Anemia In Settings Research Articles

Micronutrient-fortified rice improves haemoglobin, anaemia prevalence and cognitive performance among schoolchildren in Gujarat, India: a case-control study

Anaemia is a public health problem in India. A case-control, quasi-experimental study was conducted to evaluate the effect of a multiple micronutrient fortified rice intervention among school children (6–12 years) through the midday meal programme in Gujarat, India, over 8 months. The fortified rice provided approximately 10% Recommended Dietary Allowance of iron; 25–33% of vitamin A, thiamine, niacin and vitamin B6; and 100% of folic acid and vitamin B12. Outcomes of interest included haemoglobin concentration, anaemia prevalence, and cognitive performance. Cognitive performance was evaluated using J-PAL-validated Pratham reading and mathematics testing tools. 973 children completed the study (cases n = 484; controls n = 489). The intervention significantly increased mean haemoglobin by 0.4 g/dL (p = 0.001), reduced anaemia prevalence by 10% (p < 0.00001), and improved average cognitive scores by 11.3 points (p < 0.001). Rice fortification can help address anaemia in settings where rice is a staple food.

A multilevel approach to correlates of anaemia in women in the Democratic Republic of Congo: findings from a nationally representative survey.

Anaemia accounts for a significant proportion of pre- and post-partum morbidity and mortality in low-income countries with sequelae, including an increased risk of infection. Factors contributing to anaemia need to be addressed through the introduction of evidence-based measures to control and prevent the disease. We aimed to determine the prevalence of anaemia in women of child-bearing age in the Democratic Republic of Congo (DRC) and investigate the associated individual, household and community level factors. Cross sectional representative population data from the 2013-2014 DRC Demographic and Health Survey (DHS) was used. The primary outcome was anaemia in women, stratified according to pregnancy in those of child-bearing age. A haemoglobin level of below 11 g/dl for pregnant women and 12 g/dl for non-pregnant women was used as the indicator of anaemia. Using a three-level random intercept model this study explored risk factors at individual, household and community levels and quantified the observed and unobserved variations between households and communities. Thirty-eight percent of women in the DRC are anaemic. Anaemia is significantly higher in younger, pregnant and underweight women, as well as those with comorbidities, including HIV and malaria who are living in the capital city Kinshasa. Anaemia varies within and between households and communities in the DRC. Integrated approaches to reduce anaemia in settings with high malaria and HIV prevalence such as the DRC should target households.

A Simple, Rapid, and Inexpensive Color-Based Hemoglobin Assay As a Robust Screening Test for Severe Anemia in Limited Resource Settings

