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Risk factors for recurrent severe anemia among previously transfused children in Uganda: an age-matched case-control
Aggrey Dhabangi1, Richard Idro2, Chandy C John3
1Child Health and Development Centre, Makerere University College of Health Sciences, Mulago upper hill road, P O Box, 6717, Kampala, Uganda. adhabangi@gmail.com.
Insights
Recurrent severe anemia (RSA) in Ugandan children under five is linked to hemoglobinuria, newly diagnosed sickle cell anemia, prior transfusions, and malaria. Strategies like malaria chemoprevention and sickle cell screening can help prevent RSA.
Area of Science:
- Pediatrics
- Hematology
- Infectious Diseases
Background:
- Severe anemia (SA) recurrence is common in transfused children in resource-poor settings.
- This study investigated factors contributing to recurrent severe anemia (RSA) in Ugandan children under five.
Purpose of the Study:
- To identify risk factors for recurrent severe anemia (RSA) in previously transfused Ugandan children.
- To inform strategies for preventing and managing RSA in pediatric populations.
Main Methods:
- A case-control study was conducted in five Ugandan hospitals from March 2017 to September 2018.
- 196 children under five who had previously received transfusions for severe anemia were enrolled.
- Conditional logistic regression was used to analyze factors associated with RSA, excluding children with sickle cell anemia, cancer, or bleeding disorders.
Main Results:
- Hemoglobinuria (aOR 36.33), newly diagnosed sickle cell anemia (aOR 20.26), history of previous transfusions (aOR 6.95), and malaria infection (aOR 6.47) were significant risk factors for RSA.
- Cases had a shorter median time between earlier transfusion and enrollment (3.5 months) compared to controls (5.0 months).
Conclusions:
- Malaria chemoprevention, post-discharge hemoglobin monitoring, and sickle cell screening are practical interventions for preventing RSA.
- Further research is needed to investigate the causes of hemoglobinuria in children with RSA.
Background:
In resource-poor settings, transfused children often experience recurrence of severe anemia (SA) following discharge from hospital. This study determined the factors associated with recurrent severe anemia (RSA) among previously transfused Ugandan children aged less than 5 years.
Methods:
A case-control study was conducted in five hospitals in Uganda from March 2017 to September 2018. We prospectively enrolled 196 hospitalised children who had been transfused for severe anemia 2 weeks to 6 months prior to enrollment. Of these, 101 children (cases) were re-admitted with a hemoglobin [Hb] level of ≤6 g/dL and required transfusion; and 95 children (age-matched controls) were admitted for other clinical illness with a Hb > 6 g/dL. Children known to have sickle cell anemia, cancer, or bleeding disorders were excluded. Clinical and laboratory evaluation were done. Conditional logistic regression adjusted for age, was used to determine factors associated with RSA.
Results:
The median time (IQR) between the earlier transfusion and enrollment was 3.5 (1.9-5.7) months for cases, and was 5.0 (2.9-6.0) months for controls (p-value = 0.015). Risk factors (adjusted odds ratio, 95% confidence interval, and significance) for development of RSA were: hemoglobinuria (36.33, 2.19-600.66, p = 0.012); sickle cell anemia - newly diagnosed (20.26, 2.33-176.37, p = 0.006); history of earlier previous transfusions (6.95, 1.36-35.61, p = 0.020) and malaria infection (6.47, 1.17-35.70, p = 0.032).
Conclusion:
Malaria chemoprevention, follow up visit for Hb check after discharge from hospital and sickle cell screening among previously transfused children represent practical strategies to prevent and identify children at risk for recurrent severe anemia. The cause of hemoglobinuria in children merits further investigations.
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