Prevalence of Acute Kidney Injury in neonates admitted at a referral hospital, Harare, Zimbabwe

Objectives: To determine prevalence of acute kidney injury and associated factors, among neonates admitted at a referral hospital.Design: Cross sectional study conducted 1 May to 31 July 2010.Setting: Harare Central Hospital, Neonatal Unit. Subjects: 270 neonates ≥ 37 weeks gestation admitted within 12 hours of birth. Systematic random sampling was used to select study participants. Methods: Maternal details were collected through an interviewer administered questionnaire. Neonatal clinical examination was performed. Blood for serum creatinine was collected within 12 hours of life and repeated 24-48 hours of life.Main Outcome Measure:Acute Kidney Injury (AKI) defined by decrease of estimated Glomerular Filtration Rate (GFR) by ≥ 25% from baseline value, using RIFLE criteria (an acronym for Risk, Injury, Failure, Loss and End stage).Results: The prevalence of AKI in term neonates was 33.3% (95% CI 0.27; 0.39). Factors significantly associated with AKI were Hypoxic Ischaemic Encephalopathy (HIE) 1(OR 3.05 95%CI 1.56;5.97), HIE 2 and 3 (OR 9.57 95%CI 3.83;23.92), APGAR score ≤6 (OR 3.82 95%CI 2.16;6.78), respiratory rate >60 (OR1.96 95%CI 1.09;3.55), chest recessions (OR 2.73 95% CI 1.56;4.75), history of neonatal fits (OR 5.78 95%CI 1.56;4.75),hypothermia (OR 3.05 95%CI 1.56;4.75) and maternal age ≥35 years(OR 5.89 95%CI1.11;31.41). Strong determinants of AKI on multivariate logistic regression analysis were HIE 1, hypothermia and chest recessions.Conclusion: The prevalence of AKI in term neonates admitted at a Harare hospital was high. It is recommended to assess for AKI in neonates with identified risk factors and monitor for chronic kidney disease

Anaemia and iron deficiency in peri-urban school children born in a National HIV Prevention Programme in Zimbabwe: A cross-sectional study

Objective: To determine the prevalence of anaemia, iron deficiency and iron deficiency anaemia in school children who were bom in a national HIV prevention programme.Design: This was a community based cross-sectional study.Setting: A resource poor peri-urban setting with high prevalence of HIV infection.Subjects'. School aged children six tolO years old who were bom in a national mother-to-child HIV prevention programme.Main OutcomeMeasures: Haemoglobin (Hb), serum Ferritin (F) and serum Transferrin receptor (sTfR) levels.Results: Three hundred and eighteen children were recruited including 21 HIV positive. The prevalence of anaemia (Hb <11.5 grams per litre), iron deficiency (F<15 micrograms per litre) and iron deficiency anaemia (Hb <11.5 g/L and either F <15pg/L or sTfR> 8.3pg/L) were 15%, 4% and 2% respectively. When a higher cut-off for ferritin of 30 micrograms per litre was applied to adjust for high infection disease burden, iron deficiency prevalence increased to 32% and iron deficiency anaemia increased to 5%. Anaemia was 4.9 (C.I 1.9-12.4) times more likely to occur in HIV infected children compared to the HIV uninfected children. Maternal HIV status at birth was not related to presence of anaemia in the school children.Conclusion: Anaemia was of mild public health significance in this cohort of children. Iron deficiency anaemia contributed less than a quarter of the cases of anaemia. HIV infection was an important determinant for presence of anaemia. Therefore continued efforts to eliminate paediatric HIV infection as a way of reducing anaemia in children are essential

Anaemia and iron deficiency in peri-urban school children born in a National HIV Prevention Programme in Zimbabwe: A cross-sectional study

Objective: To determine the prevalence of anaemia, iron deficiency and iron deficiency anaemia in school children who were born in a national HIV prevention programme.Design: This was a community based cross-sectional study.Setting: A resource poor peri-urban setting with high prevalence of HIV infection.Subjects: School aged children six to 10 years old who were born in a national mother-to-child HIV prevention programme.Main Outcome Measures: Haemoglobin (Hb), serum Ferritin (F) and serum Transferrin receptor (sTfR) levels.Results: Three hundred and eighteen children were recruited including 21 HIV positive. The prevalence of anaemia (Hb <11.5 grams per litre), iron deficiency (F<15 micrograms per litre) and iron deficiency anaemia (Hb < 11.5 g/L and either F <15µg/L or sTfR > 8.3µg/L) were 15%, 4% and 2%  respectively. When a higher cut-off for ferritin of 30 micrograms per litre was applied to adjust for high infection disease burden, iron deficiency prevalence increased to 32% and iron deficiency anaemia  increased to 5%. Anaemia was 4.9 (C.I 1.9-12.4) times more likely to occur in HIV infected children compared to the HIV uninfected children. Maternal HIV status at birth was not related to presence of anaemia in the school children.Conclusion: Anaemia was of mild public health significance in this cohort of children. Iron deficiency anaemia contributed less than a quarter of the cases of anaemia.  HIV infection was an important determinant for presence of anaemia. Therefore continued efforts to eliminate paediatric HIV infection as a way of reducing anaemia in children are essential