Risk factors for presentation to hospital with severe anaemia in Tanzanian children: a case-control study.

In malaria endemic areas anaemia is a usually silent condition that nevertheless places a considerable burden on health services. Cases of severe anaemia often require hospitalization and blood transfusions. The objective of this study was to assess risk factors for admission with anaemia to facilitate the design of anaemia control programmes. We conducted a prospective case-control study of children aged 2-59 months admitted to a district hospital in southern Tanzania. There were 216 cases of severe anaemia [packed cell volume (PCV) < 25%] and 234 age-matched controls (PCV > or = 25%). Most cases [55.6% (n = 120)] were < 1 year of age. Anaemia was significantly associated with the educational level of parents, type of accommodation, health-seeking behaviour, the child's nutritional status and recent and current medical history. Of these, the single most important factor was Plasmodium falciparum parasitaemia [OR 4.3, 95% confidence interval (CI) 2.9-6.5, P < 0.001]. Multivariate analysis showed that increased recent health expenditure [OR 2.2 (95% CI 1.3-3.9), P = 0.005], malnutrition [OR 2.4 (95%CI 1.3-4.3), P < 0.001], living > 10 km from the hospital [OR 3.0 (95% CI 1.9-4.9), P < 0.001], a history of previous blood transfusion [OR 3.8 (95% CI 1.7-9.1), P < 0.001] and P. falciparum parasitaemia [OR 9.5 (95% CI 4.3-21.3), P < 0.001] were independently related to risk of being admitted with anaemia. These findings are considered in terms of the pathophysiological pathway leading to anaemia. The concentration of anaemia in infants and problems of access to health services and adequate case management underline the need for targeted preventive strategies for anaemia control

Mechanisms controlling anaemia in Trypanosoma congolense infected mice.

Trypanosoma congolense are extracellular protozoan parasites of the blood stream of artiodactyls and are one of the main constraints on cattle production in Africa. In cattle, anaemia is the key feature of disease and persists after parasitaemia has declined to low or undetectable levels, but treatment to clear the parasites usually resolves the anaemia. The progress of anaemia after Trypanosoma congolense infection was followed in three mouse strains. Anaemia developed rapidly in all three strains until the peak of the first wave of parasitaemia. This was followed by a second phase, characterized by slower progress to severe anaemia in C57BL/6, by slow recovery in surviving A/J and a rapid recovery in BALB/c. There was no association between parasitaemia and severity of anaemia. Furthermore, functional T lymphocytes are not required for the induction of anaemia, since suppression of T cell activity with Cyclosporin A had neither an effect on the course of infection nor on anaemia. Expression of genes involved in erythropoiesis and iron metabolism was followed in spleen, liver and kidney tissues in the three strains of mice using microarrays. There was no evidence for a response to erythropoietin, consistent with anaemia of chronic disease, which is erythropoietin insensitive. However, the expression of transcription factors and genes involved in erythropoiesis and haemolysis did correlate with the expression of the inflammatory cytokines Il6 and Ifng. The innate immune response appears to be the major contributor to the inflammation associated with anaemia since suppression of T cells with CsA had no observable effect. Several transcription factors regulating haematopoiesis, Tal1, Gata1, Zfpm1 and Klf1 were expressed at consistently lower levels in C57BL/6 mice suggesting that these mice have a lower haematopoietic capacity and therefore less ability to recover from haemolysis induced anaemia after infection

Risk Factors for Anaemia Among HIV Infected Children Attending Care and Treatment Clinic at Muhimbili National Hospital in Dar es Salaam, Tanzania

