Characteristics of severe anemia and its association with malaria in young children of the Kassena-Nankana District of northern Ghana.

Seth Owusu-Agyei Navrongo Health Research Center, Ministry of Health, Navrongo, Upper East Region, Ghana.

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David J Fryauff Navrongo Health Research Center, Ministry of Health, Navrongo, Upper East Region, Ghana.

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Daniel Chandramohan Navrongo Health Research Center, Ministry of Health, Navrongo, Upper East Region, Ghana.

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Kwadwo A Koram Navrongo Health Research Center, Ministry of Health, Navrongo, Upper East Region, Ghana.

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Fred N Binka Navrongo Health Research Center, Ministry of Health, Navrongo, Upper East Region, Ghana.

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Francis K Nkrumah Navrongo Health Research Center, Ministry of Health, Navrongo, Upper East Region, Ghana.

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Greg C Utz Navrongo Health Research Center, Ministry of Health, Navrongo, Upper East Region, Ghana.

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Stephen L Hoffman Navrongo Health Research Center, Ministry of Health, Navrongo, Upper East Region, Ghana.

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DOI:
https://doi.org/10.4269/ajtmh.2002.67.371
Volume/Issue:
Volume 67: Issue 4
Page(s):
371–377
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Severe anemia is thought to be the principal underlying cause of malaria death in areas of intense seasonal malaria transmission such as the Kassena-Nankana District of northern Ghana. Factors associated with severe anemia in young children, 6-24 months old, were elucidated by analyzing results of 2 malaria-associated anemia surveys (1996, 2000), separated by 4 years, but conducted in the same community and at the same seasonal time point. Age-adjusted comparison confirmed that the proportion of severely anemic children and overall mean hemoglobin (Hb) levels in the November 2000 sample were significantly improved over those of the 1996 sample (17.5 versus 26.4%, P = 0.03; Hb 7.5 versus 6.9 g/dL, P = 0.002). Weight-for-age Z-scores also indicated a significant improvement in the 2000 sample (-1.93 versus -2.20, P < 0.05). Independently, each survey identified statistically significant associations between severe anemia and age, parasite rate, fever, and sex. Relative to children with Hb > or = 6.0 g/dL, those with severe anemia (Hb < 6.0 g/dL) were older, more frequently parasitemic (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.08-2.35), more often febrile (OR, 2.44; 95% CI, 1.71-3.48), and predominantly male (OR, 1.50; 95% CI, 1.05-2.13). An association was identified in both surveys between severe anemia and residence in the northern part of the district, but no clear link was observed in relation to irrigation. Blood transfusions, a likely surrogate index of severe anemia in young children, followed a distinct seasonal pattern. Evidence suggests that dramatic peaks and troughs of severe anemia are regular and possibly predictable events that may be used to gauge the health and survival of young children in this area.

Author Notes

Published Online:
Oct 2002
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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