ABSTRACT
Anaemia is a public health problem that affects about 2 billion people worldwide. It is highly prevalent in developing countries with its prevalence; three to four times higher than that of developed countries as 53% school-age children is estimated to be suffering from anaemia. The objective of this study was to determine the prevalence of anaemia, determine the most prevalent type of anaemia and determine the factors responsible for the occurrence of anaemia.
A study was conducted on 329 folders of children aged 1-5 years that attended UNTH, Ituku Ozalla between the periods of Jan. 2014-June, 2016. A proforma was constructed and used to gather information on the socio demographic characteristics. Results of blood samples for haemoglobin estimation and malaria parasite examination were collected. Anthropometric measurements of the studied cases were also taken. Entry of data, cleaning and analysis was done using descriptive Statistical Product for Service Solution (SPSS). Of the 329 studied cases, 303(97.0%) were anaemic. The malarial parasitic load of the studied cases was (60.7%) and the most prevalent types of anaemia were iron deficiency anaemia which affected 165(54.4%) of the studied population and Sickle cell anaemia which affected 60(19.8%) of the studied population. Various factors were seen to be responsible for the occurrence of anaemia some of which include; inadequate iron intake, maternal level of education etc.
Anaemia was significantly associated with inadequate iron intake and the presence of parasites. It is recommended that health programmmes should be initiated to ensure free iron supplementation to children between the ages of 1-5 years as well as proper nutrition education.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGMENTS iv
TABLE OF CONTENTS v
LIST OF TABLE vii
LIST OF FIGURES ix
ABSTRACT x
CHAPTER 1
INTRODUCTION 1
1.1 Statement of Problem 3
1.2 Objectives of the Study 4
1.3 Significance of the Study 5
CHAPTER 2
LITERATURE REVIEW 6
2.1 Anaemia 6
2.1.1 Effects of Anaemia on Children 10
2.1.2 Conceptual Framework for the Analysis of Anaemia Risk 13
2.2 Prevalence of Anaemia 14
2.3 Causes of Anaemia in Children 16
2.4 Classification of Anaemia 20
2.5 Clinical Manifestations of Anaemia in Children 22
2.6 Diagnosis of Anaemia 22
2.7 Treatment of Anaemia 24
2.8 Nutritional Management of Iron Deficiency Anaemia 26
2.9 Factors that Predispose to the Development of Anaemia Among Children 28
2.10 Prevention of Anaemia 30
CHAPTER 3
MATERIALS AND METHODS
3.1 Study Design 33
3.2 Area of Study 33
3.3 Population of the Study 33
3.4 Sampling and Sampling Techniques 33
3.4.1 Sample Size 33
3.4.2 Sampling Procedure 34
3.5 Preliminary Activities 34
3.5.1 Preliminary Visits 34
3.5.2 Training of Research Assistants 34
3.5.3 Ethical Approval 35
3.6 Data Collection 35
3.6.1 Proforma 35
3.6.2 Anthropometric Measurements 35
3.6.3 Biochemical Measurements. 35
3.6.4 Clinical Observations 35
3.6.5 Dietary Measurements. 35
3.7 Data Analysis 35
3.8 Statistical Analysis 36
CHAPTER 4
Results and Discussion 37
4.1 Socio Demographic Characteristics of the Subjects 37
4.2 Health Status of the Children 39
4.3 Prevalence of Anaemia 39
4.4 Most Prevalent Types of Anaemia 40
4.5 Factors That Led to Anaemia 41
4.5.1 Malarial Infestation 41
4.5.2 Maternal Level of Education 42
4.5.3 Inadequate Iron Intake 43
4.5.4 Intestinal Worm Infestation 44
4.5.5 Glucose 6 Phosphate Dehydrogenase (G6PD) 45
4.6 Primary diagnosis of the studies cases 46
4.7 Mortality level of the studied cases 47
4.8 Mean Z-Scores of Anthropometric Indicators 48
4.9 Weight for Height Status of the Children 49
4.9.2. Height for Age Status of the Children 50
4.10 Weight for Age status of the Children 50
CHAPTER 5
Conclusion and Recommendations
5.1 Conclusion 51
5.2 Recommendations 51
REFERENCES
LIST OF TABLES
4.1: Socio demographic characteristics of the subjects 38
4.2 PCV Status and Malarial parasitic load of the subjects 39