There is paucity of data describing the risk factors for anaemia among HIV infected children in Tanzania. This cross sectional study was carried out to determine the contributing factors for anaemia among HIV-infected children attending Muhimbili National Hospital in Dar es Salaam. Both univariate and multivariate logistic regression analyses were performed to identify possible factors associated with anaemia in HIV-infected children. A total of 75 (44%) patients among 167 recruited HIV-infected children aged 6 months to 59 months of were found to be anaemic (Hg<11g/dl). Multivariate logistic regression demonstrated that not being on HAART (OR 3.40, 95%CI (1.20-9.60), having CD4% <25% (OR 2.30, 95%CI (1.20-34.60), having a history of tuberculosis (TB) (OR 3.23, 95%CI (1.10-9.70) and having hookworm infestation (OR 5.97, 95%CI (1.92-18.4) were independent risk factors for anaemia among HIV infected children. The analyses also showed that being HIV positive for ≥ 2.5 years resulted into a low risk of severe anaemia compared to being HIV positive for < 2.5 years. Taking multivitamins (OR 0.07, 95%, CI (0.020-0.30) and antihelminthics (OR 0.27, 95%CI (0.10-0.74) were also protective against anaemia in children. Similar factors (with exception of using antihelmintics) were associated with severe anaemia. In conclusion the factors associated with anaemia in HIV infected children were multifactorial in nature. Efforts to correct anaemia in HIV infected children should include use of HAART and treatment of infections such as TB and hookworms

Mapping the risk of anaemia in preschool-age children: the contribution of malnutrition, malaria, and helminth infections in West Africa

BACKGROUND Childhood anaemia is considered a severe public health problem in most countries of sub-Saharan Africa. We investigated the geographical distribution of prevalence of anaemia and mean haemoglobin concentration (Hb) in children aged 1-4 y (preschool children) in West Africa. The aim was to estimate the geographical risk profile of anaemia accounting for malnutrition, malaria, and helminth infections, the risk of anaemia attributable to these factors, and the number of anaemia cases in preschool children for 2011. METHODS AND FINDINGS National cross-sectional household-based demographic health surveys were conducted in 7,147 children aged 1-4 y in Burkina Faso, Ghana, and Mali in 2003-2006. Bayesian geostatistical models were developed to predict the geographical distribution of mean Hb and anaemia risk, adjusting for the nutritional status of preschool children, the location of their residence, predicted Plasmodium falciparum parasite rate in the 2- to 10-y age group (Pf PR(2-10)), and predicted prevalence of Schistosoma haematobium and hookworm infections. In the four countries, prevalence of mild, moderate, and severe anaemia was 21%, 66%, and 13% in Burkina Faso; 28%, 65%, and 7% in Ghana, and 26%, 62%, and 12% in Mali. The mean Hb was lowest in Burkina Faso (89 g/l), in males (93 g/l), and for children 1-2 y (88 g/l). In West Africa, severe malnutrition, Pf PR(2-10), and biological synergisms between S. haematobium and hookworm infections were significantly associated with anaemia risk; an estimated 36.8%, 14.9%, 3.7%, 4.2%, and 0.9% of anaemia cases could be averted by treating malnutrition, malaria, S. haematobium infections, hookworm infections, and S. haematobium/hookworm coinfections, respectively. A large spatial cluster of low mean Hb (95%) was predicted for an area shared by Burkina Faso and Mali. We estimate that in 2011, approximately 6.7 million children aged 1-4 y are anaemic in the three study countries. CONCLUSIONS By mapping the distribution of anaemia risk in preschool children adjusted for malnutrition and parasitic infections, we provide a means to identify the geographical limits of anaemia burden and the contribution that malnutrition and parasites make to anaemia. Spatial targeting of ancillary micronutrient supplementation and control of other anaemia causes, such as malaria and helminth infection, can contribute to efficiently reducing the burden of anaemia in preschool children in Africa.Funded by the University of Queensland and National Health and Medical Research Council (NHMRC), Australia

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021 : findings from the Global Burden of Disease Study 2021

