A STUDY OF SEVERE ANAEMIA IN CHILDREN IN A TERTIARY HEALTH CARE INSTITUTE

Main Article Content

Quratulain Ali
Ikram Ullah Khan
Zeeshan Ahmad
Sobia Junaid
Muhammad Daud
Sami Ullah
Haseeb Khan
Hafiza Rakhshan Urooj

Keywords

Severe anaemia, children, paediatric health, tertiary healthcare, prevalence, haematological disorders, nutritional deficiencies

Abstract

Anaemia, characterized by a deficiency of red blood cells or haemoglobin, remains a significant global health concern, particularly affecting vulnerable populations such as children. This study explores the broader landscape of severe anaemia in paediatric patients, focusing on a tertiary healthcare institute. Understanding the prevalence, contributing factors, and treatment outcomes is crucial for informing targeted interventions and improving the overall health outcomes of children grappling with this condition.


Methodology: This study investigated severe anaemia in paediatric patients admitted to Ayub Medical Complex, Abbottabad, Pakistan, spanning 2018-2022. Our research involved demographic characteristics, clinical features, laboratory parameters, treatment modalities, and etiological contributors. Examining records of 180 children (0-12 years) with confirmed severe anaemia, the study employed statistical analyses (t-tests, ANOVA, regression) and considers ethical guidelines. Data encompass patient demographics, clinical history, laboratory results, and treatment modalities.


Results: The mean age of participants is 7.5 years, reflecting a diverse age distribution. Clinical analysis identifies pre-existing chronic illnesses (16.7%), genetic disorders (8.3%), and malnutrition (13.9%). Compliance with iron supplementation is notable at 61.1%. Statistical tests reveal significant differences in haemoglobin levels and red blood cell indices among subgroups. Correlation analysis indicates a positive correlation (0.35) between iron studies and other variables. Multiple linear regression predicts haemoglobin levels (R-squared = 0.45) using vitamin B12 and folate. Etiological assessment unveils a multifactorial landscape with haematological disorders (40%), nutritional deficiencies (30%), infectious diseases (15%), and socioeconomic factors (20%) playing significant roles.


Conclusion: The study provides a comprehensive understanding of severe anaemia in paediatric patients, emphasizing demographic diversity, clinical intricacies, and multifactorial etiology. Treatment modalities, statistical analyses, and ethical considerations enrich the findings, offering valuable insights for tailored interventions and improved patient care.

