Identification and management of iron deficiency anaemia in hospitalised children in Durban, South Africa.

BACKGROUND

Despite iron deficiency anaemia (IDA) being a global challenge, guidelines on identifying and managing children in infection- burdened areas are unclear. Little is known about the investigation and treatment of IDA for hospitalised children in HIV-endemic areas.

OBJECTIVES

To determine the prevalence of anaemia in hospitalised children and to describe the factors that impact the identification and management of IDA in an urban area of South Africa (SA).

METHODS

A cross-sectional study was conducted at a referral hospital in Durban, SA, from 1 January 2019 to 31 December 2019. A chart review was performed for the clinical and laboratory data of 1 138 hospitalised children between 1 and 5 years old who had full blood count results. Standard statistical analyses were performed, including comparative analyses between those with and without anaemia.

RESULTS

There was a 24% prevalence rate of anaemia (46.2% of whom were moderate-severe). There was a greater prevalence for anaemia in malnourished children (p<0.0001) and those HIV exposed (p<0.0001). Despite 65.9% of anaemic children having microcytic hypochromic anaemia, iron studies were only performed in 12/273 (4.4%), and stool samples were tested in 16/273 (5.9%). The majority (260/273, 95.2%) of all anaemic children had a Mentzer index >13, suggesting a high prevalence of IDA. Only 10/273 (3.7%) were provided with iron. Children with microcytic hypochromic anaemia were no different in clinical presentation or outcome to other anaemic children. High numbers (55.1%) were on antibiotics, and this high infection burden may have affected the identification and management of IDA.

CONCLUSION

Malnourished and HIV-exposed children have a higher prevalence of anaemia. Despite this, <10% of children had basic investigations to identify IDA. This study highlights the urgent need to implement guidelines in identifying IDA and providing iron replacement in hospitalised children in areas with high infection burdens, including SA.