4.3 Different types of anaemia in the studied cases 40
4.4 Percentage of cases with most prevalent types of anaemia 41
4.5.2 Educational Level of the mothers 43
4.5.3 Inadequate iron intake 44
4.5.4 Parasitic load of the subjects 45
4.5.6 Number of cases that had G6PD 46
4.6 Primary diagnosis of the studied cases 46
4.8 Mean weight and height of the studied cases 49
4.9 Weight for height status of children 49
4.9.2 Height for age status of the children 50
4.10 Weight for age status of the children 50
LIST OF FIGURES
2.1 Conceptual framework for the analysis of anaemia risk 14
4.5.1 Number of cases that had malarial disease 42
4.7 Level of mortality of the studied cases 48
CHAPTER 1
INTRODUCTION
Anaemia, a most common haematologic condition marked by an abnormal reduction in red blood cells, is a leading global health threat ranking highest in countries including Nigeria (Harvey, 2003). The World Health Organization (2007), defined anaemia as a haematologic condition and a sign of an underlying disorder, characterized by a reduction in the number of red blood cells, or a reduction in the concentration of haemoglobin in the blood stream to a level below 10.5g/dl. The World Health Organization (WHO) estimated the number of anaemic persons to be about 2 billion worldwide (McLean, 2005; Egli et al., 2005). Anaemia has also been defined as a reduction below normal in the number of red corpuscles per cubic millimeter, the quantity of haemoglobin and the volume of packed red cells per 100 ml of blood as a result of impaired erythrocyte production or increased erythrocyte loss which leads to impaired tissue perfusion (Ojo and Briggs, 2009). Anaemia is considered a major public health problem and the most common nutritional deficiency around the world (DeMaeyer et al., 2000).
The prevalence of anaemia in the world is 24.8% (WHO, 2011). Furthermore, it is estimated that iron deficiency contributes towards 50% of the approximated 600 million global anaemia cases in preschool and school aged children (WHO, 2011), the groups most affected by anaemia are pregnant women (48%), school children (46%) and preschool children (39%). In developing countries, the prevalence of anaemia is three to four times higher than that of developed countries. The most highly affected population groups in developing countries are pregnant women (56%), school-age children (53%) and preschool children (42%) while in developed countries, the most-affected groups are pregnant women (18%) and preschool children (17%) (Benoist, 2005; McLean et al., 2005; Egli and Cogswell, 2005). Anaemia has multiple consequences which can be extremely severe (Goudarzi et al., 2008; Ahmadi et al., 2010). It affects the physical and mental development of an individual leading to decreased working capacity, which in turn affects the development of the country (WHO, 2011).
Management of anaemia according to Campbell (2008) entails the following: Dietary advice, administration of oral and parenteral haematinics, pre-natal supplementation with iron and folic acid coupled with malaria chemoprophylaxis in places where malaria is endemic and blood transfusion in severe cases. Not excluding personal protection (use of mosquito treated bed nets, and mosquito proof houses) and environmental hygiene as potent preventive measures against the dreaded condition anaemia.
Studies have shown that parasitic infestations contribute maximally to the anaemia in sub-Saharan Africa and these infestations present a major cause of disease and morbidity in Africa. Malaria is a protozoan infestation of erythrocytes caused in human beings by five species of the genus Plasmodium (P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi). This disease commonly found in the tropics, is a major public health problem with a consequent high morbidity and mortality among children and pregnant women in Nigeria (Onyemaobi and Onimawo, 2011).
