size of 358 bp using outer primers GAPS 5'-ATG GAC AGT TAT CTG ACC ACC CCC-3' (fwd) and USTO 5'-GCT GGG GTA TTT TTC CGA GGC GT-3' (rev) and inner primer GAPSi 5'-GTA TTA TCT AGT GAA GAC TTA CAC AAG CCT GGG-3' (fwd) located within the VP1u region.…”

Significance of Travel to Rural Areas as a Risk Factor for Malarial Anemia in an Urban Setting

“…14 These factors have been linked in various locations to CM 15 and severe anemia. 16 Duration of symptoms and distance to hospital have in several cases been identified as risk factors for severe malaria and severe anemia. 10 , 16 Investigations of insecticide-treated bed net (ITN) use and severe malaria are more extensive, but also provide conflicting results.…”

“…17 , 18 Protective effects for bed nets have been observed for anemia in Malawi 19 and severe anemia in Tanzania. 16 Bed nets were shown to increase hemoglobin levels and reduce SMA in western Kenya 20 and to reduce malaria cases in Malawi, where ITNs were socially marketed. 21 Further research is needed to clarify the different effects of socioeconomic and environmental risk factors on severe malaria occurrence.…”

Causal impact of malnutrition on mortality among adults hospitalized for medical illness in sub-Saharan Africa: what is the role of severe sepsis?

“…However, there is reason to suspect a causal effect of malnutrition on mortality. Since malnutrition increases susceptibility to infection [11][12][13][14], malnourished patients may be at higher risk of infectious complications such as severe sepsis, which can lead to death [15]. Malnutrition could also increase mortality through hypoglycemia, hypothermia, and anemia [15][16][17].…”