Severe anemia is common in limited-resource settings (LRS) of sub-Saharan Africa, affecting up to 30% of hospitalized patients and associated with high mortality rates. The World Health Organization (WHO) recommends blood transfusion for patients with hemoglobin (Hb) concentration <4 g/dL in all cases, and for patients with Hb <6 g/dL if there are other clinical complications. In reality, a Hb ≤5 g/dL is roughly used as a threshold for transfusion in many limited-resource settings. The accurate diagnosis of anemia is critical to appropriately utilize the very limited blood supply, and to triage and treat patients in a timely manner to provide life-saving care.Lack of timely transfusions for children with severe anemia has been associated with significant increase in mortality in several studies within Africa. However, accurate diagnosis of anemia is often difficult or impossible in LRS due to lack of equipment, inadequate replenishment of reagents, poor maintenance or calibration of existing equipment, inadequately trained laboratory personnel, or unreliable and inconsistent access to electricity. A recent publication (Opoka RO et al. BMC Health Serv Res2018) examining transfusion practices in Uganda demonstrated that over half of blood transfusions were administered inappropriately, either without a Hb measurement or with Hb values for which transfusion would not be recommended.The WHO Haemoglobin Colour Scale (HCS), a simple, rapid, point-of-care (POC) test requiring a single drop of blood on filter paper, was developed in an effort to improve the accurate diagnosis of anemia in settings where more definitive laboratory testing is not available. There have been many published reports of the HCS with heterogeneous results, including a recent meta-analysis demonstrating significant variation in sensitivity for the detection of anemia and severe anemia, defined as Hb ≤11 g/dL and Hb ≤7 g/dL respectively (36-76%, Marn H. Lancet Glob Health 2016). The lower limit of the HCS is 4 g/dL, and there is very limited data on its accuracy to diagnose severe anemia requiring transfusion (Hb ≤5 g/dL).The AnemoCheckTMis a rapid, inexpensive, color-based POC test initially designed to diagnose anemia in higher-resource settings, and subsequently modified for use in limited-resource settings (Tyburski et al. J Clin Invest 2014). Based on mixed results both in controlled settings within the US and in the field in Tanzania, AnemoCheck was adapted to focus on its ability to detect severe anemia warranting transfusion. The newly modified AnemoCheck-LRS test allows identification of Hb ranging from 2-8 g/dL, with sharp color changes especially differentiable at the clinically relevant 5 g/dL threshold (Figure 1) to allow accurate diagnosis of clinically meaningful severe anemia in settings where this is common.We prepared and tested 200 samples of varying Hb concentration, each of which was evaluated independently by three separate readers, for a total of 1200 evaluations. By standard CBC measurement, the 200 samples had a mean (±SD) Hbof 5.2±1.9 g/dL (range 1.7 to 10.1 g/dL). Of the 570 samples with Hb ≤8 g/dL (upper limit of AnemoCheck), the absolute difference between AnemoCheck and the gold standard CBC Hb was 0.5±0.4 g/dL (actual difference 0.2±0.7 g/dL). The WHO HCS was inaccurate, with Hb readings consistently higher than the CBC Hb, and an absolute and actual difference of 4.9±1.3 g/dL for samples within the detection range of the HCS (4-14 g/dL, n=405). Table 1 summarizes the ability of both tests to diagnose severe anemia (Hb ≤5 g/dL), demonstrating the accuracy of AnemoCheck-LRS. Furthermore, given that most readings that missed the diagnosis of anemia were within 1 g/dL of actual Hb, if 6 g/dL was used as the screening threshold to identify patients who need a more definitive diagnosis, the sensitivity of AnemoCheck increased to 99%.This study demonstrates that the new AnemoCheck-LRS assay is an accurate POC test to diagnosis very severe anemia in a controlled laboratory setting. The widely cited WHO HCS performed poorly, with a stark inability to diagnose very severe anemia in most cases. This study provides important preliminary data to support follow-up field studies that will use AnemoCheck-LRS to diagnose severe anemia, with the goal of the assay serving as a primary screening test for rapid and accurate diagnosis in settings where laboratory capacity and resources are limited. DisclosuresTyburski:Sanguina, LLC: Employment, Equity Ownership. Ware:Bristol Myers Squibb: Research Funding; Nova Laboratories: Consultancy; Biomedomics: Research Funding; Global Blood Therapeutics: Other: advisory board; Addmedica: Research Funding; Agios: Other: advisory board; Novartis: Membership on an entity's Board of Directors or advisory committees.

Hydroxyurea for sickle-cell anaemia in Africa: mind the gap.

Hydroxyurea for sickle-cell anaemia in Africa: mind the gap.

Demographic and Spatial Predictors of Anemia in Women of Reproductive Age in Timor-Leste: Implications for Health Program Prioritization

Anemia is a significant risk factor for poor health outcomes for both the mother and neonate; however, the determinants of anemia in many epidemiological settings are poorly understood. Using a subset of a nationally representative cluster survey (2010 Demographic and Health Survey) in combination with other non-contemporaneous survey data, the epidemiology of anemia among women of reproductive age in Timor-Leste has been explored. Logistic regression was used to identify risk factors, population-level impacts were estimated as population attributable fractions and spatial analytics were used to identify regions of highest risk. The DHS survey found that ∼21% of adult women in Timor-Leste are anemic (49,053; 95% CI: 37,095 to 61,035), with hemoglobin <12.0 g/dL. In this population, the main risk factors (adjusted odds ratio; 95% CI) are: currently abstaining from sex for any reason (2.25; 1.50 to 3.38); illiteracy (2.04; 1.49 to 2.80); giving birth within the previous year (1.80; 1.29 to 2.51); consumption of fruits/vegetables low in vitamin A (1.57; 1.13 to 2.20); and the district-level confirmed malaria incidence (1.31; 1.15 to 1.49). A review of prior soil-transmitted helminth surveys in Timor-Leste indicates low-to-moderate prevalence with generally low egg counts, suggesting a limited impact on anemia in this setting, although comprehensive survey data are lacking. Examination of the population-level effects highlights the impacts of both recent births and malaria on anemia, with more limited impacts from diet; the evidence does not suggest a large contribution from geohelminths within Timor-Leste. These patterns are divergent from some other settings in the Asia-Pacific region and highlight the need for further focused research. Targeting high-burden districts and by increasing access to pre/postnatal care, raising literacy levels, increasing access to family planning, and improving malaria control should be prioritized to maximize inherently limited health budgets in reaching these populations.

