Background. Anaemia in children is a significant health problem that receives little attention. This study aimed at determining the factors significantly associated with anaemia in children aged 6 to 59 months in Kenya, Malawi, Tanzania, and Uganda while accounting for the spatial heterogeneity within and between the districts of the four countries. In addition, the performance of the districts with regard to their impact on anaemia was assessed and ranked. Methods. A generalised additive mixed model with a spatial effect based on the geographical coordinates of the clusters was used. A district-level random effect was included to further account for the heterogeneity as well as to rank the performance of the districts based on the best linear unbiased prediction (BLUP). Results. The results depicted significant spatial heterogeneity between and within the districts of the countries. After accounting for such spatial heterogeneity, child-level characteristics (gender, malaria test result, and mother&#x2019;s highest education level), household-level characteristics (household size, household&#x2019;s wealth index Z-score, the type of toilet facility available, and the type of place of residence), and the country of residence were found to be significantly associated with the child&#x2019;s anaemia status. There was a significant interaction between the type of place of residence and the country of residence. Based on the BLUP for the district-level random effect, the top 3 best- and worst-performing districts within each country were identified. Conclusion. The ranking of the performance of the districts allows for the worst-performing districts to be targeted for further research in order to improve their anaemia control strategies, as well as for the best-performing districts to be identified to further determine why they are performing better and then to use these districts as role models in efforts to overcome childhood anaemia.

Danielle J. Roberts

Temesgen Zewotir

District Effect Appraisal in East Sub-Saharan Africa: Combating Childhood Anaemia

Iron deficiency anemia (IDA) during pregnancy arises because of preexisting inadequate stores or complex physiological changes and can lead to serious maternal and fetal complications. Oral iron, either as iron sulfate or fumarate, with or without folic acid, is the most commonly used treatment for IDA in pregnancy. Intravenous (IV) iron has a role in the treatment of IDA in pregnancy, particularly in women who present late, display severe anemia (Hb&#x2009;&#x2264;&#x2009;9&#x2009;g/dL), or risk factors, and are intolerant/noncompliant of oral iron. Previously, administration of IV iron was minimal, owing to potentially serious anaphylactic reactions. Recently, new IV iron products have been developed, offering better compliance, tolerability, efficacy, and a good safety profile. Our study aimed to assess the effectiveness, safety, and tolerability of IV ferric carboxymaltose (FCM) in the treatment of IDA in pregnant women in the UAE. Data from 1001 pregnant women who received at least one administration of FCM (500, 1000, or 1500&#x2009;mg) during their second or third trimester of pregnancy (2 years backward from study initiation) were collected retrospectively from electronic medical records at Corniche Hospital, Abu Dhabi, UAE. Results showed that 41.4&#x0025; of the women were able to achieve an increase of &#x2265;2&#x2009;g/dL in blood hemoglobin overall. A change of &#x2265;2&#x2009;g/dL was achieved by 27.5&#x0025; of women administered a dose of 500&#x2009;mg, 39.2&#x0025; of women administered a dose of 1000&#x2009;mg, and 63.9&#x0025; of women administered a dose of 1500&#x2009;mg of IV FCM. This indicates a directly proportional relationship between increasing IV FCM dose and the increase of &#x2265;2&#x2009;g/dL in blood hemoglobin. A total of 7 (0.7&#x0025;) women reported mild, nonserious adverse events during the study. Within the limits of this retrospective study, IV FCM therapy was safe and effective in increasing the mean hemoglobin of pregnant women with IDA.

