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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 4  |  Page : 169-173

Prevalence and clinical and laboratory profile of anemia among inpatient children under 5 years of age: A cross-sectional study


1 Senior Resident, Department of Pediatrics, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India
2 Senior Resident, Department of Pediatrics, Nilofer Hospital, Hyderabad, Telangana, India
3 Professor, Department of Pediatrics, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India
4 Post Graduate, Department of Pediatrics, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India
5 Professor and HOD, Department of Pediatrics, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India

Date of Submission06-May-2021
Date of Decision15-Jul-2021
Date of Acceptance19-Jul-2021
Date of Web Publication26-Nov-2021

Correspondence Address:
Dr. C Ramya
Professor, Department of Pediatrics, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar – 505 001, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_36_21

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  Abstract 


Background: Anemia is one of the most common health problems prevalent in Third World countries and developed countries. Anemia among children is of the most important public health problems as it is associated with overall growth and performance of children in academics.
Objective: The objective of this study was to study the prevalence of different types of anemia and their hematological and laboratory parameters in pediatric population <5 years.
Materials and Methods: A hospital-based cross-sectional study was carried out among 100 inpatient children with different causes of anemia from age 1 to 60 months in children's ward of a tertiary care center. A thorough history and detailed clinical examination along with hematological investigations were carried out as per standard guidelines.
Results: In the present study, 793 children of 1 month to 5 years were screened for anemia, and out of them, 100 children (12.6%) were found to have anemia. The inpatient prevalence of anemia in <5-year age group was 12.6%. Of them, 53% were male and 47% were female. Anemia due to iron-deficiency anemia (IDA) was 72 (72%), beta-thalassemia major was 1 (1%), beta-thalassemia minor was 5 (5%), sickle cell anemia was 6 (6%), sickle cell trait was 7 (7%), sickle cell thalassemia was 6 (6%), anemia of chronic disease was 1 (1%), megaloblastic anemia was 1 (1%), and anemia with Plasmodium falciparum malaria was 1 (1%).
Conclusion: The prevalence of anemia was high among this inpatient population of children. IDA was most common, and slight preponderance for males was seen.

Keywords: Anemia, iron-deficiency anemia, sickle cell disorder, Vitamin B12 deficiency


How to cite this article:
Sridevi B, Madhuri M, Ramya C, Yendala L, Reddy V R. Prevalence and clinical and laboratory profile of anemia among inpatient children under 5 years of age: A cross-sectional study. MRIMS J Health Sci 2021;9:169-73

How to cite this URL:
Sridevi B, Madhuri M, Ramya C, Yendala L, Reddy V R. Prevalence and clinical and laboratory profile of anemia among inpatient children under 5 years of age: A cross-sectional study. MRIMS J Health Sci [serial online] 2021 [cited 2022 Jan 19];9:169-73. Available from: http://www.mrimsjournal.com/text.asp?2021/9/4/169/331242




  Introduction Top


Anemia is one of the most common health problems prevalent in Third World countries and developed countries. According to the WHO, anemia is a condition that is characterized by decreased levels of hemoglobin (Hb) in the blood below the normal levels for a given age, gender, and physiological condition. The reduction of the levels of Hb may also be attributed to the deficiency of nutrients such as iron, folic acid, Vitamin B12, and proteins.[1],[2],[3] Anemia occurs when the Hb concentration is below two standard deviations of the distribution mean for Hb for a population of the same sex and age.[4] Iron-deficiency anemia (IDA) is that state where the physiological functioning of the brain and muscles is not maintained because of reduced iron levels in the body.[5]

Of all the various types of anemia prevalent across the globe, nutritional anemia (iron deficiency) is considered to be most prevalent.[1],[6] The characteristic feature of IDA is the presence of Hb level <110 g/L, plus a measure of poor iron status.[7]

Studies have shown that malaria,[8],[9],[10] HIV,[11],[12] iron deficiency,[13],[14] glucose-6-phosphate dehydrogenase deficiency, sickle cell anemia (SCA),[8],[9] and intestinal helminthes[15] are potential causes of anemia. Of all the types of anemia prevalent, IDA, SCA, and thalassemia are most common.

Anemia affects the overall growth and development in children. It interferes with the normal growth. It also affects the brain development. The children with anemia get tired early and thus may not be able to compete with their counterparts. This may affect their social development as they may not be accepted as peer in the surrounding groups. Anemia is also an important cause of increased morbidity and mortality for children. Anemic children are prone to infections and subsequently malnutrition. Malnutrition, in turn, makes them prone to infections, and they suffer more episodes of diarrhea and acute respiratory infections, thus making them vulnerable.[8],[9],[10],[11],[12],[13],[14] Hence, early diagnosis and treatment of anemia is most important from medical, social, and all aspects of overall development of children.

