Multiple Concurrent Illnesses Associated with Anemia in HIV-Infected and HIV-Exposed Uninfected Children Aged 6–59 Months, Hospitalized in Mozambique

Abstract

Anemia is an increasingly recognized problem in sub-Saharan Africa. To determine the magnitude, severity, and associated factors of anemia among hospitalized children aged 6-59 months, HIV-infected and HIV-exposed uninfected children (a child born to a known HIV-infected mother) with a documented fever or history of fever within the prior 24 hours of hospital admission (N = 413) were included in this analysis. Of 413 children enrolled, 364 (88%) were anemic, with 53% classified as mild anemia (hemoglobin [Hb] 7-9.9 g/dL). The most common diagnoses associated with hospital admission included acute respiratory illness (51%), malnutrition (47%), gastroenteritis/diarrhea (25%), malaria (17%), and bacteremia (13%). A diagnosis of malaria was associated with a decrease in Hb by 1.54 g/dL (P < 0.001). In HIV-infected patients, malaria was associated with a similar decrease in Hb (1.47 g/dL), whereas a dual diagnosis of bacteremia and malaria was associated with a decrease in Hb of 4.12 g/dL (P < 0.001). No difference was seen in Hb for patients on antiretroviral therapy versus those who were not. A diagnosis of bacteremia had a roughly 4-fold increased relative odds of death during hospitalization (adjusted odds ratio = 3.97; 95% CI: 1.61, 9.78; P = 0.003). The etiology of anemia in highburden malaria, HIV, tuberculosis, and poor nutrition countries is multifactorial, and multiple etiologies may be contributing to one's anemia at any given time. Algorithms used by physician and nonphysician clinicians in Mozambique should incorporate integrated and non-disease specific approaches to pediatric anemia management and should include improved access to blood culture.

Time to Detection of Anemia and Its Predictors Among Children Receiving Antiretroviral Therapy at Debre Tabor Referral Hospital and University of Gonder Compressive Specialized Hospital, 2020: A Multicenter Retrospective Follow-Up Study

“…The median duration of free from anemia was signi cantly shorter in persons with WHO clinical staging III and IV in follow-up period. The nding is in line with a study from Mozambique, west Africa, and Kenya 7,20,23 . This might be due to having advanced WHO clinical staging might compromise immunity, and can lead to severe illness due to viral replication, depletion of CD4 count, and the added burden of disease.…”

“…Anemia is the commonest disorder which is seen among HIV infected children 6 . WHO estimates that over 2 billion people are anemic worldwide, of these, more than 100 million of anemic children were living in Africa 7 . Even though ART access for HIV infected children increased dramatically, side effects have been continued after the initiation of therapy predominantly in resource-limited setting 3 .…”

“…are not yet fully developed 12 . Additionally, children are the most vulnerable population for anemia, it is responsible for a high proportion of HIV-related deaths each year 7 , up to 90% of children develop anemia during HIV infection 13 .…”

“…Anemia is a leading cause of hospital admission, reduced cognitive development, growth, and poor immune function in children 7 , since the etiology and pathogenesis of anemia are complex 14 , caused by a multifactorial of factors. such as cancer; micronutrient de ciencies; infections, such as malaria and tuberculosis(TB) 15 .…”

“…Giving attention to the young age of children 18 and children with unemployment parent 19 , children with viral load > 1000 copies/ml 9,20 , low CD4 count < 200cells/ul 21,22 , and WHO stage III/IV) 7,20,23 , have been recommended to reduce the impact of HIV associated anemia in the previous era.…”