Anaemia in hospitalised preschool children from a rural area in Mozambique: a case control study in search for aetiological agents

Moraleda, Cinta, Aguilar, Ruth, Quinto, Lloren, Nhampossa, Tacilta, Renom, Montserrat, Nhabomba, Augusto, Acacio, Sozinho, Aponte, John J., Nhalungo, Delino, Achtman, Ariel H., Schofield, Louis, Martins, Helder, Macete, Eusebio, Alonso, Pedro L., and Menendez, Clara (2017) Anaemia in hospitalised preschool children from a rural area in Mozambique: a case control study in search for aetiological agents. BMC Pediatrics, 17 (63).

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Background: Young children bear the world's highest prevalence of anaemia, the majority of which is of multifactorial aetiology, which in turn hampers its successful prevention. Even moderate degrees of anaemia are associated with increased mortality and morbidity. Despite this evidence, there is a lack of effective preventive programs and absence of consensus in the safety of iron supplementation in malaria areas, which reflects the poor understanding of the contribution of different aetiologies to anaemia. In order to reduce the anaemia burden in the most vulnerable population, a study to determine the aetiology of anaemia among pre-school Mozambican children was performed.

Methods: We undertook a case-control study of 443 preschool hospitalized children with anaemia (haemoglobin concentration < 11 g/dl) and 289 community controls without anaemia. Inclusion criteria were: age 1-59 months, no blood transfusion in the previous month, residence in the study area and signed informed consent. Both univariable and multivariable logistic regression analyses were performed to identify factors associated with anaemia and adjusted attributable fractions (AAF) were estimated when appropriate.

Results: Malaria (adjusted odds ratio (AOR) = 8.39, p < 0.0001; AAF = 37%), underweight (AOR = 8.10, p < 0.0001; AAF = 43%), prealbumin deficiency (AOR = 7.11, p < 0.0001; AAF = 77%), albumin deficiency (AOR = 4.29, p = 0.0012; AAF = 30%), HIV (AOR = 5.73, p = 0.0060; AAF = 18%), and iron deficiency (AOR = 4.05, p < 0.0001; AAF = 53%) were associated with anaemia. Vitamin A deficiency and a-thalassaemia were frequent (69% and 64%, respectively in cases) but not independently related to anaemia. Bacteraemia (odds ratio (OR) = 8.49, p = 0.004), Parvovirus-B19 (OR = 6.05, p = 0.017) and Epstein-Barr virus (OR = 2.10, p = 0.0015) infections were related to anaemia only in the unadjusted analysis. Neither vitamin B12 deficiency nor intestinal parasites were associated with anaemia. Folate deficiency was not observed.

Conclusions: Undernutrition, iron deficiency, malaria, and HIV are main factors related to anaemia in hospitalised Mozambican preschool children. Effective programs and strategies for the prevention and management of these conditions need to be reinforced. Specifically, prevention of iron deficiency that accounted in this study for more than half of anaemia cases would have a high impact in reducing the burden of anaemia in children living under similar conditions. However this deficiency, a common preventable and treatable condition, remains neglected by the international public health community.

Item ID: 50629
Item Type: Article (Research - C1)
ISSN: 1471-2431
Keywords: Anaemia, iron deficiency, children, sub-Saharan Africa, malaria, HIV
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© The Author(s). 2017 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Funders: Spanish Agency for International Cooperation and Development (AECID), Victorian State Government Operational Infrastructure Support, National Health and Medical Research Council of Australia (NHMRC), Howard Hughes Medical Institute, Victorian Community Foundation (VCF)
Projects and Grants: NHMRC Program Grant #637406, VCF George Perry Fund
Date Deposited: 20 Sep 2017 10:37
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3207 Medical microbiology > 320799 Medical microbiology not elsewhere classified @ 100%
SEO Codes: 97 EXPANDING KNOWLEDGE > 970111 Expanding Knowledge in the Medical and Health Sciences @ 100%
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