Underweight children older than 5 years with sickle cell anemia are at risk for early mortality in a low-resource setting

Klein, Lauren; Abdullahi, Shehu U.; Gambo, Safiya; Stallings, Virginia A.; Acra, Sari; Rodeghier, Mark; DeBaun, Michael R.

doi:10.1182/bloodadvances.2022008623

Cited by 4 publications

(9 citation statements)

References 28 publications

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“…Despite the association of being underweight with increased mortality 16 and hospitalizations, 17 no current studies, to our knowledge, discuss the risk factors for being underweight in children aged >5 years with SCA in both low- and high-income settings. We demonstrate that older age and lower hemoglobin level in children aged 5 to 12 years with SCA in both low- and high-income countries are risk factors for being underweight (weight-for-age z score < −1).…”

Section: Discussionmentioning

confidence: 99%

“…Our primary analysis focuses on underweight, defined as weight-for-age z score < −1, given the association with mortality in children aged <5 years 24 and children aged 5 to 12 years with SCA. 16 …”

Section: Methodsmentioning

confidence: 99%

“… 15 We recently demonstrated that children aged 5 to 12 years with SCA who are underweight (weight-for-age z score < −1) are at increased risk of mortality in a low-income setting. 16 Among 431 children aged 5 to 12 years with SCA who were followed up prospectively, weight-for-age z score was the sole determinant of death. 16 This association between undernutrition and SCA mortality further supports the observation that underweight children with SCA are at increased risk of hospitalization.…”

Section: Introductionmentioning

confidence: 99%

“… 16 Among 431 children aged 5 to 12 years with SCA who were followed up prospectively, weight-for-age z score was the sole determinant of death. 16 This association between undernutrition and SCA mortality further supports the observation that underweight children with SCA are at increased risk of hospitalization. 17 However, the risk factors for being underweight, irrespective of living in a low-income vs a high-income setting, remain unexplored.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors in underweight older children with sickle cell anemia: a comparison of low- to high-income countries

Klein,

Abdullahi,

Gambo

et al. 2023

Blood Advances

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Previously, we demonstrated that older children with sickle cell anemia (SCA) living in a low-income setting are at increased risk of death if they are underweight (weight-for-age z-score <-1). We now conducted a cross-sectional study in both low- and high-income settings to determine the consistent biological risk factors for being underweight across both low- and high-income settings for children aged 5-12 years old with SCA. The children from low- and high-income settings were eligible participants for the Primary Prevention of Stroke in Children with Sickle Cell Disease in Nigeria (SPRING, n=928) and the Silent Cerebral Infarct (SIT, North America/Europe, n=1,093) trials, respectively. The median age in the SPRING and SIT cohorts was 8.1 (IQR 6.3-10.3) and 8.5 (6.8-10.6) years, respectively (p=<0.001), and approximately half were male (49.0% and 50.8%, respectively, p=0.434). A total of 87.9% (n=816) of participants in SPRING (low-income) met the study criteria for underweight (weight-for-age z-score <-1) and 22.7% (n=211) for severely underweight (weight-for-age z-score <-3), significantly higher than the SIT (high-income) cohort at 25.7% (n=281) underweight and 0.7% (n=8) severely underweight (p<0.001 for both comparisons). In the combined cohort, older age (OR 1.24, p<0.001, 95% CI 1.17-1.31) and lower hemoglobin level (OR 0.67, p<0.001, 95% CI 0.60-0.75) were associated with being underweight. Age and hemoglobin level remained statistically significant in separate models for the SPRING and SIT cohorts. Older age and lower hemoglobin levels in children aged 5-12 with SCA are associated with increased odds of being underweight in both low- and high-income settings.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk factors in underweight older children with sickle cell anemia: a comparison of low- to high-income countries

Klein,

Abdullahi,

Gambo

et al. 2023

Blood Advances

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“…Sub-Saharan Africa is home to over 75% of all newborns with SCA, with Nigeria accounting for over 30% of children born with SCA worldwide [ 5 ]. Children with SCA and malnutrition are at a higher risk for hospitalization [ 6 ] and mortality [ 7 ]. Addressing the double burden of malnutrition and SCA is crucial for decreasing childhood mortality, especially in sub-Saharan Africa, where the majority of affected children reside.…”

