Prevalence and factors associated with moderate to severe anaemia among HIV infected children admitted at Mulago Hospital
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Introduction/ background: Anaemia is a commonly encountered haematological complication of HIV infection that has a significant impact on quality of life and clinical outcome. It is estimated that up to 90% of children develop anaemia during HIV infection. Anaemia has been found to be a significant predictor of progression to AIDS and moderate to severe anaemia is associated with an increased risk of death. In Uganda no study has been done to determine the prevalence and identify the factors associated with moderate to severe anaemia among children aged 6 months to 12 years. Objective: To determine the prevalence and describe the factors associated with moderate to severe anaemia in HIV infected children. Study design: Cross sectional study Setting: Paediatric wards of Mulago hospital Participants: Two hundred and fifteen HIV infected children aged 6 months to 12 years who were admitted on the paediatric wards from October 2006 to February 2007. Measurements: The basic social demographic characteristics of the children and their care takers, the complaints on admission, nutrition, past medical and drug history were collected using a structured questionnaire and a detailed physical examination was then done. A blood sample was taken for full haemogram, blood film for malaria parasites and typing the anaemia, CD4 count and percentage. Stool was examined for ova/cysts and occult blood. Statistical analysis: Data was processed using Epi Data 3.1 and analyzed using EPI Info version 6.04 and SPSS 13 with the help of a statistician. Bivariate analysis was done to test for association between moderate to severe anaemia and the different variables and for those which were significant, multivariate analysis was further done to test for independent association with moderate to severe anaemia. Study Results: The prevalence of moderate to severe anaemia was 50.7%. Moderate to severe anaemia was most prevalent among children age 6 to 24 months. The factors independently associated with moderate to severe anaemia were age < 60 months (OR 4.51, 95% CI 1.77-11.47, p=0.002), not taking multivitamin supplementation ( OR 4.67, 95% CI 1.97-11.06, p= 0.000), previous transfusion (OR 3.97 95% CI 1.47-10.68,p=0.006), Lymphadenopathy (OR 3.42 95% CI 1.26-9.27, p= 0.015), and malaria coinfection (OR 4.42, 95% CI 1.72-11.39, p=0.002) were independently associated with moderate to severe anaemia. The types of anaemia included microcytic normochromic (48.4%), normocytic normochromic (34.9%), microcytic hypochromic (12%), and macrocytic anaemia (2.8%). Conclusions: Moderate to severe anaemia is highly prevalent among HIV infected children admitted on the paediatric wards of Mulago hospital. The factors independently associated with moderate to severe anaemia were age < 60 months, not taking multivitamin supplementation, previous blood transfusion, lymphadenopathy and malaria coinfection. Recommendations: Young HIV infected children should be routinely evaluated for presence of anaemia and appropriate preventive and treatment measures should be emphasized so as to reduce the frequency of anaemia in HIV infected children.