Saleema Wani

Mariyam Noushad

Shabana Ashiq

REGAIN STUDY: Retrospective Study to Assess the Effectiveness, Tolerability, and Safety of Ferric Carboxymaltose in the Management of Iron Deficiency Anemia in Pregnant Women

Background. Iron deficiency anemia (IDA) in pregnant women is common, and iron supplementation is given during pregnancy to reduce birth complication. This study aimed to explore the prevalence of anemia and type of anemia after iron supplementation among pregnant women in the eastern part of Indonesia. Methods. A cross-sectional study design was conducted between January and March 2019 in three Primary Health Care (PHC) facilities at Kupang, West Timor. After consent, pregnant women who had taken their iron supplementation for at least 3 months were asked for iron pills intake by using a self-designed questionnaire and by counting the pills leftover. Complete blood count examination was performed, and the type of anemia was assessed using Shine and Lal index (SLI; MCV <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.04980993pt" id="M1" height="6.01072pt" version="1.1" viewBox="-0.0498162 -5.96091 7.75925 6.01072" width="7.75925pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-43" d="M471 153C471 170 463 194 452 212C400 220 373 229 322 255C373 281 400 290 452 298C463 316 471 339 471 357C456 366 431 371 410 370C377 329 356 310 308 279C311 336 317 364 336 413C326 432 310 451 294 459C279 451 262 432 252 413C271 364 277 336 280 279C232 310 211 329 178 370C157 371 132 367 117 357C117 340 125 316 136 298C188 290 215 281 266 255C215 229 188 220 136 212C125 194 117 171 117 153C132 144 157 139 178 140C211 181 232 200 280 231C277 174 271 146 252 97C262 78 278 59 294 51C309 59 326 78 336 97C317 146 311 174 308 231C356 200 377 181 410 140C431 139 456 143 471 153Z"/></g></svg> MCV <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.04980993pt" id="M2" height="6.01072pt" version="1.1" viewBox="-0.0498162 -5.96091 7.75925 6.01072" width="7.75925pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-43"/></g></svg> MCH/100) to determine whether anemia was due to iron deficiency or β-thalassemia trait (β-TT). In a subset of iron tablets distributed in the PHCs, Fe-concentration was measured. Results. Of 102 pregnant women included, only 25.5% had taken the pills with a pill count of &gt;80%. Interestingly, Fe-concentration in the pills from three different PHC facilities varied between 75% and 100%. After iron supplementation, however, anemia was detected in 34.3%, and based on SLI, 14.7% was suspected because of iron deficiency and 19.6% was suspective of β-TT. Of note, nonanemic pregnant women (17.6%) had also low SLI, suggesting β-TT or other hemoglobinopathies. Conclusion. Assessment of Shine and Lal index as the first step to screen the type of anemia in pregnant women from a limited area is of potential value, especially because Indonesia is located in the thalassemia belt area. An integrative approach and counseling among pregnant women with β-TT and their partners will increase thalassemia awareness and optimal birth management.

Merry M. V. Seu

Johanes C. Mose

Ramdan Panigoro

Edhyana Sahiratmadja

Anemia Prevalence after Iron Supplementation among Pregnant Women in Midwifes Practice of Primary Health Care Facilities in Eastern Indonesia

Background. Anaemia is one of the major causes of death among children under five years in Ghana. We examined the risk factors of anaemia among children under five years in the Hohoe Municipality, Ghana. Methods. This facility-based matched case control study recruited 210 children (70 cases and 140 controls) aged 6 to 59 months. Stratified and simple random sampling techniques were used to select mothers attending Child Welfare Clinic (CWC) for the screening of their children. Data were collected using a semistructured questionnaire. Finger prick blood was collected to estimate the haemoglobin (Hb) level and thick film was prepared to determine malaria parasitaemia. Axillary temperature was measured using an +electronic thermometer and anthropometric measurements were done using a weighing scale and inelastic tape measure. Continuous variables were presented as means and standard deviations and categorical variables as frequencies and proportions. Conditional logistic regression was used to determine the strength of association between the dependent and the independent variables. Statistical significance was considered at p value of &#x3c;0.05. Results. The prevalence of anaemia was high (53.8&#x25;), while children whose mothers received iron supplementation during pregnancy were 7.64 times more likely to be anaemic compared with those who did not [AOR=7.64 (95&#x25; CI:1.41-41.20.93); p=0.018]. Children with poor dietary diversity were 9.15 times more likely to have anaemia [AOR=9.15 (95&#x25; CI: 3.13-26.82); p&#x3c; 0.001]; and children whose mothers were farmers and traders were 83&#x25; [AOR = 0.17 (95&#x25; CI: 0.05-0.60); p=0.006] and 79&#x25; [AOR=0.21 (95&#x25; CI: 0.06-0.74); p=0.014], respectively, less likely to have anaemia. Conclusion. The biologic, intermediate, and underlying factors that were significantly associated with anaemia comprised maternal iron supplementation, poor dietary diversity, farmers, and traders. Given that iron supplementation during pregnancy did not protect children against anaemia, we recommend the child&#x2019;s nutritional dietary diversity is encouraged.

