Anemia among School-Age Children: Magnitude, Severity and Associated Factors in Pawe Town, Benishangul-Gumuz Region, Northwest Ethiopia

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Abstract

Background

Anemia is a global public health problem associated with increased mortality and morbidity. The cause of anemia in school-age children is multifactorial and has been associated with delayed psychomotor development, poor cognitive performance, impaired immunity and decrease working capacity. The aim of this study was to determine the magnitude, severity and determinant factors of anemia among school-age children (5–15 years) in Pawe Town, Northwest Ethiopia.

Methods

A community based cross-sectional study was conducted from March 20 to June 19, 2015 in Pawe Town. A total of 422 school-age children were included in this study. Sociodemographic and related data were collected using structured questionnaire. Anthropometric data were collected from each study participant. Hemoglobin concentration was measured using HemoCue ^® Hb 201 ⁺ System (HemoCue, Angelholm, Sweden). Blood film for malaria diagnoses and stool examination for intestinal parasites were also performed. Data were analyzed using SPSS version 20.0.

Results

The overall prevalence of anemia among school-age children was 33.9%. Mothers' illiteracy (AOR=7.5, 95% CI: 2.6–16.3), being from a family with low income (AOR=4.8, 95% CI: 1.3–10.9), being stunted (AOR=7.1, 95% CI: 2.9–11.9), being underweight (AOR=5.3, 95% CI: 2.1–13.3), infection with intestinal parasites (AOR=5.2, 95% CI: 2.1–12.6), and malaria infection (AOR=8.2, 95% CI: 1.8–14.5) were identified as associated factors of anemia.

Conclusion

In this study, anemia is a moderate public health problem among school-age children. School health strategies and interventions targeting nutritional deficiencies and parasitic infections might be very important.

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Most cited references 24

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Severe Malarial Anemia: Innate Immunity and Pathogenesis

Douglas J Perkins, Tom Were, Gregory Davenport … (2011)

Greater than 80% of malaria-related mortality occurs in sub-Saharan Africa due to infections with Plasmodium falciparum. The majority of P. falciparum-related mortality occurs in immune-naïve infants and young children, accounting for 18% of all deaths before five years of age. Clinical manifestations of severe falciparum malaria vary according to transmission intensity and typically present as one or more life-threatening complications, including: hyperparasitemia; hypoglycemia; cerebral malaria; severe malarial anemia (SMA); and respiratory distress. In holoendemic transmission areas, SMA is the primary clinical manifestation of severe childhood malaria, with cerebral malaria occurring only in rare cases. Mortality rates from SMA can exceed 30% in pediatric populations residing in holoendemic transmission areas. Since the vast majority of the morbidity and mortality occurs in immune-naïve African children less than five years of age, with SMA as the primary manifestation of severe disease, this review will focus primarily on the innate immune mechanisms that govern malaria pathogenesis in this group of individuals. The pathophysiological processes that contribute to SMA involve direct and indirect destruction of parasitized and non-parasitized red blood cells (RBCs), inefficient and/or suppression of erythropoiesis, and dyserythropoiesis. While all of these causal etiologies may contribute to reduced hemoglobin (Hb) concentrations in malaria-infected individuals, data from our laboratory and others suggest that SMA in immune-naïve children is characterized by a reduced erythropoietic response. One important cause of impaired erythroid responses in children with SMA is dysregulation in the innate immune response. Phagocytosis of malarial pigment hemozoin (Hz) by monocytes, macrophages, and neutrophils is a central factor for promoting dysregulation in innate inflammatory mediators. As such, the role of P. falciparum-derived Hz (PfHz) in mediating suppression of erythropoiesis through its ability to cause dysregulation in pro- and anti-inflammatory cytokines, growth factors, chemokines, and effector molecules is discussed in detail. An improved understanding of the etiological basis of suppression of erythropoietic responses in children with SMA may offer the much needed therapeutic alternatives for control of this global disease burden.

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Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States.