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References

[1] Mason J, Bailes A, Beda-Andourou M, Copeland N, Curtis T, Deitchler M, et al. Recent Trends in Malnutrition in Developing Regions: Vitamin A Deficiency, Anemia, Iodine Deficiency, and Child Underweight. Food Nutr Bull 2005;26:59–108. https://doi.org/10.1177/156482650502600108.
[2] Varghese J, Thomas T, Kurpad A. Evaluation of haemoglobin cut-off for mild anaemia in Asians - analysis of multiple rounds of two national nutrition surveys. Indian Journal of Medical Research 2019;150:385. https://doi.org/10.4103/ijmr.IJMR_334_18.
[3] Sultana MS, Rahman MR, Wahab MA, Ul Alam MM. Prevalence of Anaemia Based on Haemoglobin Levels among Under Five Years Children in Combined Military Hospital, Sylhet. Journal of Armed Forces Medical College, Bangladesh 2021;16:76–9. https://doi.org/10.3329/jafmc.v16i2.55305.
[4] McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr 2009;12:444. https://doi.org/10.1017/S1368980008002401.
[5] Tusa BS, Weldesenbet AB, Kebede SA. Spatial distribution and associated factors of underweight in Ethiopia: An analysis of Ethiopian demographic and health survey, 2016. PLoS One 2020;15:e0242744. https://doi.org/10.1371/journal.pone.0242744.
[6] Goel TC, Goel A. Prevention and Control. Lymphatic Filariasis, Singapore: Springer Singapore; 2016, p. 87–94. https://doi.org/10.1007/978-981-10-2257-9_9.
[7] Khan JR, Awan N, Misu F. Determinants of anemia among 6–59 months aged children in Bangladesh: evidence from nationally representative data. BMC Pediatr 2016;16:3. https://doi.org/10.1186/s12887-015-0536-z.
[8] Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. The Lancet 2016;387:907–16. https://doi.org/10.1016/S0140-6736(15)60865-0.
[9] Hare DJ, Cardoso BR, Szymlek-Gay EA, Biggs B-A. Neurological effects of iron supplementation in infancy: finding the balance between health and harm in iron-replete infants. Lancet Child Adolesc Health 2018;2:144–56. https://doi.org/10.1016/S2352-4642(17)30159-1.
[10] Janus J, Moerschel SK. Evaluation of anemia in children. Am Fam Physician 2010;81:1462–71.
[11] Woldie H, Kebede Y, Tariku A. Factors Associated with Anemia among Children Aged 6–23 Months Attending Growth Monitoring at Tsitsika Health Center, Wag-Himra Zone, Northeast Ethiopia. J Nutr Metab 2015;2015:1–9. https://doi.org/10.1155/2015/928632.
[12] Ngesa O, Mwambi H. Prevalence and Risk Factors of Anaemia among Children Aged between 6 Months and 14 Years in Kenya. PLoS One 2014;9:e113756. https://doi.org/10.1371/journal.pone.0113756.
[13] Cardoso MA, Scopel KKG, Muniz PT, Villamor E, Ferreira MU. Underlying Factors Associated with Anemia in Amazonian Children: A Population-Based, Cross-Sectional Study. PLoS One 2012;7:e36341. https://doi.org/10.1371/journal.pone.0036341.
[14] Grantham-McGregor S, Baker-Henningham H. Iron Deficiency in Childhood: Causes and Consequences for Child Development. Ann Nestle Eng 2010;68:105–19. https://doi.org/10.1159/000319670.
[15] Nairz M, Haschka D, Demetz E, Weiss G. Iron at the interface of immunity and infection. Front Pharmacol 2014;5. https://doi.org/10.3389/fphar.2014.00152.
[16] Lozoff B. Iron Deficiency and Child Development. Food Nutr Bull 2007;28:S560–71. https://doi.org/10.1177/15648265070284S409.
[17] Brabin BJ, Hakimi M, Pelletier D. An Analysis of Anemia and Pregnancy-Related Maternal Mortality. J Nutr 2001;131:604S-615S. https://doi.org/10.1093/jn/131.2.604S.
[18] Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Health 2013;1:e16–25. https://doi.org/10.1016/S2214-109X(13)70001-9.
[19] Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron Deficiency and Cognitive Achievement Among School-Aged Children and Adolescents in the United States. Pediatrics 2001;107:1381–6. https://doi.org/10.1542/peds.107.6.1381.
[20] Krantman HJ. Immune Function in Pure Iron Deficiency. Arch Pediatr Adolesc Med 1982;136:840. https://doi.org/10.1001/archpedi.1982.03970450082020.
[21] Lozoff B. Iron Deficiency and Child Development. Food Nutr Bull 2007;28:S560–71. https://doi.org/10.1177/15648265070284S409.
[22] Algarín C, Peirano P, Garrido M, Pizarro F, Lozoff B. Iron Deficiency Anemia in Infancy: Long-Lasting Effects on Auditory and Visual System Functioning. Pediatr Res 2003;53:217–23. https://doi.org/10.1203/01.PDR.0000047657.23156.55.
