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Updated: Jul 3, 2026
A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
Long term outcome of severe anaemia in Malawian children
Kamija S Phiri1, Job C J Calis, Brian Faragher
1Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi. kamijaphiri@gmail.com
Insights
Severe anaemia in African children leads to high post-discharge mortality and recurrence, with HIV being a major risk factor. Early diagnosis and treatment of HIV are crucial for improving child survival rates.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Global Child Health
Background:
- Severe anemia is a common and often fatal condition in hospitalized African children.
- Long-term outcomes and risk factors for severe anemia survivors are poorly understood.
- Early reports suggest survivors may face increased late morbidity and mortality, impacting child survival in Africa.
Purpose of the Study:
- To assess the short and long-term outcomes of severe anemia in Malawian children.
- To identify risk factors associated with death and recurrence of severe anemia.
- To inform strategies for improving child survival in regions with high severe anemia prevalence.
Main Methods:
- A 18-month follow-up study involving children (6-60 months) with severe anemia (hemoglobin
- Comparison of all-cause mortality and severe anemia recurrence rates between cases and hospital/community controls.
- Identification of risk factors for adverse outcomes using survival analysis.
Main Results:
- In-hospital mortality was 6.4%, and post-discharge mortality was 12.6% among severe anemia cases.
- Recurrence rate of severe anemia was significantly higher in cases (0.102/child-year) compared to controls (0.007/child-year).
- Human Immunodeficiency Virus (HIV) was the primary risk factor for post-discharge mortality (HR 10.5) and severe anemia recurrence (HR 5.6).
Conclusions:
- Severe anemia is associated with substantial 'hidden' post-discharge morbidity and mortality.
- This contributes significantly to overall under-five mortality in affected regions.
- Effective diagnosis and treatment of HIV in children with severe anemia are critical for reducing mortality and achieving child survival goals.
Background:
Severe anaemia is a common, frequently fatal, condition in African children admitted to hospital, but its long term outcome is unknown. Early reports that survivors may be at risk of additional late morbidity and mortality may have significant implications for child survival in Africa. We assessed the short and long term outcome of severe anaemia in Malawian children and identified potential risk factors for death and further severe anaemia.
Methodology And Findings:
For 18 months, we followed up children (6-60 months old) presenting to hospital with severe anaemia (haemoglobin
Conclusions:
Severe anaemia carries a high 'hidden' morbidity and mortality occurring in the months after initial diagnosis and treatment. Because severe anaemia is very common, this is likely to contribute importantly to overall under-five mortality. If not adequately addressed, severe anaemia may be an obstacle to achievement of the Millennium development goal No.4 on child survival. Strategies to diagnose and properly treat HIV infected children early most likely will reduce the high post-discharge mortality in severe anaemia.
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