Persistent and new-onset anaemia in children aged 6 - 8 years from KwaZulu-Natal Province, South Africa

Abstract

Anaemia impairs normal development in children and is implicated as both a cause and an effect of adverse social and economic family circumstances. [1] Global estimates of childhood anaemia indicate that 293.1 million children aged <5 years are anaemic worldwide, with 28.5% of these living in sub-Saharan Africa. [2] This high anaemia burden among children of sub-Saharan Africa is generally attributed to poverty, communicable diseases, food insecurity, HIV and other associated concerns such as access to healthcare and sanitation. [3] In South Africa (SA), where poor nutrition, poverty and poor parental education are prevalent, the implications are severe for children's future and for national development. Existing global solution strategies to control anaemia in early childhood such as micronutrient supplementation and breastfeeding support have been successful, though associated with questionable sustainability in terms of protecting children from developing anaemia after infancy. [3] A significant proportion of anaemia in school-aged children is attributed to iron deficiency. [2] Subclinical iron deficiency is even more common and has comparable developmental consequences. In the present study, anaemia was used as an indicator of deprived nutrition and poor health status. This study was conducted in a rural community from KwaZulu-Natal (KZN) province where the children are disadvantaged by poor socioeconomic circumstances. Although the association between anaemia and poverty has been described by various researchers, [1,3] the natural history of anaemia associated with poor social environments in young children is not yet well described. Methods Study population This was a longitudinal survey in KZN. This research was an ancillary study to a larger cohort study investigating the health and psychosocial needs of children. The parent study enrolled 1 787 children aged 4-6 years identified in a door-to-door survey in the Valley of a Thousand Hills. The current study was conducted when these children were undergoing follow-up assessments at ages of between 6 and 8 years. A total of 184 consecutive children over a 4-month period were invited to join this study. Diagnostic testing Haemoglobin (Hb) determination by HaemoCue (Angelholm, Sweden) was conducted by a clinician. Anaemia was defined using Hb levels. The World Health Organization (WHO)-recommended cutoffs were used to classify anaemia severity. Children aged up to 59 months had an Hb cutoff of 11.0 g/dL, and 11.5 g/dL was applied for children 5-11 years old. Children aged up to 59 months had anaemia categorised as mild for Hb levels 10.0-10.9 g/dL, moderate 7.0-9.9 g/dL and severe <7.0 g/dL, while for children 5-11 years of age anaemia was classified as mild with Hb levels 11.0-11.4 g/dL, moderate 8.0-10.9 g/dL and severe <8.0 g/dL [4] Stool and urine samples were collected and sent for microscopy at a local academic hospital. All caregivers and children were offered voluntary HIV counselling and testing.

Food and Nutrition Insecurity in Selected Rural Communities of KwaZulu-Natal, South Africa—Linking Human Nutrition and Agriculture

“…Iron deficiency has improved since the SAVACG study conducted in 1994 as the number of persons with iron deficiency decreased from 5% to 1.9% [ 18 , 19 , 20 ]. A recent longitudinal study conducted on children aged 4–6 years and 6–8 years in rural KZN found that out of the 103 children in the study, 37.9% of the children were mildly anaemic, 60.2% were moderately anaemic and 1.9% were severely anaemic [ 54 ]. These study results were in contrast to the results obtained from the 2012 SANHANES-1 study.…”

“…The study conducted by Gwetu et al [ 54 ] classified anaemia into two target groups 0–59 months (mild: 10–10.9 g/dL; moderate: 7–9.9 g/dL; and severe: <7 g/dL) and 5–11 years (mild: 11–11.4 g/dL; moderate: 8–10.9 g/dL; and severe: <8 g/dL) [ 54 ]. The 2012 SANHANES-1 study classified children under 5 years (mild: 10–10.9 g/dL; moderate: 7–9.9 g/dL; and severe: <7 g/dL) [ 20 ] Gwetu et al [ 54 ] reported that the results of their study were similar to previous national studies such as the SAVAGC and NFCS-FB-1) [ 18 , 27 ], and local studies [ 55 , 56 ]. These all indicated that the prevalence of anaemia ranged from 16.5% to 33% [ 18 , 27 , 55 , 56 ].…”

Anaemia control and the interpretation of biochemical tests for iron status in children

“…Parasite infection was further sub-divided into pathogenic and non-pathogenic parasites. Pathogenic parasites are associated with clinical symptoms such as diarrhoea, malnutrition, stunting, and cognitive impairment [ 18 , 19 ]. Non-pathogenic parasites are linked with faecal–oral contamination and were considered as an indicator of poor hygiene.…”

“…A Kappa of one shows perfect agreement, while zero reveals agreement equivalent to chance. The calculation of Kappa was based on the difference between the size of agreement present (“observed” agreement) compared to the agreement expected to be due to chance alone (“expected” agreement) [ 19 ].…”

The straight and marrow - a primary care approach to anaemia

“…South Africa has a high prevalence of anaemia in both preschool and school-aged children. Several independent studies have reported the incidence of anaemia in this population group as ranging from 22% to 57% 12,13,14 which is in stark contrast to the 10.7% stated in the South African National Health and Nutrition Examination Survey (SANHANES-1) report. 15 Nutritional deficiencies and malaria have been reported as major causes of childhood anaemia in sub-Saharan Africa.…”