Funding Information: This project was supported by the Bill & Melinda Gates Foundation. S Afzal acknowledges support from the Department of Community Medicine and Epidemiology, King Edward Medical University, Lahore, Pakistan. A Ahmad acknowledges Shaqra University, Shaqra, Saudi Arabia for supporting this work. A Badawi is supported by the Public Health Agency of Canada. L Belo acknowledges the support from Fundação para a Ciência e a Tecnologia in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A Fatehizadeh acknowledges support from the Department of Environmental Health Engineering, Isfahan University of Medical Sciences, Isfahan, Iran. S Gaihre acknowledges the Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK for their institutional support. J C Glasbey is supported by a National Institute for Health and Care Research Doctoral Research Fellowship (NIHR300175). V K Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. S Hussain was supported by Operational Program Research, Development and Education project Postdoc2MUNI (number CZ.02.2.69/0.0/0.0/18_053/0016952). S M S Islam is funded by the NHMRC and has received funding from the National Heart Foundation of Australia. N Joseph acknowledges support from the Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. H Kandel is supported by a Kornhauser Research Fellowship at The University of Sydney, Sydney, NSW, Australia. Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia, Sepang, Malaysia (grant numbers XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional support from Manipal Academy of Higher Education, Manipal, India. K Krishan acknowledges non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India. I Landires acknowledges support from Sistema Nacional de Investigación, which is supported by Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación. K Latief acknowledges funding from Taipei Medical University, Taipei, Taiwan for doctoral education during the conduct of this review. D C Malta acknowledges support from Conselho Nacional de Pesquisas (CNPq), Brazil. L Monasta received support from the Italian Ministry of Health (Ricerca Corrente 34/2017) as payments made to the Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy. A Ortiz was supported by Instituto de Salud Carlos III RICORS programme to RICORS2040 (RD21/0005/0001) funded by European Union – NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia and SPACKDc PMP21/00109, FEDER funds. J R Padubidri, A Shetty, B S K Shetty, P H Shetty, and B Unnikrishnan acknowledge the support given by Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. T Palicz acknowledges support from the National Research, Development and Innovation Office in Hungary (RRF-2.3.1-21-2022-00006, Data-Driven Health Division of National Laboratory for Health Security). G Pereira was supported with funding from NHMRC Project and Investigator Grants (1099655 and 1173991). Z Z Piracha acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. Z Quazi Syed acknowledges support from the South Asia Infant Feeding Research Network and Datta Meghe Institute of Higher Education and Research, Wardha, India. A Rahman acknowledges Charles Sturt University, Wagga Wagga, NSW, Australia. U Saeed acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University, Cairo, Egypt and the Egyptian Fulbright Mission Program. P A Shah acknowledges the support from Bangalore Medical College and Research Institute, part of the Rajiv Gandhi University of Health Sciences, Bangalore, India. M R Tovani-Palone acknowledges support from Saveetha Institute of Medical and Technical Sciences, Chennai, India. D Vervoort is supported by the Canadian Institutes of Health Research Vanier Canada Graduate Scholarship. X Xu is supported by a postdoctoral fellowship funded by the Heart Foundation of Australia (award number 102597) and Scientia Program at the University of New South Wales, Sydney, NSW, Australia. C Yu acknowledges support from the National Natural Science Foundation of China (grant number 82173626). Funding Information: This project was supported by the Bill & Melinda Gates Foundation. S Afzal acknowledges support from the Department of Community Medicine and Epidemiology, King Edward Medical University, Lahore, Pakistan. A Ahmad acknowledges Shaqra University, Shaqra, Saudi Arabia for supporting this work. A Badawi is supported by the Public Health Agency of Canada. L Belo acknowledges the support from Fundação para a Ciência e a Tecnologia in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A Fatehizadeh acknowledges support from the Department of Environmental Health Engineering, Isfahan University of Medical Sciences, Isfahan, Iran. S Gaihre acknowledges the Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK for their institutional support. J C Glasbey is supported by a National Institute for Health and Care Research Doctoral Research Fellowship (NIHR300175). V K Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. S Hussain was supported by Operational Program Research, Development and Education project Postdoc2MUNI (number CZ.02.2.69/0.0/0.0/18_053/0016952). S M S Islam is funded by the NHMRC and has received funding from the National Heart Foundation of Australia. N Joseph acknowledges support from the Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. H Kandel is supported by a Kornhauser Research Fellowship at The University of Sydney, Sydney, NSW, Australia. Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia, Sepang, Malaysia (grant numbers XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional support from Manipal Academy of Higher Education, Manipal, India. K Krishan acknowledges non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India. I Landires acknowledges support from Sistema Nacional de Investigación, which is supported by Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación. K Latief acknowledges funding from Taipei Medical University, Taipei, Taiwan for doctoral education during the conduct of this review. D C Malta acknowledges support from Conselho Nacional de Pesquisas (CNPq), Brazil. L Monasta received support from the Italian Ministry of Health (Ricerca Corrente 34/2017) as payments made to the Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy. A Ortiz was supported by Instituto de Salud Carlos III RICORS programme to RICORS2040 (RD21/0005/0001) funded by European Union – NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia and SPACKDc PMP21/00109, FEDER funds. J R Padubidri, A Shetty, B S K Shetty, P H Shetty, and B Unnikrishnan acknowledge the support given by Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. T Palicz acknowledges support from the National Research, Development and Innovation Office in Hungary (RRF-2.3.1-21-2022-00006, Data-Driven Health Division of National Laboratory for Health Security). G Pereira was supported with funding from NHMRC Project and Investigator Grants (1099655 and 1173991). Z Z Piracha acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. Z Quazi Syed acknowledges support from the South Asia Infant Feeding Research Network and Datta Meghe Institute of Higher Education and Research, Wardha, India. A Rahman acknowledges Charles Sturt University, Wagga Wagga, NSW, Australia. U Saeed acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University, Cairo, Egypt and the Egyptian Fulbright Mission Program. P A Shah acknowledges the support from Bangalore Medical College and Research Institute, part of the Rajiv Gandhi University of Health Sciences, Bangalore, India. M R Tovani-Palone acknowledges support from Saveetha Institute of Medical and Technical Sciences, Chennai, India. D Vervoort is supported by the Canadian Institutes of Health Research Vanier Canada Graduate Scholarship. X Xu is supported by a postdoctoral fellowship funded by the Heart Foundation of Australia (award number 102597) and Scientia Program at the University of New South Wales, Sydney, NSW, Australia. C Yu acknowledges support from the National Natural Science Foundation of China (grant number 82173626).Peer reviewedPublisher PD

