Causes And Management Of Anaemia Among Children

Medical and Health Science Project and Seminar Material

Causes And Management Of Anaemia Among Children


Abstract


According to WHO (2011) anemia is ranked a severe public health problem (defined as a prevalence of equal to or more than 40%) and is second after malaria to cause mortality among children below five years in developing countries mostly because of poor diet and access to food due to poverty, ignorance and poor sanitation in rural areas. Anemia has been established as a global public health problem affecting about one third of the world’s population, notably pre-school aged children with a global prevalence in those between 0-5 years rising to 47.4%. Anemia can adversely affect cognitive advancement, performance in school, physical and behavioral growth especially in developing countries where resources to determine the underlying etiology remain poor. Therefore, this study aimed at determining the prevalence of anemia and the associated factors among children aged 6 to 59 months attending university of uyo teaching hospital.

A hospital-based cross-sectional descriptive and analytical study to determine the prevalence and the factors associated with anemia was conducted in UUTH. A sample size of 288 was chosen. Consecutive enrollment technique was used whereby study subjects were recruited as they came and as they met the inclusion criteria. A total of two hundred (200) respondents took part in the study.

Majority (41%) were between 6 to 11 months, 55% were males and 45% females. The prevalence of anemia among the children was 61%; where 15% had mild anaemia, 24.0% being moderate and 22.00% being severe. The prevalence was highest in children 12-23 months at 30%. The factors that were associated with anaemia included; child having had an episode of fever in past three months (P=0.050), malaria diagnosis (P=0.000), presence of sickle cell disease (P=0.046) and respondent’s education level being either at no education (P=0.007) or at primary level (P=0.041). The risk factors that increased the likelihood of anaemia included low or no education level of the respondent, positive malaria diagnosis and sickle cell anaemia

Prevalence of anemia among children aged 6 to 59 months was high in UUTH. Presence and severity of anemia was positively correlated with malaria, sickle cell anaemia and low education level of caretakers. There is need to invest in measures to prevent anaemia and sensitization of masses on early malaria detection, sickle cell screening and dangers of anaemia


Chapter One


Introduction

1.1 Background to the Study

Anemia is one of commonest problems worldwide whereby one third of the world’s population suffers from anemia. Anemia is a public health problem globally, with its impact felt more in human health, social and economic development of both individuals and nations (WHO, 2011). Anemia is a condition in which the concentration of Hemoglobin, Packed Cell Volume, and number of red blood cells is below the lower limits recommended for individual’s age, sex and altitude (Cheesbrough, 2006). According to WHO (2011) anemia is second after malaria to cause mortality among children under five years in developing countries mostly because of poor diet and access to food due to poverty, ignorance or lack of information on what foods to eat and how to prepare them, and poor sanitation in rural areas.

The most commonly affected groups within the community are young children, pregnant women, elderly people and the people with chronic infections such as TB, HIV/AIDS, Malaria, pelvic inflammatory disease, osteomyelitis, pneumonia and bacterial endocarditis (Thompson, 2013). The causative agents of anemia are broadly categorized into three groups (Cheesbrough, 2006). First category is blood loss which can be either acute or chronic bleeding; this causes the loss of red blood cells and hemoglobin. The second category is anemia characterized by increased red blood cell destruction and is generally known as hemolytic anemia. The third category is impaired production of red blood cells; this causes a disturbance of proliferation and differentiation of stem cells (McIntyre et al., 2006).
Anaemia is a global public health threat especially in the developing countries (Leal et al., 2011). In Africa, the prevalence of anaemia among preschool children is estimated at 64.6% (McLean et al., 2008), however community-based estimates of anaemia prevalence among children in settings where malaria is endemic range from 49 to 76% (Schellenberg et al., 2003). Childhood anaemia is a preventable condition, which has serious consequences including growth retardation, poor immune system and increased susceptibility to infections (Shaw et al.,2011), and death (Kikafunda et al.,2009) and has severe socio-economic consequences for families andcommunities. Despite several interventions like de-worming, malarial presumptive treatment, provision of fortified complimentary foods or enriched foods (Kikafunda et al.,2009), that have been put in place to increase the iron status of children less than five years, anaemia remains a challenge in Uganda. It is estimated that 50% of children below five years in Uganda have anaemia (Kuziga et al., 2017). The prevalence of anaemia among children in the East Central region of Uganda, the setting for this study is even higher at 67.5% (UBOS, 2011). According to the recent Uganda malaria indicator survey (UBOS, 2015), malaria prevalence among children under five years was highest in the East Central region (where Jinja district lies), where 36% of children tested positive for malaria. Thus interventions to address anaemia and chronic malnutrition should be delivered in an integrated manner in order to comprehensively address the anaemia and various underlying problems. university of uyo teaching hospital receives patients from many many local governments among others thus is a good representative of the picture in Eastern Uganda. There is need to concomitantly prioritize interventions to prevent anaemia and malnutrition in these communities in order to realize the much needed reduction of morbidity and mortality among infants and children in Uganda and other countries in sub-saharan Africa. Iron-deficiency anaemia is the most prevalent nutritional disorder in the world, affecting both developed and developing countries. Anaemia is most prevalent among pregnant women and children below five years of age and is particularly prevalent during the first two years of life (Rosa et al, 2014).