The main objective of this study was to study the prevalence of different types of anemia and their hematological and laboratory parameters in pediatric population <5 years.


  Materials and Methods Top


Study design

This was a hospital-based cross-sectional descriptive study.

Study center

Children between the age groups of 1 month and 60 months who presented with anemia and also those who presented with other complaints were incidentally found to have anemia from the Department of Pediatrics, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar.

Sample size

During the study period, 793 children of age 1 month to 60 months that were admitted in the inpatient ward of the Department of Pediatrics were screened for anemia. Out of them, 100 (12.6%) were found to have anemia. These 100 children were included in this study.

Study period

The duration of this study was from January 2019 to June 2020.

Ethical considerations

Institutional Ethics Committee permission was obtained. Child assent was taken from the parents after explaining the nature of the study. All children were treated and managed as per the standard guidelines.

Inclusion criteria

  • Consecutive samples of children with anemia of either gender under 5 years admitted in the Department of Pediatrics with anemia.


Exclusion criteria

  • Children with anemia attending the outpatient department
  • Neonates.


Procedure and methods

Anemia was defined as Hb <11 g/dl. A thorough history and detailed clinical examination was done for each patient, and the data were recorded in the standard case record form. The venous blood sample was collected in ethylenediaminetetraacetic acid tubes, and the samples were analyzed using and Auto-Analyzer (Sysmex KX-21), having three-part differentials. The list of the parameters evaluated are: Hb%, packed cell volume, red blood cell count, mean corpuscular volume, mean corpuscular Hb (MCH), mean cell Hb concentration, red cell distribution width (11.5%–14.5%), platelet count, and total white blood cell count including the differential count. Peripheral smears were prepared on glass slides and stained with Leishman's stain. The reticulocyte count was done by the supravital staining technique using Brilliant cresyl blue. IDA was confirmed by serum ferritin estimation and also by iron storage assessment of bone marrow examination using Perl's stain. Among the macrocytic anemia, suspected cases of megaloblastic anemia were confirmed by bone marrow examination, serum B12, and folate estimations.

The hemolytic anemia cases, which were suspected on clinical and peripheral blood examination, were taken up for a complete hematological work-up including Hb electrophoresis, osmotic fragility, and Coombs test depending on the specific requirement. Other ancillary tests including stool examination (occult blood, ova, and cysts), urine examination, liver function tests, renal function tests, Mantoux test, and radiological investigations such as chest X-ray, skeletal survey, ultrasonography, and computed tomography scan were done whenever required.

Statistical analysis

The data were entered and analyzed using Windostat 9.2 software. Percentage, proportions, and contingency tables were used for description of the data. The clinical and the laboratory profiles of the various anemia reported were analyzed.


  Results Top


A total number of admissions in pediatric medical ward during the study period were 1582 (excluding neonates). Under 5-year age group, pediatric admissions (excluding neonates) during the study period were 793, of which 100 were found suffering from anemia due to various reasons. The results are as follows. The inpatient prevalence of anemia in <5-year age group was 12.6%.

[Figure 1] depicts age and sex distribution. Among them, 53% were male and 47% were female. The mean age of boys and girls was 28.50 and 20.74 months, respectively (P = 0.001).
Figure 1: Age and sex distribution

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According to [Figure 2], 49 (49%) were in upper-lower, 25 (25%) in lower-middle, 21 (21%) were in lower, and 5 (5%) were in upper-middle class as per modified Kuppuswamy scale.
Figure 2: Socioeconomic status according to modified Kuppuswamy scale

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According to [Figure 3], of the entire sample, 83% were from rural areas and 17% from urban areas.
Figure 3: Locality-wise frequency

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[Figure 4] depicts the percentage of cases with different causes of anemia – highest 72% diagnosed with IDA.
Figure 4: Diagnosis of anemia

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[Table 1] depicts the complaint of pallor by parents in their children 19 (19%) in the age group of 1 year, 22 (22%) in the age group below 2 years, 11 (11%) in the age group of 3 years, 12 (12%) in the age group of 4 years, and 8 (8%) in the age group of 5 years.
Table 1: Clinical profile of pallor in patients

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[Table 2] depicts that pica history was absent in children with sickle thalassemia and a number of patients who underwent transfusions were 33% in beta-thalassemia and 61% in SCA. 61% and 33% of the patients diagnosed with SCA and sickle thalassemia reported with icterus.
Table 2: Clinical profile of patients with anemia

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Hepatomegaly and splenomegaly were observed in 4 (5.5%) and 4 (5.5%) IDA children, respectively. Hepatosplenomegaly, hepatomegaly, and splenomegaly were observed in 3 (50%), 1 (16.6%), and 1 (16.6%) thalassemia patients, respectively.

