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Severe anemia in African kids has multiple causes

AnemiaFeb 29, 08

Severe anemia is associated with considerable illness and death in African children and the results of new study conducted in Malawi indicate that multiple causes are to blame. The information from this study could lead to new ways to prevent and treat severe anemia in African children, researchers say.

Interestingly, folate and iron deficiencies, which are widely believed to be the most common causes of severe anemia in African children, were actually not prominent causes, according to Dr. Job C. J. Calis, from the Academic Medical Center in Amsterdam and colleagues.

They examined the causes of anemia by conducting a case-control study of 381 severely anemic preschool-age children and 757 children without anemia. The subjects were drawn from both urban and rural settings in Malawi.

The strongest risk factor for severe anemia, which raised the risk by more than fivefold, was bacterial invasions of the blood or “bacteremia,” Calis and colleagues report in Thursday’s edition of The New England Journal of Medicine.

Other significant risk factors included malaria, hookworm infection, HIV infection, vitamin A deficiency, and vitamin B12 deficiency.

Further analysis showed that malaria was a risk factor only in urban settings, not in rural settings. The majority of hookworm infections (76 percent) involved children younger than age 2.

Folate deficiency, sickle cell disease, and laboratory signs of inflammation were not commonly seen. Similarly, relative few case patients had iron deficiency and its presence was actually associated with a decreased risk of the major risk factor - bacterial infection.

“Our findings indicate that even in the presence of malaria parasites, additional or alternative diagnoses (responsible for severe anemia) should be considered,” Calis and colleagues write. The results, “if confirmed in different settings, will contribute to the assessment of new therapeutic and preventive strategies for Africa.”

SOURCE: The New England Journal of Medicine, February 28, 2008.

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