Hemoglobin Levels In Children Research Articles

An Estimation of Haemoglobin Levels in Children with Early Childhood Caries- A Retrospective Study

Aim: This study aimed to evaluate Haemoglobin (Hb) levels in children with Early Childhood Caries(ECC) and to find out whether there is any variation from normal values in Hb level in children with earlychildhood caries.Materials & Methods: In this retrospective study the Hb levels and dmft status of 281 children with ECCin the age group of 0 to 6 years were evaluated. The mean Hb values calculated were compared with thesuggested normal levels by the World Health Organisation for the particular age group. Kruskal Wallis testand post hoc test comparisons were done to compare differences in Hb levels in 4 different groups based ondmft values in children with ECC.Results: Overall mean value of Hb in children with ECC was 10.93 ± 1.73 g/dl and mean dmft was 7.19 ±4.3. Group 1 with less than 5 dmft value showed significant difference in Hb values compared to children ingroups with higher dmft values (p?0.05).Conclusions: Half of the study population had low haemoglobin levels i.e. below that of WHO criteria.Children with more than 5 dmft score had significantly lower Hb levels compared to children with less dmftvalues (p?0.05). There was no significant difference noticed in the Hb levels in between boys and girls withECC. This descriptive study results point that ECC can result in low Hb levels in children, however authorssuggest that an analytical study with a control group should be done to test the hypothesis.

Hemoglobin Levels on Trichuris trichiura Infection in Children

Worm infections often caused by worms transmitted through the soil (Soil-Transmitted Helminths). Types of STH worms include roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura) and hookworms (Ancylostoma duodenale and Necator Americanus). Worms commonly suffered by school-age children with the most aged between 5-14 years. Worms can affect the intake, digestion, absorption, and metabolism of food, which can result in loss of protein, carbohydrates, fats, and vitamins. Trichuris trichiura and hookworm can cause massive amounts of blood loss and decreased hemoglobin levels. This study aims to determine the relationship of Trichuris trichiura infection with hemoglobin levels in children in the village of East Serang Kilasah, Banten. This research is an analytic survey with a cross-sectional design with 42 respondents. The sampling technique used was purposive sampling. The results of the fecal examination by the Kato-Katz method found 23 children (54.76%) with mild worm levels and 19 children (45.24%) with moderate worm levels. The results of blood tests found 36 children (85.71%) with normal hemoglobin levels and six children (14.79%) with low hemoglobin levels. Based on the results of statistical tests, the results obtained P-value 0.004 (P-value

Effect of routine seasonal malaria chemoprevention on malaria trends in children under 5\xa0years in Dangassa, Mali

BackgroundSeasonal malaria chemoprevention (SMC) is a new strategy to prevent malaria in children under 5 years old. It has been recommended by the World Health Organization since 2012 in malaria-endemic areas with seasonal transmission. This study aimed to assess the changes in malaria indicators through two consecutive years of SMC routine implementation in children under 5 years old in Dangassa, where malaria is endemic with a long and high transmission season.MethodsFrom 2012 to 2016, a cohort study was conducted in Dangassa village. The study team based in the village followed all malaria clinical cases in children under 5 years old at the community health centre. During the study, SMC was routinely implemented in collaboration with the National Malaria Control Programme. The Cox regression model was used in order to compare malaria risk during the study.ResultsThe Cox regression model showed a significant reduction in malaria clinical incidence, both in 2015 (HR = 0.27 (0.18–0.40), 95% CI) and in 2016 (HR = 0.23 (0.15–0.35), 95% CI) of SMC implementation compared to October 2013. Gametocyte and fever prevalence was lower between September and October during SMC implementation (2015 and 2016) compared to the same period before SMC implementation (2013–2014). A slight increase of malaria incidence was observed in December at the end of SMC implementation.ConclusionSMC has significantly reduced both malaria incidence and gametocyte prevalence and improved haemoglobin levels in children under 5 years old after 2 years of routine implementation.