The silent burden of anaemia in Tanzania children:a community-based study

Objective was to document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old,thereby assisting in the development of effective strategies for controlling anaemia.\ud \ud Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern\ud United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed.\ud \ud Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6–11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1–5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron\ud was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was notassociated with risk of anaemia.\ud \ud Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria

Prevalence of Malaria and Anaemia among HIV Infected Pregnant women Receiving Co-trimoxazole Prophylaxis in Tanzania: A Cross Sectional Study in Kinondoni Municipality.

HIV-infected pregnant women are particularly more susceptible to the deleterious effects of malaria infection particularly anaemia. In order to prevent opportunistic infections and malaria, a policy of daily co-trimoxazole prophylaxis without the standard Suphadoxine-Pyrimethamine intermittent preventive treatment (SP-IPT) was introduced to all HIV infected pregnant women in the year 2011. However, there is limited information about the effectiveness of this policy. This was a cross sectional study conducted among HIV-infected pregnant women receiving co-trimoxazole prophylaxis in eight public health facilities in Kinondoni Municipality from February to April 2013. Blood was tested for malaria infection and anaemia (haemoglobin <11 g/dl). Data were collected on the adherence to co-trimoxazole prophylaxis and other risk factors for malaria infection and anaemia. Pearson chi-square test, Fischer's exact test and multivariate logistic regression were used in the statistical analysis. This study enrolled 420 HIV infected pregnant women. The prevalence of malaria infection was 4.5%, while that of anaemia was 54%. The proportion of subjects with poor adherence to co-trimoxazole was 50.5%. As compared to HIV infected pregnant women with good adherence to co-trimoxazole prophylaxis, the poor adherents were more likely to have a malaria infection (Adjusted Odds Ratio, AOR = 6.81, 95%CI = 1.35-34.43, P = 0.02) or anaemia (AOR = 1.75, 95%CI = 1.03-2.98, P = 0.039). Other risk factors associated with anaemia were advanced WHO clinical stages, current malaria infection and history of episodes of malaria illness during the index pregnancy. The prevalence of malaria was low; however, a significant proportion of subjects had anaemia. Good adherence to co-trimoxazole prophylaxis was associated with reduction of both malaria infection and anaemia among HIV infected pregnant women

