Prevalence of Anaemia and Associated Factors among Preterm Infants Attending Post-Natal Follow Up Clinic at Muhimbili National Hospital, Dar Es Salaam, Tanzania

Abstract

Background: Globally, approximately one million under-five children die each year due to prematurity, accounting for 35% of all neonatal deaths a year. Anaemia is among the complications of prematurity and it has a significant public health importance However, locally there is paucity of data on the magnitude of anaemia and their associated factors in this vulnerable group. Therefore, this study was conducted to establish the magnitude of anaemia, its severity, associated factors and changes in haemoglobin during 4 weeks of follow up. Findings from this study are expected to provide evidence for the development of the strategies to prevent anaemia in preterm infants and hence reducing morbidity and mortality. Objectives: To determine the prevalence of anaemia, its severity and associated factors, as well as changes in haemoglobin among preterm infants attending follow-up clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania. Methods: This was a hospital based cross-sectional study with longitudinal follow up conducted among premature infants attending follow-up clinic at Muhimbili National Hospital. A total of 370 preterm infants were enrolled and structured questionnaires were used to record sociodemographic and clinical information. Data entry and cleaning was done using SPSS software version 25. Descriptive analysis was summarized as frequencies, mean with standard deviation (SD) and median with interquartile range (IQR). Overall proportion of children with anaemia was calculated and contingency tables were made for bivariate analysis to explore the associated factors. To test the association between the variables, Chi-square and where applicable, Fischer’s exact test were used for categorical variables while Student’s t-test and Mann-Witney U test were used for continuous variables. Logistic regression was used to determine the independent factors. The odds ratio and 95% confidence intervals were estimated for each studied factor. Probability value (p) of <0.05 was considered statistically significant. Results: A total of 370 premature infants were recruited into the study. The median gestation age was 32 weeks (IQR=28-34). Two thirds of preterm infants (62%) were on haematinics supplementation while only 13% were on recommended dosage. The overall proportion of preterm infants with anaemia at 6 weeks chronological age was 38.4% and 74% of these infants had moderate anaemia. Independent factors for anaemia were; gestation age between 32 to less than 34 weeks (OR=2.21, 95% CI 1.15-4.25, p=0.017) and phlebotomy status, with the odds of having anaemia increased as the number of phlebotomies increased (OR=2.3; 95% CI 1.23-4.30; P=0.010) and (OR=7.2, 95% CI 3.62-14.16, p=<0.001). Nevertheless, 57% of the preterm infants with anaemia had haemoglobin increase of ≥1g/dl after 4 weeks follow-up. All of these preterm infants were on haematinics and 27% of whom had received blood transfusion during the 4 weeks follow-up. Conclusion and recommendations: Anaemia is prevalent among preterm infants at Muhimbili National Hospital despite majority of them being on haematinics supplementation. Slight improvement in haemoglobin levels was observed after 4 weeks follow-up among preterm infants with anaemia. Screening preterm infants for anaemia during follow-up should be emphasized and there is a need to minimize phlebotomy blood loss during early post-natal life.