Hemoglobin Levels on Trichuris trichiura Infection in Children

Worm infections often caused by worms transmitted through the soil (Soil-Transmitted Helminths). Types of STH worms include roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura) and hookworms (Ancylostoma duodenale and Necator Americanus). Worms commonly suffered by school-age children with the most aged between 5-14 years. Worms can affect the intake, digestion, absorption, and metabolism of food, which can result in loss of protein, carbohydrates, fats, and vitamins. Trichuris trichiura and hookworm can cause massive amounts of blood loss and decreased hemoglobin levels. This study aims to determine the relationship of Trichuris trichiura infection with hemoglobin levels in children in the village of East Serang Kilasah, Banten. This research is an analytic survey with a cross-sectional design with 42 respondents. The sampling technique used was purposive sampling. The results of the fecal examination by the Kato-Katz method found 23 children (54.76%) with mild worm levels and 19 children (45.24%) with moderate worm levels. The results of blood tests found 36 children (85.71%) with normal hemoglobin levels and six children (14.79%) with low hemoglobin levels. Based on the results of statistical tests, the results obtained P-value 0.004 (P-value <0.05). This result means that there is a significant relationship between Trichuris trichiura infection and hemoglobin levels in children in the Kilasah Serang Timur village of Banten. Efforts should be made from the local health office to increase knowledge about personal hygiene to villagers through health education to prevent helminth infections and to administer mass worm medicines every six months. It is also necessary to administer blood enhancing drugs for anemic citizens.

Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey

BackgroundMalnutrition in mothers and children is a significant public health challenge in developing countries such as Nepal. Although undernutrition in children has been gradually decreasing, the coexistence of various forms of malnutrition in mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of various forms of malnutrition and associated factors among mother-child pairs residing in the same household.MethodsA total sample of 2261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements and hemoglobin levels of children and anthropometric measurements of their mothers were collected. Bivariate and multivariable logistic regression models were used to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM).ResultsPrevalence of DBM and TBM was 6.60% (95% CI: 5.13–8.84) and 7.00% (95% CI: 5.42–8.99) respectively in the same households. In the adjusted multivariable logistic regression models, mothers with short stature (AOR = 4.18, 95% CI: 2.04–8.52), from the richest wealth quintile (AOR = 2.46, 95% CI: 1.17–5.15), aged over 35 years (AOR = 3.08, 95% CI: 1.20–7.86), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.03–4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature (AOR = 5.01, 95% CI: 2.45–10.24), from the richest wealth quintile (AOR = 2.66, 95% CI: 1.28–5.54), aged over 35 years (AOR = 3.41, 95% CI: 1.26–9.17), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.00–4.18) were more likely to suffer from the TBM.ConclusionsOverall, there is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Older mothers with short stature and those from richer wealth quintiles were more likely to suffer from double and triple burden of malnutrition.

Evaluation of iron intake in preschool children in a setting with high anemia burden.

BackgroundIron deficiency anemia affects millions of children worldwide. Iron intake assessments can inform targeted interventions.MethodsThis cross-sectional study describes diet and hemoglobin levels of children 1–5 y of age in a resource-limited setting in the Dominican Republic. The study team performed meal observations and measurements, dietary questionnaires, and point-of-care hemoglobin testing.ResultsIron intake and bioavailability were low, with liberal estimates indicating that not more than 40% of subjects consumed the recommended daily allowance for iron. Forty of 80 children had anemia, with 23% demonstrating moderate or severe anemia.ConclusionsPoor observed iron intake likely contributes to the high prevalence of anemia in this population.

Individual and contextual predictors of children's hemoglobin levels from Southern Brazilian municipalities in social vulnerability.

Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.

Association Between Anemia and First-time Febrile Seizure: A Case Control Study

Introduction: Febrile seizure is the most frequent neurological disorder in children below five years old. The direct cause is unknown. Some studies report association between anemia and febrile seizure. Even though anemia is highly prevalent in Indonesia, only one study assessed this association.
 Objective: To compare the hemoglobin level in children with febrile seizure and febrile children without seizure, and to assess the relationship between anemia and febrile seizure.
 Method: This retrospective case control study used medical record of febrile children aged 6 months to 3 years old hospitalized at Landak General Hospital between May 2016 to April Hemoglobin level from first laboratory examination then compared between fifty children with first-time febrile seizure (case group) and a hundred febrile children without seizure (control group).
 Results: Hemoglobin level was lower in case group compared to control group (p<0,001). Children with febrile seizure were more likely to be anemic compared to febrile children without seizure [OR 6,73; 95% CI 3,18 to 14,26].
 Conclusion: There is a significantmean difference between hemoglobin level of children with febrile seizure compared to febrile children without seizure. Children with febrile seizure were six times more likely to have anemia.

