|
|
 | |||||||||||||||||||||||||||||||||||||||||||||||
 | |||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||
Background Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied.
Methods We conducted a case–control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool children without severe anemia in urban and rural settings in Malawi. Causal factors previously associated with severe anemia were studied. The data were examined by multivariate analysis and structural equation modeling.
Results Bacteremia (adjusted odds ratio, 5.3; 95% confidence interval [CI], 2.6 to 10.9), malaria (adjusted odds ratio, 2.3; 95% CI, 1.6 to 3.3), hookworm (adjusted odds ratio, 4.8; 95% CI, 2.0 to 11.8), human immunodeficiency virus infection (adjusted odds ratio, 2.0; 95% CI, 1.0 to 3.8), the G6PD–202/–376 genetic disorder (adjusted odds ratio, 2.4; 95% CI, 1.3 to 4.4), vitamin A deficiency (adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.8), and vitamin B12 deficiency (adjusted odds ratio, 2.2; 95% CI, 1.4 to 3.6) were associated with severe anemia. Folate deficiency, sickle cell disease, and laboratory signs of an abnormal inflammatory response were uncommon. Iron deficiency was not prevalent in case patients (adjusted odds ratio, 0.37; 95% CI, 0.22 to 0.60) and was negatively associated with bacteremia. Malaria was associated with severe anemia in the urban site (with seasonal transmission) but not in the rural site (where malaria was holoendemic). Seventy-six percent of hookworm infections were found in children under 2 years of age.
Conclusions There are multiple causes of severe anemia in Malawian preschool children, but folate and iron deficiencies are not prominent among them. Even in the presence of malaria parasites, additional or alternative causes of severe anemia should be considered.
Source Information
From the Malawi–Liverpool–Wellcome Trust Clinical Research Programme, College of Medicine (J.C.J.C., K.S.P., A.I.P., P.M., M.K., M.E.M., M.B.H.) and the College of Medicine (J.C.J.C., K.S.P., A.I.P., M.E.M., M.B.H.), Blantyre, Malawi; Emma Children's Hospital, the Global Child Health Group (J.C.J.C., B.J.B., M.B.H.), the Department of Clinical Epidemiology and Biostatistics (R.J.H.), and the Department of Medical Microbiology, Laboratory of Clinical Virology (M.G.H.M.B.) — all at the Academic Medical Center, Amsterdam; the Liverpool School of Tropical Medicine (E.B.F., I.B., M.E.M.) and the Child and Reproductive Health Group, Liverpool School of Tropical Medicine (B.J.B., L.E.C., M.B.H.), Liverpool, United Kingdom; the Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands (P.J.M.H.); the Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands (L.L.); and the Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom (Y.Y.T., K.A.R., A.R., D.P.K.).
Address reprint requests to Dr. Calis at Emma Children's Hospital, Academic Medical Center, the Global Child Health Group, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands, or at job.calis{at}gmail.com.
Related Letters:
Severe Anemia in Malawian Children
Graham S. M., de Mast Q., Swinkels D., van der Ven A., Antony A. C., Calis J. C.J., Phiri K. S., van Hensbroek M. B.
Extract |
Full Text |
PDF
N Engl J Med 2008;
358:2290-2291, May 22, 2008.
Correspondence
This article has been cited by other articles:
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | TERMS OF USE | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved. |
Previous
