Malaria is an important cause of morbidity and mortality in Uganda. It is associated with a wide range of complications including severe anaemia especially in children. Anaemia impairs motor and cognitive developing in children and is a common cause of hospital admissions, blood transfusions and deaths. Blood transfusions are not only costly to the health system but also carry the risk of transmission of HIV to the recipients in countries like Uganda where HIV is highly prevalent. The pathogenesis of malaria-associated anaemia is complex, multi-factorial, and not clearly understood. Studies have shown that pre-existing iron deficiency aggravates the severity of malarial anaemia. However, there are concerns that iron supplementation leads to formation of more young red blood cells, which are more prone to plasmodium falciparum infection and that circulating iron provides the developing parasites with the iron they require to grow. These concerns are sometimes an impediment to implementation of iron supplementation programmes. Despite these concerns iron supplementation is recommended in malarious areas where iron deficiency is prevalent. Unfortunately, in Uganda the magnitude of iron deficiency in patients with malaria and anaemia is not known.
To assess the iron status in patients with malaria and anaemia attending Mulago hospital assessment centre clinic.
Study setting: Mulago hospital assessment centre.
Descriptive cross sectional study with an analytical component
Patients with plasmodium falciparum and anemia aged 6 months to 12 years. For this analysis anemia was taken as hemoglobin level of 10g/dl or less.
Patients were recruited from the Mulago hospital assessment centre by systematic random sampling. A face-to-face interview using a standardized questionnaire on symptoms related to malaria and anemia was administered and a complete physical examination performed. A full blood count, peripheral blood film and parasite density was done for each patient, serum ferritin and C-reactive protein was also determined. Each patient’s Stoll was examined for hookworm ova and occult blood. Other parasites were documented for patient management.
The prevalence of iron deficiency found in this population was 40% according to serum ferritin concentrations as a measure of body iron stores. Seventy two percent of the children had a hypochromic microcytic type of anemia. The mean MCV, MCH and MCHC respectively were 74.6fl, 24.5pg and 33.1g/dl. Mean HB was 7.8+- 2g/dl. Children with previous episodes of malaria had a lower MCV. All the children had inflammation (CRP>6MG/I) and there was a positive correlation between CRP and serum ferritin (p=0.047). No correlation was found between parasite density and iron status of the children. Hookworm infestation was detected in only 4.5% of the children.
CONCLUSION AND RECOMMNEDATION:
The study shows that a significant proportion of children with malaria-associated anaemia attending Mulago Hospital Assessment Centre have iron deficiency. The high prevalence of hypochromic microcytes could be due to IDA. More reliable criteria for defining iron deficiency such as haematological response to iron therapy are needed to ascertain the exact prevalence. Neverthless given the large number of children with evidence of depleted iron stores, iron supplementation should be considered in children with malaria associated anemia, after anti-malarial therapy especially in areas where no facilities exist for the specific diagnosis of anemia.