[23] Beard JL, Connor JR. I RON S TATUS AND N EURAL F UNCTIONING. Annu Rev Nutr 2003;23:41–58. https://doi.org/10.1146/annurev.nutr.23.020102.075739.
[24] Lozoff B, Beard J, Connor J, Felt B, Georgieff M, Schallert T. Long-Lasting Neural and Behavioral Effects of Iron Deficiency in Infancy. Nutr Rev 2008;64:S34–43. https://doi.org/10.1111/j.1753-4887.2006.tb00243.x.
[25] Moffatt MEK, Longstaffe S, Besant J, Dureski C. Prevention of iron deficiency and psychomotor decline in high-risk infants through use of iron-fortified infant formula: A randomized clinical trial. J Pediatr 1994;125:527–34. https://doi.org/10.1016/S0022-3476(94)70003-6.
[26] Santos RF dos, Gonzalez ESC, Albuquerque EC de, Arruda IKG de, Diniz A da S, Figueroa JN, et al. Prevalence of anemia in under five-year-old children in a children’s hospital in Recife, Brazil. Rev Bras Hematol Hemoter 2010;33:100–4. https://doi.org/10.5581/1516-8484.20110028.
[27] Alvarez-Uria G, Naik PK, Midde M, Yalla PS, Pakam R. Prevalence and Severity of Anaemia Stratified by Age and Gender in Rural India. Anemia 2014;2014:1–5. https://doi.org/10.1155/2014/176182.
[28] Akbarpour E, Paridar Y, Mohammadi Z, Mard A, Danehchin L, Abolnezhadian F, et al. Anemia prevalence, severity, types, and correlates among adult women and men in a multiethnic Iranian population: the Khuzestan Comprehensive Health Study (KCHS). BMC Public Health 2022;22:168. https://doi.org/10.1186/s12889-022-12512-6.
[29] Goswmai S, Das KK. Socio-economic and demographic determinants of childhood anemia. J Pediatr (Rio J) 2015;91:471–7. https://doi.org/10.1016/j.jped.2014.09.009.
[30] Patel KK, Vijay J, Mangal A, Mangal DK, Gupta SD. Burden of anaemia among children aged 6–59 months and its associated risk factors in India – Are there gender differences? Child Youth Serv Rev 2021;122:105918. https://doi.org/10.1016/j.childyouth.2020.105918.
[31] Ozdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars 2015;50:11–9. https://doi.org/10.5152/tpa.2015.2337.
[32] Al Sulayyim HJ, Al Omari A, Badri M. An assessment for diagnostic and therapeutic modalities for management of pediatric Iron defficiency Anemia in Saudi Arabia: a crossectional study. BMC Pediatr 2019;19:314. https://doi.org/10.1186/s12887-019-1704-3.
[33] Animasahun BA, Itiola AY. Iron deficiency and iron deficiency anaemia in children: physiology, epidemiology, aetiology, clinical effects, laboratory diagnosis and treatment: literature review. J Xiangya Med 2021;6:22–22. https://doi.org/10.21037/jxym-21-6.
[34] Kline NE. A practical approach to the child with anemia. Journal of Pediatric Health Care 1996;10:99–105. https://doi.org/10.1016/S0891-5245(96)90080-2.
[35] Piel FB. The Present and Future Global Burden of the Inherited Disorders of Hemoglobin. Hematol Oncol Clin North Am 2016;30:327–41. https://doi.org/10.1016/j.hoc.2015.11.004.
[36] Pandey AK, Gautam D, Tolani H, Neogi SB. Clinical outcome post treatment of anemia in pregnancy with intravenous versus oral iron therapy: a systematic review and meta-analysis. Sci Rep 2024;14:179. https://doi.org/10.1038/s41598-023-50234-w.
[37] Kumar T, Taneja S, Yajnik CS, Bhandari N, Strand TA. Prevalence and predictors of anemia in a population of North Indian children. Nutrition 2014;30:531–7. https://doi.org/10.1016/j.nut.2013.09.015.
[38] Caicedo O, Villamor E, Forero Y, Ziade J, Pérez P, Quiñones F, et al. Relation between vitamin B12 and folate status, and hemoglobin concentration and parasitemia during acute malaria infections in Colombia. Acta Trop 2010;114:17–21. https://doi.org/10.1016/j.actatropica.2009.11.005.
[39] Moscheo C, Licciardello M, Samperi P, La Spina M, Di Cataldo A, Russo G. New Insights into Iron Deficiency Anemia in Children: A Practical Review. Metabolites 2022;12:289. https://doi.org/10.3390/metabo12040289.
[40] Alim M, Verma N, Kumar A, Pooniya V, Abdul Rahman R. Etio-Hematological Profile and Clinical Correlates of Outcome of Pancytopenia in Children: Experience From a Tertiary Care Center in North India. Cureus 2021. https://doi.org/10.7759/cureus.15382.
[41] Grantham-McGregor S, Ani C. A Review of Studies on the Effect of Iron Deficiency on Cognitive Development in Children. J Nutr 2001;131:649S-668S. https://doi.org/10.1093/jn/131.2.649S.