1.2 Statement of the Problem

Anemia is a major child health problem worldwide and one-third of the world’s population suffers from anemia, notably over half of the children in developing countries (WHO, 2011). It is estimated that 50% of children under five years in Uganda have anaemia (Kuziga et al., 2017), which has serious consequences including growth retardation, poor immune system and increased susceptibility to diseases (Shaw et al, 2011), and death (Kikafunda et al, 2009). The prevalence of anaemia among children in the East Central region of Uganda, the setting for this study is even higher at 67.5% (UBOS, 2011). According to the recent Uganda malaria indicator survey (UBOS, 2015), malaria prevalence among children under five years was highest in the East Central region (where university of uyo teaching hospital lies). Interventions to address anaemia and chronic malnutrition should be delivered in an integrated manner in order to comprehensively address the anaemia and various underlying problems; however, there is hardly any recent documented published study on the prevalence of anaemia among children aged 6 to 59 months attending university of uyo teaching hospital which this study seeks to address.


1.3 Objectives of the Study

The aim of the study was to determine the causes and management of anaemia among children attending university of uyo teaching hospital.

Specific objectives

  1. To assess the prevalence of anemia by sex and age groups in children between 6 to 59 months of age attending university of uyo teaching hospital.
  2. To establish factors associated with anemia in children between 6 to 59 months of age attending university of uyo teaching hospital.

1.4 Research Questions

  1. What is the prevalence of anemia by sex and age groups in children aged 6 to 59 months attending university of uyo teaching hospital?
  2. What are factors associated with anemia in children below 6 to 59 months of age attending university of uyo teaching hospital?

1.5 Significance of the Study

Anaemia is a global public health threat especially in the developing countries (Leal et al., 2011), and in Africa, the prevalence of anaemia among preschool children is estimated at 64.6% (McLean et al., 2008), however, community-based estimates of anaemia prevalence among children in settings where malaria is endemic range from 49 to 76% (Schellenberg et al., 2003).

Despite several interventions like de-worming, malarial presumptive treatment, provision of fortified complementary foods or enriched foods (Kikafunda et al.,2009), that have been put in place to increase the iron status of children between 6 to 59 months of age, anaemia remains a challenge in Uganda. There is need to concomitantly prioritize interventions to prevent anaemia and malnutrition in communities in order to realize the much needed reduction of morbidity and mortality among infants and children in Nigeria.

This study established the prevalence and factors associated with anemia in children 5 to 69 months of age and it attempted to seek to provide information on the trends of anemia in children 6 to 59 months old attending university of uyo teaching hospital. This will help in prioritizing the allocation of resources, intervention strategies and also help in policy formulation so as to have effective diagnosis and treatment of the anemia. It will also help to provide information where the health care providers can base on counseling parents and guardians on the factors associated with anaemia. Considering the high prevalence of childhood anaemia in Uganda, its deleterious effects on children’s health, possible developmental repercussions, and the absence of specific public health policies addressing this problem, anaemia is a high priority topic for investigation. Thus, this study aimed to assess the prevalence of anaemia among children between 6 and 59 months of age and to identify high-risk subgroups based on the analysis of possible associated factors. Results from this study will also contribute to the available body of literature for future research.


1.6 Scope of the Study

The study focused on social demographic, environmental and individual factors associated with the prevalence of anaemia in children between 6 to 59 months of age attending UUTH

The study was a hospital based analytical cross sectional study design and utilized both qualitative and quantitative parameters. The study was carried out at university of uyo teaching hospital, pediatric unit located in Akwa-ibom state which is located in south-south Nigeria. The study determined the prevalence of anaemia among children 6 to 59 months of age attending university of uyo teaching hospital. The study was carried out for a period of five months (April to August 2018) at the pediatric unit using random sampling method to attain the required number of patients. university of uyo teaching hospital was chosen based on the fact that it’s a referral hospital receiving patients from major LGA.


1.7 Limitation of Study

Finance,inadequate materials and time constraint were the challenges the researchers encountered during the course of the study


1.8 Definition of Operational Terms

Abscess:

A swollen area within body tissue containing an accumulation of pus.

Anaemia:

Anaemia was defined using WHO classification of anaemia as hemoglobin level of less than 11g/dl.

Dyspnea:

Shortness of breath

Endocarditis:

Inflammation of the endocardium

Erythematous:

Superficial reddening of the skin caused by dilation of the blood capillaries, as a result of injury or irritation.

Hemoglobin:

A red protein containing iron responsible for transporting oxygen in blood of vertebrates.

Inflammation:

Physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as reaction to injury or infection.

Mild Anaemia:

Hemoglobin level of 10 to10.9g/dl. Moderate anaemia: Hemoglobin level of 7 to 9.9g/dl.