Predictors and Consequences of Anaemia Among Antiretroviral-Naïve HIV-Infected and HIV-Uninfected Children in Tanzania.

Predictors and consequences of childhood anaemia in settings with high HIV prevalence are not well known. The aims of the present study were to identify maternal and child predictors of anaemia among children born to HIV-infected women and to study the association between childhood anaemia and mortality. Prospective cohort study. Maternal characteristics during pregnancy and Hb measurements at 3-month intervals from birth were available for children. Information was also collected on malaria and HIV infection in the children, who were followed up for survival status until 24 months after birth. Dar es Salaam, Tanzania. The study sample consisted of 829 children born to HIV-positive women. Advanced maternal clinical HIV disease (relative risk (RR) for stage > or =2 v. stage 1: 1.31, 95 % CI 1.14, 1.51) and low CD4 cell counts during pregnancy (RR for <350 cells/mm3 v. > or =350 cells/mm3: 1.58, 95 % CI 1.05, 2.37) were associated with increased risk of anaemia among children. Birth weight <2500 g, preterm birth (<34 weeks), malaria parasitaemia and HIV infection in the children also increased the risk of anaemia. Fe-deficiency anaemia in children was an independent predictor of mortality in the first two years of life (hazard ratio 1.99, 95 % CI 1.06, 3.72). Comprehensive care including highly active antiretroviral therapy to eligible HIV-infected women during pregnancy could reduce the burden of anaemia in children. Programmes for the prevention of mother-to-child transmission of HIV and antimalarial treatment to children could improve child survival in settings with high HIV prevalence

Anaemia and cognitive function among Chinese elderly in Old Folks Homes

The relationship between anaemia and cognitive function was evaluated among 35 Chinese elderly (24 men and 11 women) aged 60 to 85 years (mean age 70.1 ± 6.7 years) from five old folks homes in Klang Valley. They were interviewed to obtain information on social and health status, habitual dietary intake and cognitive function. Hodkinson’s Abbreviated Mental Test was used to measure the cognitive function. Haematological indices which included Full Blood Count (FBC), serum iron, serum ferritin, Total Iron Binding Capacity (TIBC), serum folate and serum cobalamine (vitamin B12) weremeasured using an automated analyzer. Anthropometric measurements and clinical signs of anaemia were also examined. The findings indicated that the prevalence of anaemia as assessed using haemoglobin alone was 22.9%, while iron deficiency anaemia based on low serum iron, microcytic and hypochromic criterion was detected among 5.7% of the sample. Subclinical folate and vitamin B12 deficiencies were diagnosed among 34.3% and 8.6% of the subjects. However, there was no occurrence of megaloblastic anaemia. There was a positive correlation between cognitive score with mid upper arm circumference (MUAC) (r=0.547, p<0.01) and body mass index (BMI) (r=0.501, p < 0.01). All subjects with low haemoglobin and serum iron and approximately three quarter of subjects with folate and vitamin B12 deficiencies were classified as having cognitive impairment. In conclusion, subclinical malnutrition and anaemia may play a role in the deterioration of cognitive function in the elderl