Long Term Outcome of Severe Anaemia in Malawian Children

Abstract

BackgroundSevere anaemia is a common, frequently fatal, condition in African children admitted to hospital, but its long term outcome is unknown. Early reports that survivors may be at risk of additional late morbidity and mortality may have significant implications for child survival in Africa. We assessed the short and long term outcome of severe anaemia in Malawian children and identified potential risk factors for death and further severe anaemia.Methodology and FindingsFor 18 months, we followed up children (6–60 months old) presenting to hospital with severe anaemia (haemoglobin ≤5g/dl) and their hospital and community controls with the aim to compare all cause mortality and severe anaemia recurrence rates between the groups, and to identify risk factors for these adverse outcomes. A total of 377 cases, 377 hospital controls and 380 community controls were recruited. Among cases, the in-hospital mortality was 6.4% and post-discharge all cause mortality was 12.6%, which was significantly greater than in hospital controls (2.9%) or community controls (1.4%) (Log rank test, p<0.001). The incidence of recurrence of severe anaemia among the cases was 0.102 per child-year (95% Confidence Interval 0.075–0.138), and was significantly higher than the 0.007 per child-year (95% CI 0.003–0.015) in the combined controls (p<0.0001). HIV was the most important risk factor both for post-discharge mortality (Hazard Ratio 10.5, 95% CI 4.0–27.2) and for recurrence of severe anaemia (HR 5.6, 95% CI 1.6–20.1).ConclusionsSevere anaemia carries a high ‘hidden’ morbidity and mortality occurring in the months after initial diagnosis and treatment. Because severe anaemia is very common, this is likely to contribute importantly to overall under-five mortality. If not adequately addressed, severe anaemia may be an obstacle to achievement of the Millennium development goal No.4 on child survival. Strategies to diagnose and properly treat HIV infected children early most likely will reduce the high post-discharge mortality in severe anaemia.

Long term mortality after community and facility based treatment of severe acute malnutrition: Analysis of data from Bangladesh, Kenya, Malawi and Niger

“…Studies have shown that long term survival of children discharged after treatment for malaria, diarrhoea and respiratory infection may be worse than that reported here for children discharged from therapeutic feeding programmes (Islam et al, 1996;Phiri et al, 2008;Roy et al, 1983;Snow et al, 2000;Veirum et al, 2007;West et al, 1999). Indeed, in Bangladesh an incidence mortality rate of 465 deaths per 1000 PY has been reported in children followed in the community after recovery from acute diarrhoea (Islam et al, 1996).…”

The effects of co-infection with human parvovirus B19 and Plasmodium falciparum on type and degree of anaemia in Ghanaian children

“…In most cases, it is due to two or more causative agents rather than a single one [1][2][3] . Malaria, bacteraemia, helminthiasis, human parvovirus B19 (B19V) infection and other infections such as tuberculosis and HIV/AIDS have been widely reported as important factors contributing to the high prevalence of anaemia in many populations [3][4][5][6][7][8][9][10][11][12][13][14][15][16] . Even though some individual causes have been identified,…”

Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis

“…Furthermore, malnutrition, anaemia, hypoxaemia, longer hospitalization and discharge against medical advice exacerbate this risk. [6][7][8][9][10][11][12] Additional data are needed to guide the development of strategies for effective follow-up care that will reduce post-discharge mortality.…”