J Halterman, J M Kaczorowski, C Aligne … (2001)

Iron deficiency anemia in infants can cause developmental problems. However, the relationship between iron status and cognitive achievement in older children is less clear. To investigate the relationship between iron deficiency and cognitive test scores among a nationally representative sample of school-aged children and adolescents. The National Health and Nutrition Examination Survey III 1988-1994 provides cross-sectional data for children 6 to 16 years old and contains measures of iron status including transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin. Children were considered iron-deficient if any 2 of these values were abnormal for age and gender, and standard hemoglobin values were used to detect anemia. Scores from standardized tests were compared for children with normal iron status, iron deficiency without anemia, and iron deficiency with anemia. Logistic regression was used to estimate the association of iron status and below average test scores, controlling for confounding factors. Among the 5398 children in the sample, 3% were iron-deficient. The prevalence of iron deficiency was highest among adolescent girls (8.7%). Average math scores were lower for children with iron deficiency with and without anemia, compared with children with normal iron status (86.4 and 87.4 vs 93.7). By logistic regression, children with iron deficiency had greater than twice the risk of scoring below average in math than did children with normal iron status (odds ratio: 2.3; 95% confidence interval: 1.1-4.4). This elevated risk was present even for iron-deficient children without anemia (odds ratio: 2.4; 95% confidence interval: 1.1-5.2). We demonstrated lower standardized math scores among iron-deficient school-aged children and adolescents, including those with iron deficiency without anemia. Screening for iron deficiency without anemia may be warranted for children at risk.

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Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infections: a study in Côte d'Ivoire.

P Adou, F S Asobayire, L Davidsson … (2001)

Iron deficiency is highly prevalent in most developing countries. However, its detection is often obscured by infections and inflammatory disorders that are common in the same populations. The aim of this study was to estimate the prevalence of iron deficiency with or without concurrent anemia in different population groups from Côte d'Ivoire and to evaluate the influence of infectious and inflammatory disorders on iron-status indexes. Blood samples from 1573 children, women, and men were analyzed for hemoglobin, serum ferritin, zinc protoporphyrin, and serum transferrin receptor. C-reactive protein was used as the indicator of inflammation or infection, and samples were screened for malarial parasites and hemoglobinopathies. Iron deficiency was defined as 2 of 3 iron-status indexes outside the cutoff values, and iron deficiency anemia (IDA) was defined as iron deficiency with concurrent anemia. Pearson's correlation coefficients were used to evaluate the influence of malaria and inflammation on iron-status indexes. The prevalence of iron deficiency was 41-63% in the women and children and 13% in the men, whereas the prevalence of IDA was 20-39% in the women and children and 4% in the men. The detection of iron deficiency and IDA was obscured by the high prevalence of inflammatory disorders. Iron deficiency and IDA are highly prevalent in the women and children in Côte d'Ivoire. Iron deficiency was detected in approximately 50% of anemic women and children, which indicates that hemoglobin alone is not a good indicator of iron status when inflammatory disorders are highly prevalent. The serum transferrin receptor is the most useful single indicator of iron deficiency because it was the only iron-status index unaffected by malaria or inflammation.

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Author and article information

Journal

Journal ID (nlm-ta): Ethiop J Health Sci

Journal ID (iso-abbrev): Ethiop J Health Sci

Title: Ethiopian Journal of Health Sciences

Publisher: Research and Publications Office of Jimma University (Jimma, Ethiopia )

ISSN (Print): 1029-1857

ISSN (Electronic): 2413-7170

Publication date (Print): May 2018

Volume: 28

Issue: 3

Pages: 259-266

Affiliations

[1 ]Departemnt of Medical Laboratory Science, College of Health Science, Assosa University, Assosa, Ethiopia

[2 ]School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia

Author notes

Funding: Assosa University, Ethiopia

Competing Interests: The authors declare that this manuscript was approved by all authors in its form and that no competing interest exists.

* yaregala3@ 123456gmail.com ; yaregal.asres@ 123456ju.edu.et

Article

Publisher ID: jEJHS.v28.i3.pg259

DOI: 10.4314/ejhs.v28i3.3

PMC ID: 6016356

PubMed ID: 29983525

SO-VID: 840a77dc-32dd-40ee-8699-189db590e73f

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Anemia among School-Age Children: Magnitude, Severity and Associated Factors in Pawe Town, Benishangul-Gumuz Region, Northwest Ethiopia

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Abstract

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Conclusion

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Chinese Journal of School Health

Most cited references 24

Severe Malarial Anemia: Innate Immunity and Pathogenesis

Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States.

Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infections: a study in Côte d'Ivoire.

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