Impact of micronutrient powder on anemia in children aged 10-35 months in Apurimac, Peru

Objective. To assess the impact of micronutrient powder supplementation (MNP) in reducing anemia in children aged 10 to 35 months in Apurimac, Peru. A secondary analysis of the database of the Evaluation of supplementation with MNP in the Apurímac region, conducted by the National Food and Nutrition Center (CENAN, in Spanish) between 2009 and 2010, was conducted. The intervention group was defined as children who consumed 60 or more packets of MNP; to generate the controls (children who did not consume MNP), we applied a propensity score matching (PSM); and, to estimate the impact of the MNP, we compared the prevalence of anemia in each study group, weighted by the probability of participation, applying three matching algorithms: nearest neighbor, kernel and local linear regression. All calculations were performed in the Stata 14 SE statistical program. The prevalence of anemia was significantly lower by up to 11 percentage points in the intervention group compared to controls (p=0.001), and mean hemoglobin increased by 0.3 g/dL in the same group (p<0.001). MNP supplementation showed impact in reducing anemia and increasing hemoglobin level in children who consumed 60 or more packets of MNP over a six-month period. Efforts to reduce anemia by using MNP to prevent this nutritional deficiency should continue.

Is there an association between vitamin D level and iron deficiency in children?

Vitamin D (VitD) affects the erythropoiesis. The aim of this study was to evaluate the association between maternal/child 25-OH VitD (25-OHD) levels and iron deficiency (ID) and anemia (IDA) in children aged 6 months-5 years. Between September 2014 and January 2016 children who were admitted to outpatient clinic were included to study. We excluded the children with acute or chronic infection, malnutrition, chronic disease and preterm birth history. Complete blood count, serum iron, total iron binding capacity, ferritin, 25-OHD levels were examined from children and their mothers. Iron and VitD supplementation during infancy and pregnancy and breastfeeding history were questioned. The study included totally 117 children. There were 67 children with ID/IDA [Group 1, mean age (years):2.05±1.24 (0.5-5)] and 50 normal children [Group 2, mean age (years): 1.87±1.12 (0.58-5)]. There were more VitD deficient children and mothers in Group 1 than in Group 2 (respectively, children 49.3 % vs. 20 % p=0.002; mothers 94 % vs.64 %, p=<0.001). There was a positive correlation between hemoglobin levels of children and maternal/child 25-OHD.The independent risk factors for IDA in children were longer exclusively breastfeeding time (odds ratio [OR], 0.35; 95 % confidence interval [CI], 0.1550.789; p=0.011), shorter duration of regular iron supplementation during infancy and pregnancy (infancy: OR,1.69; 95 % CI 1.148-2.508; p=0.008. pregnancy: OR,1.39; 95 % 0,1.070-1.820; p=0.014) and lower maternal 25-OHD level (OR,1.16; 95 % 0,1.034-1.292; p=0.011). Maternal/child VitD deficiency is associated with ID/IDA in children aged 6 months-5 years.

Valproik Asitin Epileptik Çocuklarda Fetal Hemoglobin Sentezi Üzerine Etkileri

Valproic acid has been used to treat epilepsy in children. The most common side effects are hepatotoxicity, anemia and thrombocytopenia. However the effect of valproic acid on fetal hemoglobin levels has not been revealed adequately. In this study it was aimed to search the effect of valproic acid on hemoglobin levels in children receiving valproic acid. In the present cross sectional study the research group consisted of children with epilepsy who had been receiving valproic acid monotherapy for at least six months. The control group contained children without epilepsy or valproic acid medication. The data from 44 patients and 57 controls were analyzed. The mean percentage of HbF of the study group and control group were 0.48 ±0.96 (%) and 0.25 ±0.61 (%) respectively, and there was no statistical difference between groups. There was a positive relation between blood valproic acid level and HbF levels. The present research showed that valproic acid has no effect on HbF levels. For children on valproic acid therapy, the detection of increased fetal hemoglobin levels must be evaluated carefully.

