Anaemia prevalence and its associated factors in children under 5 years in Western China: a systematic review

BackgroundIron-deficiency anaemia disproportionately affects children in low-income and middle-income areas; Western China is a prime example. Given the health risks associated with childhood anaemia and the large heterogeneity of published studies on this subject, we conducted a systematic review of the evidence regarding anaemia prevalence and associated factors in children under 5 years in Western China.MethodsWe searched for all relevant studies on the prevalence of iron deficiency anaemia in children under 5 years in Western China, obtaining research between 1 January 2011 and 30 June 2021, in English and Chinese from Medline, Embase, PubMed, Web of Science, CNKI, WanFang Data and VIP. Two reviewers independently screened titles and abstracts; three reviewed full texts of relevant articles for data extraction and performed quality assessments. The median prevalence was calculated on unweighted pooling, stratified by region, sex, age and ethnic group. Associated factors and a linear trend chart were conducted to identify trends and research highlights.ResultsAmong the 55 articles included, most were cross-sectional studies (39, 70.91%). The prevalence of anaemia in children under 5 years in Western China ranged from 3.69% to 75.74% (median 42.54% (IQR 25.62%–52.56%)); the highest levels were in Qinghai province: 59.10%–75.74% (median 67.80% (IQR 64.70%–72.75%)); the highest levels were reported in the subgroup of children aged 6–12 months (median 50.09% (IQR 34.35%–59.04%)). Regional contexts, individual sociodemographic characteristics and feeding behaviours, and nutritional programme interventions were factors associated with anaemia prevalence.ConclusionThe prevalence of anaemia in children under 5 years in Western China is concerningly high. For this multiethnic and economically underdeveloped region, more high-quality and prospective studies are needed to inform evidence based and targeted preventive strategies to decrease the high prevalence of anaemia among young children.

Iron deficiency anaemia: pathophysiology, assessment, practical management

The WHO has recognised iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected with this condition. Although the most common causes of IDA are gastrointestinal bleeding and menstruation in women, decreased dietary iron and decreased iron absorption are also culpable causes. Patients with IDA should be treated with the aim of replenishing iron stores and returning the haemoglobin to a normal level. This has shown to improve quality of life, morbidity, prognosis in chronic disease and outcomes in pregnancy. Iron deficiency occurs in many chronic inflammatory conditions, including congestive cardiac failure, chronic kidney disease and inflammatory bowel disease. This article will provide an updated overview on diagnosis and management of IDA in patients with chronic conditions, preoperative and in pregnancy. We will discuss the benefits and limitations of oral versus intravenous iron replacement in each cohort, with an overview on cost analysis between the different iron formulations currently on the market.

DIAGNOSTIC SIGNIFICANCE OF MEASURING RETICULOCYTE MATURITY INDICES IN IRON DEFICIENCY ANAEMIA

Objective: To evaluate the diagnostic significance of reticulocyte maturity indices in iron deficiency anaemia. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi, from Sep 2019 to Jun 2020. Methodology: A total of 340 children, ages between 1 and 5 years of either gender, were divided into two groups based on haemoglobin and ferritin level. Group A comprised of 203 children with haemoglobin >11 g/dL andferritin level >7 ng/ mL. Group B comprised of 137 children with haemoglobin <11g/dL and ferritin <7 ng/mL. Red blood cell and reticulocyte parameters were compared. Results: Iron deficiency anaemia was found to be 37.6% in the study population. Comparison revealed that the children in groups B had significantly higher mean red cell distribution width (17.1 ± 1.3% vs. 13.3 ± 1.3%) and significantly lower hemoglobin (9.5 ± 1.0 g/dL vs. 12.7 ± 1.0 g/dL), mean corpuscular hemoglobin (21.8 ± 2.5 pg vs. 28.6 ± 2.3 pg), mean corpuscular volume (69.4 ± 3.5 fL vs. 80.4 ± 3.3 fL), mean corpuscular hemoglobin concentration (31.5 ± 1.8 g/dL vs. 32.7 ± 1.6 g/dL) and serum ferritin level (4.5 ± 2.6 mg/mL vs. 55.9 ± 32.1 ng/mL). No significant differences in the mean total red blood cell count, hematocrit and reticulocytes between two groups were noted (p>0.05) and significant differences were noted in terms of low, medium & high fluorescence ratios in both groups (p<0.05). Conclusion: Our findings suggest that medium fluorescence ratio and high fluorescence ratio.......