Severe Anaemia:

Hemoglobin level of less than 7g/dl. Osteomyelitis: Inflammation of bone or bone marrow

Pelvic Inflammatory Disease:

Inflammation of the female genital tract, accompanied by fever and lower abdominal pain.


1.9 Organizations of the Study

The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study.

The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.


Chapter Five


Summary, Conclusion and Recommendations

5.1 Summary of Findings

This study was done to assess the causes and the factors associated with anaemia in children 6-59 months of age attending university of uyo teaching hospital. A total number of 200 children participated in the study and it was found that the prevalence of anaemia was 61%. According to the Demographic and Health Survey (2016), it was recorded that 53% of the children aged between 6 to 59 months suffered from some degree of anaemia, Therefore, the prevalence obtained from this study indicated a higher prevalence of 61% as compared to the Demographic and Health Survey. However, another study done by Kuziga and collaborators, in Namutumba district in Uganda in 2017, found that 58.8% of the children were anaemic. The increased prevalence of anaemia in this study could possibly be due to the lack of knowledge of the parents and other caregivers about anaemia, high prevalence of intestinal parasites due to poor sanitation and other co-morbidities for example severe malaria and sickle cell anaemia or poor dietary intake of nutrients among these children (Kuziga et al.,2017).

Anaemia was highest among the females 64.4% than the males 49.1%. 15% of all children had mild anaemia, 24% had moderate anaemia and 22% had severe anaemia. The prevalence of anaemia for the different age groups was as follows; 6-11 months (10%), 12-24 months (30%), 25-35 months (6%), 36-47 months (9%) and 48 to 59 months (6%). These results are comparable to those of a study done by Kuziga et al., (2017) and it indicated that the anaemia prevalence was highest among those aged 12-23 months followed by those aged 6-11 months and lowest in those 48-59 months of age. And also comparable to another study done by Rosa et al., (2014) in Cape Verde which indicated risk of anaemia to be higher in children below 24 months. This vulnerability is likely to be due to the increased need for iron at this age and inadequate introduction of iron rich foods into the diet following weaning Austin et al., (2012).

According to WHO classification, which denotes anemia based on Haemoglobin levels as mild (10-10.9g/dl), moderate (9.9-7.0g/dl) and severe (<7.0g/dl). The prevalence of anaemia from this study was mild anaemia (15%), moderate anaemia (24%) and severe anaemia (22%). The higher prevalence of moderate anaemia is probably because most of these children are asymptomatic and it may not be detected clinically unless careful physical examination has been done and haemoglobin levels of the children have been investigated (Kuziga et al., (2017), Schellenberg et al., 2003).

At bivariate analysis, the risk factors associated with anaemia from this study were found to include: Presence of sickle cell anaemia (P= 0.046), low level of education that’s to say the (non- educated parents (P= 0.007), well as a positive malaria diagnosis (P= 0.000). Malaria remains a burden in developing countries and one of the complications of severe malaria is anaemia which occurs as a result of haemolysis of red blood cells (Rosa et al., 2006), and this could explain why it is a risk factor in this study.

The other risk factors were; low level of education that’s to say the non-educated parents (P=0.007) and those who stopped at primary level (P=0.041) and this may be attributed to lack of adequate knowledge on diet especially foods rich in iron an important component of hemoglobin plus knowledge on anaemia, its etiology and presentations as well as poor health seeking behavior of the parents.

At multivariate analysis, the risk factors most likely to cause anaemia included; malaria and sickle cell anaemia. Malaria is due to failure of parents to seek medical attention and failure to use insecticide treated mosquito nets. Sickle cell anaemia of is a form of anaemia whereby there’s defect in production of the haemoglobin chain causing sickling of red blood cells and subsequent reduction in haemoglobin levels leading to anaemia or there’s continued sequestration of red blood cells into the spleen. This calls for important screening and sensitization of caregivers on the importance of these conditions and prevent further complications which can lead to death.


5.2 Conclusion

The prevalence of anaemia was relatively high at 61% with associated risk factors including malaria, sickle cell anaemia and low education level with the risk factors most likely to cause anaemia being malaria and sickle cell anaemia. This calls for intervention practices in this study area so as to mitigate these risk factors.


5.3 Recommendations

Anaemia is highly prevalent among children and there is need to invest in measures to prevent anaemia, especially among children in the rural areas.

Educate parents and other care givers about anaemia and its related etiologies and preventive measures and regular screening for malaria and sickle cell anaemia.

Encouraging the government to continue with distribution of insecticide treated mosquito nets.

Care givers should clear bushes and ponds around their homes which are breeding grounds for mosquitoes.
Educate caregivers on symptoms such as hyperthermia or any fevers and quickly seek medical attention to prevent complications.

Government should support regular conduction of prevalence surveys such as this descriptive cross sectional study from time to time to track progress.

Another study should be conducted taking into considerations the limitations of this study, such as not assessing the nutritional assessment of the children, the food score and the type of anaemia according to the etiology.


Causes And Management Of Anaemia Among Children


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