Phyllis Atta Parbey

Elvis Tarkang

Emmanuel Manu

Hubert Amu

Martin Amogre Ayanore

Fortress Yayra Aku

Sorengmen Amos Ziema

Samuel Adolf Bosoka

Martin Adjuik

Margaret Kweku

Risk Factors of Anaemia among Children under Five Years in the Hohoe Municipality, Ghana: A Case Control Study

Background. Interleukin-6 (IL-6) proinflammatory cytokine is associated with the pathogenesis of rheumatoid arthritis and development of anemia in it. This is a comparative study of inflammatory and hematological parameters in RA patients with anemia of chronic disease (ACD) and iron deficiency anemia (IDA). It aimed to demonstrate the changes in serum level of IL-6, ferritin level, and hematological parameters in different groups of patients with RA and to find out the potential correlation between serum level of IL-6 and ferritin level and the relationship between serum level of IL-6 and iron status. Methods. The study included 89 patients from both sexes divided into four groups (group 1: 30 iron deficiency anemia (IDA), 59 RA; group 2: 20 RA-COMBI; group 3: 23 RA-ACD; and group 4: 16 nonanemic RA). These different groups were compared with a healthy group of 50 healthy individuals. Different blood parameters (WBC, RBC, HGB, HCT, MCV, and MCH) have been evaluated. Serum concentrations of IL-6, hsCRP, anti-CCP, and ferritin were measured in all patients and healthy individual using enzyme-linked immunosorbent assay ELISA. Results. There were significant changes in most of blood parameters between the groups, and there was a significant increase in the levels of IL-6 among RA patients. This increase was highly significant among RA-ACD patients in particular, and this elevation has been directly correlated with clinical indices of disease activity such as hsCRP, ESR, anti-CCP, and ferritin. There was an inverse relationship between ferritin and all iron status parameter, such as RBC, HGB, and haematocrit. Conclusion. IL-6 and ferritin level estimation may be workable tests to differentiate the patients with IDA and ACD in RA.

Eman Tariq Ali

Azza Sajed Jabbar

Ali Nazar Mohammed

A Comparative Study of Interleukin 6, Inflammatory Markers, Ferritin, and Hematological Profile in Rheumatoid Arthritis Patients with Anemia of Chronic Disease and Iron Deficiency Anemia

Background. Anemia is a major public health problem worldwide. Adolescent girls are the most vulnerable group of population due to different reasons. The aim of this study was to assess the prevalence of anemia and associated factors among school adolescent girls in rural towns of Bahir Dar City Administration, North West Ethiopia. Methods. A cross-sectional study was conducted from March 5 to April 15, 2017, on 443 randomly selected school adolescent girls. Data were collected using pretested structured questionnaire and anthropometric measurements. Blood sample was also collected to assess the hemoglobin (Hgb) value of study participants. SPSS version 20 was used to analyze data. Descriptive statistics were used to describe data. Bivariate and multivariable logistic regression models were used to identify the associated factors with the outcome variable. Crude and adjusted odds ratios with 95&#x25; confidence interval (CI) were calculated to identify the variables significantly associated with the outcome variable. Result. The prevalence of anemia was 11.1&#x25;. Household family size [AOR=3.2, 95&#x25;CI (1.29-7.89)], average household monthly income &#x3c;500 ETB [AOR=10; 95&#x25;CI (2.49-41.26)], 501-1000 ETB [AOR=6, 95&#x25;CI (2.54-14.33)], history of intestinal parasitic infection [AOR=2.7; 95&#x25; CI (1.19-6.21)], duration of menstruation flow [AOR=2.4; 95&#x25;CI (1.08- 5.44)], and BMI for age [AOR-3.2; 95&#x25; CI (1.43-7.05)] were the predictors of anemia. Conclusion and Recommendation. Anemia was a mild public health problem among school adolescent girls in the study area. Household monthly income, family size, intestinal parasite infections, duration of menstruation, and BMI for age are predictors of anemia. Thus, intervention strategies should focus on prevention and early treatment of intestinal parasite, nutritional education, screening, and iron supplementation programs to prevent anemia among school adolescent girls.