Early childhood development and risk factors in rural China: a cohort study

Objective: To investigate the development status and risk factors of infants and toddlers in rural China. Methods: In this cohort study, 603 infants (6-12 months of age, Phase Ⅰ) in the rural areas of QinLing-Bashan (Qin-Ba) in Shaanxi were recruited in the control group that received no intervention from April 2013 to October 2015. Three follow-up visits were performed every six months (Phase Ⅱ(12-18 months of age), Phase Ⅲ (18-24 months of age) and Phase Ⅳ(24-30 months of age)). In all the 4 phases (Ⅰ-Ⅳ), general data of the children and the families were collected by questionnaires, early childhood growth and development were assessed by door to door visits, children's hemoglobin levels were determined by laboratory tests, and the cognitive and motor development screening was conducted by the Bayley Scales of Infant and Toddler Development. Logistic regression was used to analyze the risk factors affecting the development of infants and toddlers in rural areas and the data were analyzed in terms of risk factors from infants, guardians and family. Results: Phase Ⅱ, Phase Ⅲ and Phase Ⅳ survey recruited 497, 483 and 486 participants respectively. The incidences of cognitive impairment (mental development scores<80) in rural areas of southern Shaanxi were 13.4% (81/603) in Phase Ⅰ(6-12 months), 20.1%(100/497) in PhaseⅡ(12-18 months), 42.9% (207/483) in Phase Ⅲ(18-24 months) and 50.4%(245/486) in Phase Ⅳ(24-30 months) respectively, which showed a significant increase with age (χ(2)=233.40, P<0.01); the incidences of psychomotor impairment (psychomotor development scores<80) of Phase Ⅰ, Phase Ⅱ, Phase Ⅲ and Phase Ⅳ were 25.0% (151/603), 26.8% (133/497), 8.3% (40/483) and 11.9% (58/486), which showed a significant decrease with age (χ(2)=87.08, P<0.01). Multivariate logistic regression analysis showed that the leading risk factor of the cognitive development of 24-30-month-old children was the mothers' poor education background (≤9 years of school education) (OR=2.56, P<0.01), and the main risk factors affecting psychomotor development were the mothers' poor education background (≤9 years of school education) (OR=2.64, P<0.05) and growth retardation (OR=2.95, P=0.07). Conclusions: The early childhood development (especially cognitive development) in the rural areas of Qin-Ba in Shaanxi of China is not optimistic. More attention should be paid to the early childhood development in rural China, especially to the development of children from the mothers with poor education background.

Maternal Nutritional Knowledge and its Association with Iron Deficiency Anemia in Children

This study aimed at assessing the maternal nutritional knowledge and determining the association between nutritional knowledge and Hb status of their children. A total of 143 children of 2 – 10 years was selected for this study from local community. Data was collected using questionnaire for maternal nutritional knowledge and portable hemoglobinometer for identifying hemoglobin status of children. SPSS version 22 was used for data entry and analysis. Among the mothers who had poor nutritional knowledge (7.69%) all the children were anaemic. Even among mothers with average knowledge (63.64%) a vast majority of children were anaemic (86.8%). Among mothers with high nutritional knowledge (28.67%) more than half (58.5%) children were anaemic. Relationship between maternal nutrition knowledge and hemoglobin level of children was statistically significant (p&lt;0.001). The results showed a very high rate of anaemia and a significant association between maternal knowledge and Hemoglobin status of their children, as proved by many studies.

Prevalence and determinants of stunting in a conflict-ridden border region in Armenia - a cross-sectional study

BackgroundDespite global efforts, stunting remains a public health problem in several developing countries. The prevalence of stunting among 0- to 5-year-old children in Armenia has increased from 17% in 2000 to 19% in 2010. A baseline study was conducted among preschool children in Berd, a region near the northeastern border of Armenia that has experienced intermittent military tension for over 20 years.MethodsWe conducted a cross-sectional study including 594 children aged 6-month- 6 years old and their caregivers in our analysis, to assess the prevalence and determinants of stunting. We calculated the anthropometric measurements and hemoglobin levels of children; analyzed children’s stool and conducted a survey with children’s caregivers. We employed the hierarchical logistic regression model to explore the predictors of stunting among 25–72 months old children and multivariable logistic regression models to investigate the predictors of stunting among 6–24 months old children. Individual and residence level variables were included in the models including anemia, minimum dietary diversity, mothers’ height, the overall duration of breastfeeding, birthweight, child’s history of diarrhea and mean socio-economic score.ResultsThe prevalence of stunting was significantly higher among the 6–24 months old children (13.3%) compared to the children aged 25–72 months old (7.8%). We did not find any differences in the prevalence of stunting by place of residence in either age group. The 6–24 months old children who consumed at least four food groups during the previous day (minimum dietary diversity) had 72% lower odds of being stunted (p < 0.05). Each kilogram increase in birthweight was associated with 76% lower odds of being stunted (OR = 0.24, p < 0.01). Mother’s height significantly decreased the odds of stunting among the children 25–72- months old (OR = 0.86, p < 0.001). BMI was also a significant predictor of stunting among both age-groups.ConclusionsThe study results highlight the significance of mother’s height, birthweight, and adequate complementary feeding to reduce stunting. Further studies are needed to determine the possible association of anemia and stunting with the ongoing conflict in the region, as well as socioeconomic conditions and food insecurity in the region.

