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. Copyright 2008 Massachusetts Medical Society.
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. Copyright 2008 Massachusetts Medical Society.
Authors: Philip E Thuma; Janneke van Dijk; Rick Bucala; Zufan Debebe; Sergei Nekhai; Thea Kuddo; Mehdi Nouraie; Günter Weiss; Victor R Gordeuk Journal: J Infect Dis Date: 2011-01-15 Impact factor: 5.226
Authors: Job C J Calis; Kamija S Phiri; Raymond J W M Vet; Rob J de Haan; Francis Munthali; Robert J Kraaijenhagen; Paul J M Hulshof; Malcolm E Molyneux; Bernard J Brabin; Michaël Boele van Hensbroek; Imelda Bates Journal: AIDS Date: 2010-11-27 Impact factor: 4.177
Authors: Kathryn Maitland; Sarah Kiguli; Peter Olupot-Olupot; Charles Engoru; Macpherson Mallewa; Pedro Saramago Goncalves; Robert O Opoka; Ayub Mpoya; Florence Alaroker; Julius Nteziyaremye; George Chagaluka; Neil Kennedy; Eva Nabawanuka; Margaret Nakuya; Cate Namayanja; Sophie Uyoga; Dorothy Kyeyune Byabazaire; Bridon M'baya; Benjamin Wabwire; Gary Frost; Imelda Bates; Jennifer A Evans; Thomas N Williams; Elizabeth C George; Diana M Gibb; A Sarah Walker Journal: N Engl J Med Date: 2019-08-01 Impact factor: 91.245
Authors: K S Phiri; J C J Calis; D Kachala; E Borgstein; J Waluza; I Bates; B Brabin; M Boele van Hensbroek Journal: J Clin Pathol Date: 2009-08 Impact factor: 3.411