Getachew Mengistu

Muluken Azage

Hordofa Gutema

Iron Deficiency Anemia among In-School Adolescent Girls in Rural Area of Bahir Dar City Administration, North West Ethiopia

Background. Glucose-6-phosphate dehydrogenase (G6PD) converts glucose-6-phosphate into 6-phosphogluconate in the pentose phosphate pathway and protects red blood cells (RBCs) from oxidative damage. Their deficiency therefore makes RBCs prone to haemolysis. Sickle cell disease (SCD) on the other hand is a hereditary blood disorder in which there is a single nucleotide substitution in the codon for amino acid 6 substituting glutamic acid with valine. SCD patients are prone to haemolysis due to the shape of their red blood cells and if they are deficient in G6PD, the haemolysis may escalate. Reported studies have indicated variations in the prevalence of G6PD deficiency in SCD patients and as such further work is required. The aim of this study was therefore to estimate the incidence of G-6-PD deficiency among SCD patients and to determine its impact on their RBC parameters as a measure of incidence of anaemia. Methods. A total of 120 clinically diagnosed SCD patients of genotypes HbSS and HbSC were recruited into the study. About 5ml of blood was collected via venipuncture from each patient and used to run G6PD, full blood count, and haemoglobin (Hb) electrophoresis tests. The data were analyzed using SPSS version 20 and Graphpad prism. Result. G6PD deficiency was detected in 43 (35.83&#x25;) of the participants made up of 16 (13.33&#x25;) males and 27 (22.50&#x25;) females of whom 17 (14.17&#x25;) had partial deficiency and 10 (8.33&#x25;) full deficiency. Statiscally significant differences p=0.036 and p=0.038 were established between the Hb concentration of the participants having a G6PD deficiency and those with normal G6PD activity for males and females, respectively. Conclusion. From the results obtained, it implies that G6PD deficiency may increase the severity of anaemia in SCD patients. There is therefore the need to screen all SCD patients for G6PD deficiency to ensure that their condition is not exacerbated during treatment.

Samuel Antwi-Baffour

Jonathan Kofi Adjei

Peter Owadee Forson

Stephen Akakpo

Ransford Kyeremeh

Mahmood Abdulai Seidu

Comorbidity of Glucose-6-Phosphate Dehydrogenase Deficiency and Sickle Cell Disease Exert Significant Effect on RBC Indices

Ant&#xf3;nio Robalo Nunes

Ana Palricas Costa

Sara Lemos Rocha

Ana Garcia de Oliveira

Corrigendum to &#x201c;Efficacy and Tolerability of Intravenous Ferric Carboxymaltose in Patients with Iron Deficiency at a Hospital Outpatient Clinic: A Retrospective Cohort Study of Real-World Clinical Practice&#x201d;

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Anemia publishes original research articles and review articles on all types of anemia. Articles focus on patient care, health systems, and epidemiology, among other relevant topics.

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Anemia publishes original research articles and review articles on all types of anemia. Articles focus on patient care, health systems, and epidemiology, among other relevant topics.

Anemia