Assessing the impact of differences in malaria transmission intensity on clinical and haematological indices in children with malaria

BackgroundMalaria control interventions have led to a decline in transmission intensity in many endemic areas, and resulted in elimination in some areas. This decline, however, will lead to delayed acquisition of protective immunity and thus impact disease manifestation and outcomes. Therefore, the variation in clinical and haematological parameters in children with malaria was assessed across three areas in Ghana with varying transmission intensities.MethodsA total of 568 children between the ages of 2 and 14 years with confirmed malaria were recruited in hospitals in three areas with varying transmission intensities (Kintampo > Navrongo > Accra) and a comprehensive analysis of parasitological, clinical, haematological and socio-economic parameters was performed.ResultsAreas of lower malaria transmission tended to have lower disease severity in children with malaria, characterized by lower parasitaemias and higher haemoglobin levels. In addition, total white cell counts and percent lymphocytes decreased with decreasing transmission intensity. The heterozygous sickle haemoglobin genotype was protective against disease severity in Kintampo (P = 0.016), although this was not significant in Accra and Navrongo. Parasitaemia levels were not a significant predictor of haemoglobin level after controlling for age and gender. However, higher haemoglobin levels in children were associated with certain socioeconomic factors, such as having fathers who had any type of employment (P < 0.05) and mothers who were teachers (P < 0.05).ConclusionsThe findings demonstrate significant differences in the haematological presentation and severity of malaria among areas with different transmission intensity in Ghana, indicating that these factors need to be considered in planning the management of the disease as the endemicity is expected to decline after control interventions.

Hemoglobin target in children with chronic kidney disease: valuable new information

The international guideline from Kidney Disease: Improving Global Outcomes suggests a hemoglobin target of 11 to 12 g/dl for children with chronic kidney disease. However, information to support this proposal is very limited in the pediatric population. Because of controversy, the unmet need is the establishment of an appropriate target hemoglobin level in children with chronic kidney disease. Here, Rheault and colleagues provide valuable new information, reporting the association of hemoglobin levels with cardiovascular morbidity in pediatric hemodialysis patients.

Prenatal anemia control and anemia in children aged 6-23months in sub-Saharan Africa.

It is unclear whether routine prenatal anemia control interventions can reduce anemia risk in young children. This study examines the associations between prenatal iron supplementation and/or deworming and anemia in children aged 6-23months in sub-Saharan Africa (SSA). We analyzed data from Demographic and Health Surveys conducted between 2003 and 2014 in 25 SSA countries. The surveys collected data on prenatal iron supplementation and deworming and determined children's hemoglobin levels through blood testing. We assessed the associations between prenatal iron supplementation and/or deworming and anemia using multinomial logistic regression. The study included 31,815 mother-child pairs: 25.0%, 41.4%, and 4.8% of children had mild, moderate, and severe anemia, respectively. Compared with children whose mothers did not take iron and deworming drugs prenatally, the risk of moderate/severe anemia was reduced among children whose mothers took only iron supplements for ≥6months (odds ratio [OR]: 0.58; 95% confidence interval [CI]: 0.45-0.76); only deworming drugs (OR: 0.73; 95% CI: 0.56-0.93); deworming drugs plus iron for <6months (OR: 0.79; 95% CI: 0.67-0.93); and deworming drugs plus iron for ≥6months (OR: 0.77; 95% CI: 0.59-0.99). Prenatal use of only iron for <6months was not associated with moderate/severe anemia. Prenatal iron and/or deworming drugs had no effect on mild anemia. Prenatal anemia control interventions are associated with reduced risk of moderate/severe anemia but not with mild anemia in young children in SSA. Iron supplements should be taken for ≥6months or with deworming drugs prenatally to reduce moderate/severe anemia risk in children.