Haematological Profile in Microcytic Hypochromic Anaemia in Children

INTRODUCTION: The most common disorders presenting with microcytic hypochromic anaemia are iron deficiency anaemia (IDA) and β-Thalassemia trait (β-TT), and each of them has different pathogenesis and treatment modality. Here we intend to see the haematological profile in microcytic hypochromic anaemia in children apart from IDA and Thalassemia with respect to age and gender. MATERIAL AND METHODS: A total of 95 pediatric patients between the ages of 2 to 12 years with microcytic hypochromic anaemia were included in the study. Blood samples obtained from each patient were evaluated for various haematological and biochemical profiles along with haemoglobin electrophoresis. It was a hospital based observational cross-sectional study done for a period of 18 months from January 2019 to July 2020. RESULTS: Severe anaemia was seen in 55 (57.89%) cases, followed by 38 (40.00%) cases with moderate anaemia and 2 (2.11%) cases with mild anaemia. Majority of the cases showed IDA, which were 85 (89.5%) cases, followed by 6 (6.3%) cases with β-TT and 4 (4.2%) cases with β-TM. RBC count, hematocrit and RDW showed significant variation between IDA, β-TM and β-TT. Most number of correctly diagnosed cases were shown by Ricerca Index with 90 (94.74 %). CONCLUSION: Our study concludes RBC count and RDW, along with Srivasthava Index, Ricerca Index and RDW Index could be used as reliable indices to differentiate between iron deficiency anaemia and β-Thalassemia. Red cell indices, serum iron profile and haemoglobin electrophoresis complement each other for the precise diagnosis of underlying cause of microcytic hypochromic anaemia.

Comparative study of efficacy and safety of parenteral iron sucrose versus ferric carboxymaltose in treatment of postpartum iron deficiency anaemia

Background: Postpartum anaemia often leads to multiple clinical complications in mother as well as infant and iron supplementation with parenteral iron is the preferred treatment modality. The present study was planned to compare the efficacy and tolerability of IV iron sucrose and IV ferric carboxymaltose in treatment of postpartum iron deficiency anaemia.Methods: This randomized, parallel, open label, prospective 4-weeks study was conducted from June 2019 to December 2020 in women with postpartum anaemia admitted to obstetrics and gynaecology inpatient department of a tertiary care hospital. Women with postpartum iron deficiency anaemia (N=60) were randomly divided into two groups; receiving Injection iron sucrose (N=30, maximum dose 500 mg) or Injection ferric carboxymaltose (N=30, maximum dose 500 mg). Change in haemoglobin and serum ferritin levels from baseline to the end of 2 and 4 weeks of treatment were evaluated.Results: The results showed early, sustained and significant increase in the haemoglobin levels in both the groups. However, the difference was not significant between groups (p=0.2). Evaluation of replenishment of iron stores (serum ferritin) showed improvement in both the groups, however in FCM group the rise was found to be significant (p<0.05).Conclusions: FCM in a lower dose of 500mg was found to be safe and effective in significantly improving haemoglobin concentration as well as in replenishing iron stores in patients with postpartum anaemia.

Prevalence of Anaemia, Iron Deficiency, and Iron Deficiency Anaemia in Women of Reproductive Age and Children under 5 Years of Age in South Africa (1997–2021): A Systematic Review

Using a systematic review method, the prevalence of anaemia, iron deficiency (ID), and iron deficiency anaemia (IDA) in women of reproductive age (WRA) and children under 5 years of age was obtained to inform priorities in health planning and policy in South Africa. We searched electronic databases for articles published between 1997 and 2021. A total of 713 articles were identified, of which 14 articles comprising 9649 WRA and 4085 children were included. Since most of the included studies were of low quality, we did not pool data in a meta-analysis due to heterogeneity (I2 > 75%). In WRA, anaemia prevalence ranged from 22.0% to 44.0%; ID from 7.7% and 19.0%; and IDA from 10.5% to 9.7%. The prevalence of anaemia in pregnancy was 29.0% to 42.7%; and 60.6% to 71.3% in HIV-infected pregnant women. Three national surveys reported anaemia in children at 28.9%, 10.7%, and 61.3%, respectively. Overall, among the children under 5 years old, anaemia was more prevalent in 1-year-olds (52.0%) compared to the other age groups. Between 2005 and 2012, ID increased by 3.8% and IDA decreased by 83.2% in children. Anaemia in WRA and children under 5 years in South Africa was a moderate public health concern. Therefore, interventions addressing anaemia should be intensified, and policies on iron supplementation and food fortification need to be revised and aligned to the WHO multiple micronutrient supplementation recommendations.