Two (2.7%) out of 72 IDA patients and 2 (15.3%) out of 13 SCA patients showed symptoms like tachypnea with dyspnea in congestive heart failure. Thirteen (18%) out of 72 IDA patients, 1 (7.6%) out of SCA patients, had ejection systolic murmur.

Koilonychia was noted only in 6 (8.3%) of 72 patients diagnosed with iron deficiency anemia. Frontal bossing and malar prominences were found in 2% and 1% of children, respectively.


  Discussion Top


In the present study, 793 children between the ages of 1 month and 5 years were screened for anemia; out of them, 100 children were found to have anemia. The prevalence of anemia in our study was 12.6% compared to 77.8% prevalence reported by Saba et al.[16] Sahu et al. has reported anemia in 93.8% of children below 5 years of age in their community-based study.[17]

In the present study, 53% were male and 47% were female, i.e., the proportion of anemia in males outnumbered the females (1.2:1) compared to ratio by Saba et al.[16] who reported a ratio of 1.4:1.

The prevalence of IDA in our study was 72%. Among children, 23.5% belonged under the lower and upper-lower class of socioeconomic status according to the modified Kuppuswamy socioeconomic scale. Forty-nine percent of anemic children belonged to lower class, and this was in accordance with Ullah and Zahid.[18]

Sex predominance was slightly found in our study, with 38 females (52.7%) and 34 males (47.2%) reported with IDA. Subjective symptoms (lethargy, easy fatigability, and irritability) were seen in 13.8% of cases whereas objective symptoms such as breathlessness and palpitations were seen in 5.5% of cases.

In the evaluation of IDA, pallor was found to be the most common clinical manifestation and this was also shown by Ullah and Zahid.[18] The most consistent feature was found to be koilonychia which was found exclusively in IDA. The iron profile examinations performed in our study were found to be very appropriate in distinguishing the IDA from other anemia. The total iron-binding capacity (TIBC) levels obtained in our study were found to be higher (443.98) than a study done by Lundblad et al. with TIBC (399.5) and thus indicating the chronicity of the condition.[19]

The iron profile examinations performed in our study were found to be in distinguishing the IDA from other anemia. The recent advances in diagnosing IDA are free erythrocyte protoporphyrin, transferrin saturation, and serum ferritin as discussed by Lundblad et al.[19] In our study, IDA was found to be most prevalent similar to the study conducted by Saroja and DeSouza.[20]

The prevalence of beta-thalassemia minor was more than the others, more between the age groups of 13 and 36 months. We found that in the present study the prevalence of SCA was 6%; that of sickle cell trait was 7%; and the prevalence of sickle thalassemia was 6%. 76% and 66% of the patients diagnosed with SCA and sickle thalassemia showed sickling test positive. Overall contribution of Vitamin B12 deficiency to the global burden of anemia was not significant, and this was in accordance with our study where the Vitamin B12 deficiency accounted for only 1% of the entire sample. Similar findings were also shown by Saroja and DeSouza.[20]


  Conclusion Top


The prevalence of anemia was more in the rural region with low socioeconomic status and males more commonly affected. IDA was most common, and slight preponderance for males was seen.

Limitations

This study was conducted in hospitalized patients and hence the results in our study are not a true representative of the general population. Quantitative estimation of C-reactive protein was not done, which would have identified false-positive elevation of serum ferritin. Recently, there has been great success in the field of bone marrow transplantation of thalassemia major patients but in our study could not perform any transplantation procedures. Hence, further studies are recommended to formulate a policy in treating those patients with anemia.

Ethical approval

The study was reviewed and approved by the Institute Ethics Committee, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar.