In Nigeria, few studies have been reported to have been carried out on anaemia among preschool and school age children living in different parts of the country; hence, the problem this research work seeks out to address is the prevalence of anaemia in children aged 1-5 years that attended University of Nigeria teaching hospital (UNTH) between Jan. 2014- June 2016.
1.1 STATEMENT OF PROBLEM
Anaemia is a widespread public health problem in school children with major consequences for health as well as social and economic development. Globally, anaemia affects about 46% of pre-school children with prevalence ranging from 38.6% to 82.6% in Edo, Ogun and Abia States (Osazuwa, 2011). Asia and Africa have the highest prevalence of anaemia in all the vulnerable groups.
In Nigeria, the prevalence of anaemia among pregnant women ranges from 35.3% in Lagos (Osazuwa and Ayo, 2010). Among children, it ranges from 38.6% in Edo State (Imade and Onimawo, 2010) to 82.6% in Abia (Ukegbu and Asumugha, 2011).
Toteja et al., (2006) pointed out the burdens of anaemia among children as inadequate iron stores, higher risk of morbidity and mortality as well as a decline in mental concentration and physical activity.
The major health consequences in children are cognitive and growth impairment, increased morbidity from infectious diseases and reduced work capacity. Although the etiology of anaemia is complex and multifactorial, iron deficiency accounts for about 50% of all cases of anaemia which results in anaemia and parasitic diseases. Presently in the South East Nigeria, there is no specific intervention in place for the prevention of anaemia among children aged 1-5 years and the paucity of data on the burden of anaemia on this age group has made it difficult to define appropriate interventions.
WHO recommended that chemotherapy be given for helminthic infestations as a strategy to prevent anaemia, but presently this is only done in Federal capital territory (FCT), Nigeria, where it is given to children under 5. Few studies have reported on anaemia among school age children living in the different parts of Nigeria and there is paucity of information in children attending UNTH, Ituku Ozalla and this makes it difficult to formulate appropriate policies. UNTH, Ituku Ozalla was selected because it treats patients from all over the state and the findings from this study will provide the first data on the prevalence of anaemia in children aged 1-5 years that attended UNTH, Ituku Ozalla between the period of Jan. 2014 to June, 2016.
It is apparent that the prevalence of anaemia in developing countries is about four times that of developed countries. The iron content of breast milk is low and cannot supply enough for the full-term infant after the age of 6 months. Therefore, prolonged breastfeeding as well as inadequate amounts of absorbable iron in complementary foods explains the peak prevalence of anaemia between about 9 and 18 months of age. About half of the infants in developing countries become anaemic by 12 months (WHO, 2012).
I was motivated to carry out the study because the causes of anaemia have regional variations and further variation is expected among children aged 1-5 years. However, the prevalence of anaemia and the factors responsible for its occurrence among children aged 1-5 years remains understudied in South-East Nigeria.
1.2 OBJECTIVES OF THE STUDY
The general objective of this study is to determine the prevalence of anaemia on children aged 1-5 years that attended UNTH, Ituku Ozalla.
The specific objectives include:
1. Determine the prevalence of anaemia among children aged 1-5 years that attended UNTH within the stipulated years.
2. Determine the most prevalent types of anaemia in the studied cases.
3. Identify factors responsible for the occurrence of anaemia in the studied cases.
1.3 SIGNIFICANCE OF THE STUDY
This study aims to look at anaemia among children that attended UNTH, Ituku Ozalla within the stipulated years. It is hoped that it will provide baseline data for further studies on anaemia among children living in South Eastern Nigeria as a whole and provide stakeholders with evidence based information to develop appropriate interventions for this vulnerable group.
This research will be of great benefit to Nutritionists, Nurses, Dietitians, the community and the society at large because it will provide them with the evidence that anaemia is still prevalent among children aged 1-5 years the most prevalent type and factors responsible for their occurrence . This in turn will motivate these professional bodies and the society at large to come together to make policies that will help to reduce anaemia among children.
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