Hemoglobin Status and Externalizing Behavioral Problems in Children.

Background: Still considered one of the most prevalent nutritional problems in the world, anemia has been shown in many studies to have deleterious effects on neurobehavioral development. While most research efforts have focused on investigating the effects of anemia on social and emotional development of infants by using a cross-sectional design, research is still needed to investigate whether early childhood anemia, beyond infantile years, is linked with behavioral problems. Objective: This study assessed whether (1) hemoglobin (Hb) levels in early childhood are associated with externalizing behavior; and (2) this relationship is confounded by social adversity. Methods: Hemoglobin levels were taken from children (N = 98) of the China Jintan Cohort Study at age 4 years, and externalizing behaviors (attention and aggression) were assessed with the Child Behavior Checklist (ASEBA-CBCL) at age 6 years (mean age 5.77 ± 0.39 years old). Results: Compared with other children in the sample, children with relatively lower Hb levels at age 4 had more behavioral problems in both attention and aggression at age 6, independent of social adversity. For boys, this association was significant for attention problems, which did not interact with social adversity. For girls, the association was significant for aggression, which interacted with social adversity. While girls on average exhibited higher social adversity than boys, the main effect of Hb was only significant in girls with low social adversity. Conclusions: These results indicate that there is an inverse association between hemoglobin levels and later behavioral problems. Findings of this study suggest that regular monitoring of children’s hemoglobin levels and appropriate intervention may help with early identification of behavioral problems.

Functional and anatomical evidence of cerebral tissue hypoxia in young sickle cell anemia mice

Cerebral ischemia is a significant source of morbidity in children with sickle cell anemia; however, the mechanism of injury is poorly understood. Increased cerebral blood flow and low hemoglobin levels in children with sickle cell anemia are associated with increased stroke risk, suggesting that anemia-induced tissue hypoxia may be an important factor contributing to subsequent morbidity. To better understand the pathophysiology of brain injury, brain physiology and morphology were characterized in a transgenic mouse model, the Townes sickle cell model. Relative to age-matched controls, sickle cell anemia mice demonstrated: (1) decreased brain tissue pO2 and increased expression of hypoxia signaling protein in the perivascular regions of the cerebral cortex; (2) elevated basal cerebral blood flow , consistent with adaptation to anemia-induced tissue hypoxia; (3) significant reduction in cerebrovascular blood flow reactivity to a hypercapnic challenge; (4) increased diameter of the carotid artery; and (5) significant volume changes in white and gray matter regions in the brain, as assessed by ex vivo magnetic resonance imaging. Collectively, these findings support the hypothesis that brain tissue hypoxia contributes to adaptive physiological and anatomic changes in Townes sickle cell mice. These findings may help define the pathophysiology for stroke in children with sickle cell anemia.

Effect of micronutrient powder supplementation for two and four months on hemoglobin level of children 6–23 months old in a slum in Dhaka: a community based observational study

Anemia is pervasive among children under the age of two years in Bangladesh. This study aimed to assess the effect of daily supplementation of multiple micronutrient powder (MNP) for 2 months and 4 months primarily on hemoglobin status of children aged 6–23 months living in a slum of Dhaka, Bangladesh. It was a community-based observational study where a total of 402 children and 578 children were enrolled for 2 months and 4 months MNP supplementation respectively. Venous blood was collected at enrollment and 5 months later. Hemoglobin level was measured and morbidity episodes recorded from twice weekly home visits. At enrollment, hemoglobin levels were 10.57 ± 1.28 g/dl and 10.78 ± 1.35 g/dl across 2 months and 4 months MNP supplementation groups respectively, compared to 10.65 ± 1.36 g/dl and 11.14 ± 1.11 g/dl at the end-line after MNP supplementation. Plasma hemoglobin increased only after 4 months supplementation in difference-in-difference analysis and this was significantly more in younger children after adjusting the confounding variables (p = 0.03). Prevalence of anemia had improved for both at 2 months (p = 0.015) and 4 months (p = 0.004) of MNP supplementation. Incidence rate ratios (IRR) for diarrhea, cough and fever were comparable across the groups during the supplementation periods and IRR for acute lower respiratory tract infection was significantly lower in 4 months supplementation group with a IRR of 0.30 (95 % CI; 0.22, 0.42). Four months MNP supplementation was relatively more effective in improving hemoglobin level in children 6–24 months.