Prevalence and some causative factors of severe anaemia among children admitted to the Acute Care Unit [of] Mulago Hospital

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dc.creator Nakiboneka, Ssenabulya Deborah
dc.date 2013-07-02T08:32:08Z
dc.date 2013-07-02T08:32:08Z
dc.date 2003-05
dc.date.accessioned 2018-09-04T12:50:03Z
dc.date.available 2018-09-04T12:50:03Z
dc.identifier
dc.identifier http://hdl.handle.net/10570/1474
dc.identifier.uri http://hdl.handle.net/10570/1474
dc.description A dissertation submitted in partial fulfillment of the requirements for the award of the degree of Master of Medicine in Paediatrics and Child Health of Makerere University
dc.description Introduction: Anaemia is a major cause of childhood morbidity and mortality worldwide especially in developing countries. It is an important paediatric health problem in Sub-Saharan Africa where up to 45% of hospitalized children have severe anaemia and receive blood transfusion. Whereas severe anaemia is a common paediatric emergency in Mulago hospital in Uganda, its prevalence in children has not been established, and there is no up to date information on its aetiology. Objective: To determine the prevalence and causative factors of severe anaemia among children admitted to the Acute Care Unit, Mulago Hospital. Design: Cross sectional and case control study, Setting: Mulago National Referral and Teaching Hospital, Kampala, Uganda Participants: Children aged 3-60 months admitted to the Acute Care Unit from September 2002 to April 2003. Cases comprised of 92 children with a haemoglobin level less than 5g/dl. The controls comprised of 92 children with a haemoglobin level between 5g/d to 11g/dl, matched with the cases for age and sex. Another 1400 children admitted to the Acute Care Unit from February to April 2003 were recruited for the prevalence study. Measurements: Basic socio-demographic characteristics of the children and caretakers were collected using a questionnaire. A complete physical examination was performed and blood was taken for haemoglobin level, blood count, peripheral film, haemoglobin electrophoresis, C-reactive protein and serum ferritin. Stool was examined for hookworm ova and occult blood. Statistical analysis: Data was processed using EPI-INFO and SPSS computer software packages, and summarized using frequency tables and histograms. The Chi-squared test was used for categorical variables and the students t-test for continuous variables. Multiple logistic regression was used to determine factors predictive of severe anaemia. Results: Three hundred (21.4%) of the 1400 admitted children had severe anaemia. The majority (75%) of the severely anaemic children were less than 2 years of age. Most children with severe anaemia presented with fever (93.5%), difficulty in breathing (54.3%), heart failure (28.6%), and 20% had had previous blood transfusions. Koilonychia (OR 5.3, CI 1.46-19.0), gallop rhythm (OR 4.78, CI 1.83-12.97), splenomegaly (OR 3.68, CI 1.92-7.04), and hepatomegaly (OR 3.77, CI 1.92-7.04) were significantly associated with severe anaemia. However only koilonychia (OR 6.937, CI 0.03-0.52), gallop rhythm (OR 3.57, CI 1.34-9.34), a history of previous blood transfusion (OR 3.141, CI 1.143-10.53), and hepatomegaly (OR 3.471 CI 0.181-0.485) were independently associated with severe anaemia on logistic regression. Malaria (58.7%), sickle cell gene (13%) and iron deficiency (13%) were the major causes of severe anaemia. The cause was not determined in 23.9% of children. Concerning the aetiology there was no statistically significant difference between the cases and controls. However iron deficiency anaemia was more common amongst the controls. There was no statistically significant difference in mortality between the cases and controls. Five of the cases had pneumonia and four were in heart failure. Conclusions: The prevalence (21.4%) of severe anaemia amongst children admitted to the Acute Care Unit is unacceptably high. Malaria is still the leading cause of severe anaemia and one in five children had a history of previous blood transfusion. Recommendations: There is need to reinforce measures for preventing malaria so as to reduce the frequency of severe anaemia in children. There is need for a detailed prospective clinical audit of children admitted with severe anaemia in Mulago Hospital involving a higher number of children. More studies are needed to determine the contribution of other causes such as HIV, folate and glucose 6-phosphate dehydrogenase enzyme deficiency to severe anaemia.
dc.language en
dc.subject Anemia in children Anaemia – Developing countries
dc.subject Malaria Severe anaemia Mulago Hospital
dc.title Prevalence and some causative factors of severe anaemia among children admitted to the Acute Care Unit [of] Mulago Hospital
dc.type Thesis, masters


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