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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Nutritional status, hospitalization and mortality among patients with sickle cell anemia in Tanzania
Sharon E Cox1, Julie Makani, Anthony J Fulford
1Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar-es-Salaam, Tanzania. sharon.cox@lshtm.ac.uk
Insights
Malnutrition, specifically wasting, is common in Tanzanian children with sickle cell anemia and predicts increased hospital admissions. Early nutritional interventions are crucial for managing this condition.
Area of Science:
- Pediatric Hematology
- Nutritional Science
- Global Health
Background:
- Reduced growth is a known complication in children with sickle cell anemia (SCA).
- Limited data exist on the long-term clinical impact of poor nutrition in SCA patients.
- This study investigated malnutrition prevalence and its association with clinical outcomes in Tanzanian SCA patients.
Purpose of the Study:
- To determine the prevalence of malnutrition at cohort enrollment in Tanzanian children with SCA.
- To assess whether poor nutritional status predicts morbidity and mortality in this cohort.
- To inform targeted nutritional interventions for SCA management.
Main Methods:
- Anthropometric measurements were taken for 1,618 SCA patients (ages 0.5-48 years) and 717 controls.
- Prospective surveillance recorded hospitalizations and mortality over a 5.5-year period (March 2004-September 2009).
- Statistical analyses examined associations between nutritional status (stunting, wasting, BMI z-score) and clinical outcomes.
Main Results:
- Sickle cell anemia was significantly associated with stunting (36.2%) and wasting (18.4%).
- Wasting and low body mass index (BMI) z-scores predicted increased hospitalization risk (P=0.04 and P=0.02, respectively).
- Height-for-age z-score and overall mortality were not significantly associated with anthropometric measures.
Conclusions:
- Significant undernutrition, particularly wasting, is prevalent in this Tanzanian SCA cohort.
- Wasting is a key predictor of increased hospital admissions in children with SCA.
- Nutritional interventions should prioritize the prevention and treatment of wasting in SCA patients.
Background:
Reduced growth is common in children with sickle cell anemia, but few data exist on associations with long-term clinical course. Our objective was to determine the prevalence of malnutrition at enrollment into a hospital-based cohort and whether poor nutritional status predicted morbidity and mortality within an urban cohort of Tanzanian sickle cell anemia patients.
Design And Methods:
Anthropometry was conducted at enrollment into the sickle cell anemia cohort (n=1,618; ages 0.5-48 years) and in controls who attended screening (siblings, walk-ins and referrals) but who were found not to have sickle cell anemia (n=717; ages 0.5-64 years). Prospective surveillance recorded hospitalization at Muhimbili National Hospital and mortality between March 2004 and September 2009.
Results:
Sickle cell anemia was associated with stunting (OR=1.92, P<0.001, 36.2%) and wasting (OR=1.66, P=0.002, 18.4%). The greatest growth deficits were observed in adolescents and in boys. Independent of age and sex, lower hemoglobin concentration was associated with increased odds of malnutrition in sickle cell patients. Of the 1,041 sickle cell anemia patients with a body mass index z-score at enrollment, 92% were followed up until September 2009 (n=908) or death (n=50). Body mass index and weight-for-age z-score predicted hospitalization (hazard ratio [HZR]=0.90, P=0.04 and HZR=0.88, P=0.02) but height-for-age z-score did not (HZR=0.93, NS). The mortality rate of 2.5 per 100 person-years was not associated with any of the anthropometric measures.
Conclusions:
In this non-birth-cohort of sickle cell anemia with significant associated undernutrition, wasting predicted an increased risk of hospital admission. Targeted nutritional interventions should prioritize treatment and prevention of wasting.
