Abstract
BackgroundAn individual with visceral Leishmaniasis (VL) commonly present with anemia and one of the VL treatment center in northwest Ethiopia has been recommended iron-folic acid supplementation to these patients. But there is no documented evidence whether iron-folic acid supplementation improves the hematological profile of patients. Therefore, the study aimed to assess change in hemoglobin (Hb) and its determinant factors among VL patients with and without iron-folic acid supplementation in northwest Ethiopia.MethodsA retrospective cohort study was conducted from January 2015 to December 2016. Data were entered into Epi-Data version 3.1 and transferred to Statistical Package for Social Science (SPSS) version 20 for analysis. Independent sample T-test and linear regression were used to compare the change in Hb and identify factors associated with a change in Hb, respectively. A 95% confidence level and p-values less than 0.05 were used determine statistically significant.ResultsFrom a total of 602 VL patients, 299 (49.7%) were from University of Gondar hospital. The mean (±SD) change of Hb from baseline to end of treatment was 0.99(±1.64) and 1.61(±1.88) g/dl with and without iron-folate supplementation, respectively, with mean difference 0.62, 95% CI (0.34, 0.90) and a p-value of < 0.0001. In multiple linear regressions, combination therapy of sodium stibogluconate-paramomycin (SSG-PM) was positively associated with a change of Hb (β [SE, p]: 0.710/0.15, < 0.0001). Whereas age (− 0.030/0.009, 0.001), nasal bleeding (− 0.261/0.123, 0.035), baseline white blood cell (− 0.139/0.044, 0.002) and hemoglobin (− 0.513/0.031, < 0.0001), end of treatment spleen size (− 0.059/0.015, < 0.0001) and iron-folic acid supplementation (− 0.574/0.163, < 0.0001) were negatively associated with change of Hb.ConclusionIron-folic acid supplementation had a negative effect on the change of Hb. A combination therapy of SSG-PM, age, nasal bleeding, baseline white blood cells and Hb, and iron-folic acid supplementation were the determinants of change of Hb. Therefore, avoiding iron-folic acid supplementation and strengthening VL treatment with a combination of SSG-PM and, and early identification of complications is recommended for a better outcome.
Highlights
An individual with visceral Leishmaniasis (VL) commonly present with anemia and one of the VL treatment center in northwest Ethiopia has been recommended iron-folic acid supplementation to these patients
The pathology of the disease depends on the Leishmania species, and visceral leishmaniasis (VL), caused by Leishmania donovani andLeishmania infantum, is the most severe and fatal with 40,000 s death annually [4, 5]
Study design and setting An institution based retrospective cohort study was conducted from March to April 2017 at the University of Gondar Leishmaniasis Research and Treatment Center (UoG-LRTC) and Abdurafi Medicines sans Frontiers Holland kala-azar treatment center (MSF-KTC), northwest Ethiopia
Summary
An individual with visceral Leishmaniasis (VL) commonly present with anemia and one of the VL treatment center in northwest Ethiopia has been recommended iron-folic acid supplementation to these patients. The study aimed to assess change in hemoglobin (Hb) and its determinant factors among VL patients with and without iron-folic acid supplementation in northwest Ethiopia. Anemia is a condition characterized by a decrease in hemoglobin concentration below the acceptable range [1]. It is a major global public health problem, especially in developing countries. In addition to nutritional deficiency, anemia is caused by infectious diseases. It is caused by one of a vector born and neglected protozoal infection, Leishmaniasis. The disease is affecting largely the poorest of the poor, and highly associated poor health care systems [6]
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