Acknowledgment

The authors would like to thank Professor Late Dr. Madoori Srinivas sir.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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World Health Organization. Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization; 2001. Available from: https://www.who.int/nutrition/publications/gs_infant_feeding_text_eng.pdf. [Last accessed on 2020 Jun 12].  Back to cited text no. 1
    
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Weissinger F. Basic principals and clinical significance of iron-deficiency. Fortschr Med 1999;115:35-8.  Back to cited text no. 2
    
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Sakiewicz P, Paganini E. The use of iron in patients on chronic dialysis: Mistake and misconceptions. J Nephrol 1998;11:5-15.  Back to cited text no. 3
    
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WHO, UNICEF, UNU. Iron Deficiency Anemia: Assessment, Prevention, and Control. Guide for Program Managers. Geneva: World Health Organization; 2001. Available from: https://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf. [Last accessed on 2020 Jun 12].  Back to cited text no. 4
    
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Parkin PC, DeGroot J, Maguire JL, Birken CS, Zlotkin S. Severe iron-deficiency anaemia and feeding practices in young children. Public Health Nutr 2016;19:716-22.  Back to cited text no. 5
    
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Ullah I, Zahid M, Khan MI, Shah M. Prevalence of anemia in pregnant women in district Karak Khyber Pakhtunkhwa, Pakistan. Int J Biosci 2013;3:77-83.  Back to cited text no. 6
    
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Martins S, Logan S, Gilbert RE. Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anemia. Cochrane Database Syst Rev 2013;13:CD0001444.  Back to cited text no. 7
    
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Fernando SD, Goonethilleke H, Weerasena KH, Kuruppuarachchi ND, Tilakaratne D, de Silva D, et al. Geo-helminth infections in a rural area of Sri Lanka. Southeast Asian J Trop Med Public Health 2001;32:23-6.  Back to cited text no. 8
    
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World Health Organization. Hemoglobin Concentrations for the Diagnosis of Anemia and Assessment of Severity, Vitamin and Mineral Nutrition Information System. Geneva, Switzerland: World Health Organization; 2011. Available from: https://www.who.int/vmnis/indicators/haemoglobin/en/. [Last accessed on 2020 Jun 12].  Back to cited text no. 9
    
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World Health Organization. Interim WHO Clinical Staging of HIV/AIDS and HIV/AIDS Case Definitions for Surveillance in African Region, WHO/HIV; 2005. Available from: https://www.who.int/hiv/pub/guidelines/clinicalstaging.pdf. [Last accessed on 2020Jun 12].  Back to cited text no. 10
    
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Cheesbrough M. District Laboratory Practices in Tropical Countries. Part 1. Cambridge, UK: Cambridge University Press; 1999. Available from: https://rlmc.edu.pk/themes/images/gallery/library/books/Microbiology/Monica%20Cheesbrough%20District%20Laboratory%20Practice%20in%20Tropical%20Countries,%20Part%201, Second%20Edition%20%202005.pdf. [Last. [Last accessed on 2020 Jun 12].  Back to cited text no. 11
    
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Mohammed H. Modified Ziehl-Neelson Method. Vol. 11. The Ethiopian Health and Nutrition Research Institute (EHNRI); 2010.  Back to cited text no. 12
    
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Johannessen A, Naman E, Gundersen SG, Bruun JN. Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania. BMC Infect Dis 2011;11:190.  Back to cited text no. 13
    
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Denue BA, Kida IM, Hammagabdo A, Dayar A, Sahabi MA. Prevalence of anemia and immunological markers in HIV-infected patients on highly active antiretroviral therapy in northeastern Nigeria. Infect Dis (Auckl) 2013;6:25-33.  Back to cited text no. 14
    
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Alem M, Kena T, Baye N, Ahmed R, Tilahun S. Prevalence of Anemia and Associated Risk Factors among Adult HIV Patients at the Anti-Retroviral Therapy Clinic at the University of Gondar Hospital, Gondar, Northwest Ethiopia 2013; 2: 662.  Back to cited text no. 15
    
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Saba F, Poornima S, Balaji PA, Varne SR, Jayashree K. Anemia among hospitalized children at a multispecialty hospital, Bangalore (Karnataka), India. J Family Med Prim Care 2014;3:48-53.  Back to cited text no. 16
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Sahu T, Sahani NC, Patnaik L. Childhood anemia: A study in tribal area of Mohana blocks in Orissa. Indian J Community Med 2007;32:106-8.  Back to cited text no. 17
    
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Ullah I, Zahid M. Iron deficiency anemia in school age children in district Karak Khyber. Open J Blood Dis 2014;4:9-15.  Back to cited text no. 18
    
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Lundblad K, Rosenberg J, Mangurten H, Angst DB. Severe iron deficiency anemia in infants and young children, requiring hospital admission. Glob Pediatr Health 2016;3:1-5.  Back to cited text no. 19
    
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