World Health Organization’s Growth Reference Overestimates the Prevalence of Severe Malnutrition in Children with Sickle Cell Anemia in Africa

Abstract

Anthropometric indices are widely used to assess the health and nutritional status of children. We tested the hypothesis that the 2007 World Health Organization (WHO) reference for assessment of malnutrition in children with sickle cell anemia (SCA) overestimates the prevalence of severe malnutrition when compared to a previously constructed SCA-specific reference. We applied the WHO and SCA-specific references to children with SCA aged 5–12 years living in northern Nigeria (Primary Prevention of Stroke in Children with SCA in sub-Saharan Africa (SPRING) trial) to determine the difference in prevalence of severe malnutrition defined as body mass index (BMI) Z-score <−3 and whether severe malnutrition was associated with lower mean hemoglobin levels or abnormal transcranial Doppler measurements (>200 cm/s). A total of 799 children were included in the final analysis (median age 8.2 years (interquartile range (IQR) 6.4–10.4)). The application of the WHO reference resulted in lower mean BMI than the SCA-specific reference (−2.3 versus −1.2; p < 0.001, respectively). The use of the WHO reference when compared to the SCA-specific reference population also resulted in a higher prevalence of severe malnutrition (28.6% vs. 6.4%; p < 0.001). The WHO reference significantly overestimates the prevalence of severe malnutrition in children with SCA when compared to an SCA-specific reference. Regardless of the reference population, severe malnutrition was not associated with lower mean hemoglobin levels or abnormal transcranial Doppler (TCD) measurements.

The Lancet Nigeria Commission: investing in health and the future of the nation

“…Programmes have been able to increase the uptake of skilled maternal health attendants and encourage the use of facility-based maternal and child health services, 82 reduce mother to child HIV transmission, 83 prevent strokes in children with sickle-cell disease, 84 , 85 and generally improve collaboration and promote uptake of evidence-based interventions. 86 , 87 , 88 …”

“…Programmes have been able to increase the uptake of skilled maternal health attendants and encourage the use of facility-based maternal and child health services, 82 reduce mother to child HIV transmission, 83 prevent strokes in children with sickle-cell disease, 84,85 and generally improve collaboration and promote uptake of evidence-based interventions. [86][87][88] Nonetheless, rates are well above the levels required to meet SDG 3•1 and 3•2 to substantially reduce maternal, neonatal, and child mortality. UN estimates of neonatal mortality in 2019 were of 36 per 1000 livebirths and GBD estimates of 49 per 1000 livebirths, both at levels far above the targets.…”

Low educational level of head of household, as a proxy for poverty, is associated with severe anaemia among children with sickle cell disease living in a low‐resource setting: evidence from the SPRING trial

“…Our unanticipated finding suggests that BMI has no impact on the severity of anaemia. Similarly, our group recently reported that there was no significant association between severe malnutrition (using BMI) and low haemoglobin 31 …”

“…Similarly, our group recently reported that there was no significant association between severe malnutrition (using BMI) and low haemoglobin. 31 As expected with cross-sectional study design, our study has limitations. Due to its cross-sectional design, we were unable to ascertain the causes of severe anaemia and the clinical impact of severe anaemia on overall health, disease severity and mortality.…”

Perfil epidemiológico e clínico de usuários do centro municipal de referência de indivíduos com doença falciforme em Feira de Santana/Bahia

“…Portanto, os indivíduos em situação socioeconômica vulnerável merecem atenção especial no que diz respeito às perspectivas médica e psicossocial, visto estarem mais expostos aos fatores sociais determinantes da DF (Paiva e Silva et al, 1993). Essa condição é relatada por Ghafuri et al (2020) ao sinalizarem a necessidade de recursos para tratamento e gerenciamento da desnutrição em crianças nigerianas com AF. Assim, é possível inferir que a mesma necessidade pode ser atribuída às crianças brasileiras, visto que a desnutrição, apesar de cada vez menor, ainda é um problema social relevante no país.…”