A profile of acqured caused of childhood anaemia in general paediatric wards at Muhimbili national hospital Dar es salaam, Tanzania

Abstract

Background: Anaemia is a growing public health problem and greatly determines the prognosis of children in the paediatric wards. There is paucity of data describing its magnitude, haematological values and acquired causes among patients admitted in paediatric wards. Anaemia is the major cause of morbidity and mortality in paediatric age yet the magnitude of acquired causes of anaemia have been inadequately studied in Tanzania. Objectives: The study was aimed at determining the profile of acquired causes of childhood anaemia in general paediatric wards at Muhimbili National Hospital (MNH) in Dar es Salaam. Study design: This was a descriptive cross -sectional study. Study setting: This was conducted at MNH in general paediatric wards from zo" August, 2009 to is" December, 2009; and Subjects: A total of 315 patients, aged 1- 84 months, consecutively admitted were recruited in the study. Methods: After informed verbal consent from the guardian or parent was obtained, information on demographic and clinical characteristics was collected from the parent or guardian. Physical examination and laboratory tests on blood; stool samples for hookworm screening; blood slides for malaria parasites; Human Immunodeficiency Virus (HIV) screening; blood peripheral smears; active serum vitamin 812; serum folate; serum transferrin; and serum iron were done on all subjects. Additional information was taken from medical files. The prevalence of anemia was determined as a percentage of all paediatric patients recruited during the time of data collection. All information was recorded using questionnaires and analysis was done using SPSS version 13.0. A P value of < 0.05 was considered statistically significant. Results: Fatigue, headache, pallor, jaundice, hepatomegaly and splenomegaly were shown to be the most common presenting clinical feature in patients with anaemia (p < 0.05). The status of anaemia (Hb < 11 g/dl) was 80.3 %. The proportion of malaria was7.9%, HIV seropositve was 10.2% and hookworm was 1.0% of all admissions. There was an increased risk of anaemia in patients with

VII HIV seropositve and or malaria although this was not statistically significant (OR> 1.0, p> 0.05). Iron deficiency was the most common micronutrient deficiency occurring in 42% of all admissions and 41 - 46% among the anaemic children; around one third of non anaemic patients had iron deficiency (p = 0.05). The proportion of folate deficiency was 8.6% and vitamin BI2 deficiency 3.4% of all recruited patients (p > 0.05). Conclusions: Status of anaemia was 80.3%. Iron deficiency was common but HIV seropositive, malaria, hookworm, folate and vitamin B 12 deficiencies were not prominent. It was noted that one third of the non anaemic paediatric patients have iron deficiency as initial stages of developing anaemia. Recommendations: Iron studies should be performed in microcytic anaemia and causes of iron deficiency investigated. Iron food fortification programs should be developed and implemented. Further studies should be done to determine serum BI2 and serum and red cell folate levels in children on a large scale in order to resolve the controversy of these micronutrient deficiencies in children. Study limitation: Since this was a cross sectional hospital based study, bias could not be avoided in determining the profile of acquired causes of chi ldhood anaemia.