Predictors and consequences of anaemia among antiretroviral-naïve HIV-infected and HIV-uninfected children in Tanzania

Predictors and consequences of childhood anaemia in settings with high HIV prevalence are not well known. The aims of the present study were to identify maternal and child predictors of anaemia among children born to HIV-infected women and to study the association between childhood anaemia and mortality. Prospective cohort study. Maternal characteristics during pregnancy and Hb measurements at 3-month intervals from birth were available for children. Information was also collected on malaria and HIV infection in the children, who were followed up for survival status until 24 months after birth. Dar es Salaam, Tanzania. The study sample consisted of 829 children born to HIV-positive women. Advanced maternal clinical HIV disease (relative risk (RR) for stage > or =2 v. stage 1: 1.31, 95 % CI 1.14, 1.51) and low CD4 cell counts during pregnancy (RR for <350 cells/mm3 v. > or =350 cells/mm3: 1.58, 95 % CI 1.05, 2.37) were associated with increased risk of anaemia among children. Birth weight <2500 g, preterm birth (<34 weeks), malaria parasitaemia and HIV infection in the children also increased the risk of anaemia. Fe-deficiency anaemia in children was an independent predictor of mortality in the first two years of life (hazard ratio 1.99, 95 % CI 1.06, 3.72). Comprehensive care including highly active antiretroviral therapy to eligible HIV-infected women during pregnancy could reduce the burden of anaemia in children. Programmes for the prevention of mother-to-child transmission of HIV and antimalarial treatment to children could improve child survival in settings with high HIV prevalence.

The potential role of private pharmacies in maternal iron supplementation in rural Tanzania.

The reduction of maternal anemia is an agreed public health goal but one that has been very difficult to achieve. On Pemba Island, Tanzania, more than 90% of pregnant women are anemic, despite government efforts to identify and treat anemia during antenatal clinic visits. To investigate the potential of private pharmacies to be accessed for iron supplements for maternal anemia. We compared and contrasted the care given at private pharmacies and public clinics in terms of six characteristics: accuracy, affordability, availability, geographic accessibility, accommodation, and acceptability. We used data from in-depth interviews, surrogate customer encounters, governmental medicine record reviews, and participant observation. The accuracy of health care workers' advice about the treatment of anemia at private pharmacies and government clinics was similar. Supplements purchased at pharmacies were sometimes cheaper than the free supplements from the government, when the costs of transportation and time spent at the clinic were considered. Supplements at private pharmacies were always available, whereas the supply at government clinics was erratic. Private pharmacies were physically closer, socially less distant, and more accommodating than government clinics. Both clinics and private pharmacies were socially acceptable to pregnant women, although government clinics were typically not attended until later in pregnancy. The private sector probably has untapped potential for the reduction of maternal anemia in settings in which public health services fall short. Private pharmacies can contribute to the reduction of maternal anemia on Pemba Island and beyond.

Diagnostic accuracy of the haemoglobin colour scale in neonates and young infants in resource-poor countries

Due to the insidious nature of infant anaemia, this disorder frequently remains undetected and untreated by health-care workers in resource-poor settings. We assessed the accuracy of a low-cost and simple diagnostic tool, the haemoglobin colour scale (HCS), in estimating haemoglobin (Hb) values in infants between zero and four months of age. In a rural hospital in Zambia, blood samples were analysed for Hb concentration by HCS and HemoCue method. Bland-Altman plots were used to express agreement between the two methods. The mean difference between HCS and HemoCue at birth (n = 94), two months (n = 87) and four months (n = 69) was 0.39, 0.20 and -0.11 g/dL, respectively. Limits of agreement were -2.39 to 1.51, -1.80 to 2.20 and -1.98 to 1.75 g/dL, respectively. Disagreement with HemoCue measurements of more than 2 g/dL was noted in only 4% of all blood samples. We conclude that the HCS provides Hb estimations in infants aged 0-4 months that are sufficiently accurate to improve timely recognition of anaemia in settings where there is no laboratory.