Section: Introductionmentioning

confidence: 99%

Impact of maternal depression on malnutrition treatment outcomes in older children with sickle cell anemia

Ritter,

Abdullahi,

Gambo

et al. 2024

BMC Nutr

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Background Malnutrition and sickle cell anemia (SCA) result in high childhood mortality rates. Although maternal depression is an established risk factor for malnutrition in younger children, little is known about its impact on treatment response in children with malnutrition. We aimed to determine the relationship, if any, between maternal depression scores and malnutrition treatment outcomes in older children with SCA. Methods We conducted a planned ancillary study to our randomized controlled feasibility trial for managing severe acute malnutrition in children aged 5–12 with SCA in northern Nigeria (NCT03634488). Mothers of participants completed a depression screen using the Patient Health Questionnaire (PHQ-9).We used a multivariable linear regression model to describe the relationship between the baseline maternal PHQ-9 score and the trial participant’s final body mass index (BMI) z-score. Results Out of 108 mother-child dyads, 101 with maternal baseline PHQ-9 scores were eligible for inclusion in this analysis. At baseline, 25.7% of mothers (26 of 101) screened positive for at least mild depression (PHQ-9 score of 5 or above). The baseline maternal PHQ-9 score was negatively associated with the child’s BMI z-score after 12 weeks of malnutrition treatment (β=-0.045, p = 0.041). Conclusions Maternal depressive symptoms has an impact on malnutrition treatment outcomes. Treatment of malnutrition in older children with sickle cell anemia should include screening for maternal depression and, if indicated, appropriate maternal referral for depression evaluation and treatment. Trial Registration The trial was registered at clinicaltrials.gov (#NCT03634488) on January 30, 2018, https://clinicaltrials.gov/study/NCT03634488.

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Feasibility trial for the management of severe acute malnutrition in older children with sickle cell anemia in Nigeria

Abdullahi,

Gambo,

Murtala

et al. 2023

Blood Advances

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Children with sickle cell anemia (SCA) living in Nigeria are at an increased risk of malnutrition, which contributes to increased morbidity and mortality. However, evidence-based guidelines for managing malnutrition in children with SCA are lacking. To address this gap, we conducted a multicenter, randomized controlled feasibility trial to assess the feasibility and safety of treating children aged 5-12 years with SCA and uncomplicated severe acute malnutrition (body mass index z-score <-3). Children with SCA and uncomplicated severe acute malnutrition were randomly allocated to receive supplemental ready-to-use therapeutic food (RUTF) with or without moderate-dose hydroxyurea therapy (20 mg/kg/day). Over a six-month enrollment period, 3,190 children aged 5-12 years with SCA were evaluated for eligibility, and 110 of the 111 eligible children were enrolled. During the 12-week trial, no participants withdrew or missed visits. One participant died of unrelated causes. Adherence was high for hydroxyurea (94%), based on pill counts) and RUTF (100%, based on the number of empty sachets returned). No refeeding syndrome event or hydroxyurea-related myelosuppression occurred. At the end of the trial, the mean change in body mass index z-score was 0.49 (sd=0.53), and 39% of participants improved their body mass index z-score to >-3.0. Our findings demonstrate the feasibility, safety, and potential of outpatient treatment for uncomplicated severe acute malnutrition in children aged 5-12 years with SCA in a low-resource setting. However, RUTF sharing with household and community members potentially confounded the response to malnutrition treatment. This trial was registered at clinicaltrials.gov (#NCT03634488).

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Underweight children older than 5 years with sickle cell anemia are at risk for early mortality in a low-resource setting

Cited by 4 publications

References 28 publications

Risk factors in underweight older children with sickle cell anemia: a comparison of low- to high-income countries

Risk factors in underweight older children with sickle cell anemia: a comparison of low- to high-income countries

Impact of maternal depression on malnutrition treatment outcomes in older children with sickle cell anemia

Feasibility trial for the management of severe acute malnutrition in older children with sickle cell anemia in Nigeria

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