Prevalence and Factors Associated With Malnutrition among Patients with Sickle Cell Disease in Dar Es Salaam, Tanzania

Abstract

Sickle cell disease (SCD) and its variants are genetic disorders resulting from the presence of a mutated form of hemoglobin, HbS. The disease occurs as a result of a point mutation in the β globin chain of Hb molecule; where a non-polar amino acid, valine, is substituted for a polar amino acid, glutamic acid. Africa has the greatest burden of SCD, with up to 75% of the 300,000 global births per year and where childhood mortality remains high, ranging 50 - 90%. It is known that homozygous (SS) sickle cell disease interferes with physical growth during childhood and early adolescence and that affected children weigh less and are shorter than healthy counterparts. Growth restriction in SCD is complex and multiple factors are likely to contribute, such as the haematological and cardiovascular, social factors, endocrine function and metabolic and nutritional status. The current prevalence of malnutrition in patients with SCD and the relationship between Hb levels and nutritional status are not known. Hence, this study will help fill this knowledge gap. Aim of the study: To determine prevalence, factors and complications associated with malnutrition among patients with SCD in Dar es Salaam Tanzania. Methodology: This was a hospital-based cross-sectional study carried out at the Muhimbili National Hospital (MNH) and Temeke Hospital in Dar Es Salaam, Tanzania, over a period of 6 months. Non-probability consecutive sampling technique was used to recruit 246 children and adolescents with SCD, aged 6 months to 15 years, who routinely attend haematology clinics. Questionnaire was used. Nutritional status was assessed using WHO scores anthropometric indices; weight for height, height/length for age. Blood samples were also collected to measure vitamin B12 and Hb level. Analysis was done using SPSS version 23. Results: The overall prevalence of malnutrition among patients with SCD was 59.7% that is undernutrition was 58.2% and while obesity was 1.2%. Majority of patients with SCD and malnutrition had a haemoglobin level of 6.50-7.9 g/dL. In this study, majority of the patients with SCD and malnutrition had normal Vitamin B12 levels except for 2% that had low levels Conclusion: This study found that SCD is associated with malnutrition and growth retardation. And as the age increases the children were at more risk of being underweight as the study supports underweight was more common in children above 5 years of age. The study established that majority of patient with SCD and malnutrition had haemoglobin level that ranged between 6.50-7.9 g/dL. The study also established that majority of patients with SCD and malnutrition had normal levels of Vitamin B12. Recommendations: Anthropometric measurements to be part of clinical practice of patients with SCD who attend haematology clinic so that they are noted early with malnutrition and intervention is made early either through supplementation of macro and micro nutrients or through nutritional educational.