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Changing trends in blood transfusion in children and neonates admitted in Kilifi District Hospital, Kenya.

Pedro R, Akech S, Fegan G, Maitland K - Malar. J. (2010)

Bottom Line: A decline in malaria and paediatric admissions to the Kilifi District Hospital has been reported recently.The number and proportion of admissions transfused also declined significantly over this time (chi2 for trend = 152, P < 0.0001).The impact of reduced malaria transmission on child morbidity has positive public benefits on the demand and use of blood for paediatric transfusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Kenya Medical Research Institute-Wellcome Trust Programme, PO Box 230, Kilifi, Kenya.

ABSTRACT

Background: Severe anaemia is a common cause for hospitalization in children in sub-Saharan Africa. Malaria plays an important aetiological role, resulting in a substantial burden of paediatric transfusion in hospitals. A decline in malaria and paediatric admissions to the Kilifi District Hospital has been reported recently. This study aimed to investigate whether this trend affected clinical burden, clinical severity of anaemia and requirements for paediatric transfusion.

Methods: Eight-year retrospective review of paediatric admissions to Kilifi District Hospital, Kenya describing the frequency of moderate and severe anaemia, blood transfusion and case fatality over time. Definitions for severe anaemia were Hb <8 g/dl for newborns and <5 g/dl for other age groups and for moderate anaemia was Hb 8 to <11 g/dl for newborns and 5 to <9.3 g/dl for other age groups. Life threatening anaemia was defined as severe anaemia (Hb <5 g/dl) complicated by either deep breathing or prostration or profound anaemia (Hb <4 g/dl) alone.

Results: Of the 35,139 admissions 13,037 (37%) had moderate anaemia and 2,265 (6%) had severe anaemia; respiratory distress complicated 35% of cases with Hb <5 g/dl. Concurrent with the decline in malaria there was a marked decline in the prevalence of severe anaemia between 2002 (8%) and 2009 (< 4%) (chi2 for trend = 134, P < 0.0001). The number and proportion of admissions transfused also declined significantly over this time (chi2 for trend = 152, P < 0.0001). Of the 2,265 children with severe anaemia 191 (8%) died. Case fatality remained unchanged during this period (P < 0.26) and was largely explained by the unchanged proportion with life-threatening anaemia, present in 58-65% of cases throughout the study period.

Conclusion: The impact of reduced malaria transmission on child morbidity has positive public benefits on the demand and use of blood for paediatric transfusion. Despite an overall reduction in paediatric transfusion requirement, case fatality of severe anaemia remained unchanged over this decade. Further research is required to improve outcome from severe anaemia, particularly in the high-risk group with life threatening features.

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Cases with severe anaemia by age group and year of admission.
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Figure 2: Cases with severe anaemia by age group and year of admission.

Mentions: Concurrent with the decline in malaria there was a marked decline in the prevalence of severe anaemia (Figure 2) from 2002 to 2009 (chi2 for trend = 134, P < 0.0001). Overall, 8% of admissions in 2002 had severe anaemia which decreased to < 4% by 2009. The effect was the most dramatic in infants and young children where proportions with severe anaemia declined from 10% of admissions to 2%. A steep decline was present in most age groups except children 5-12 years who showed an initial steep decline in prevalence in the years 2002-2005, which plateaued then rose again in 2008.


Changing trends in blood transfusion in children and neonates admitted in Kilifi District Hospital, Kenya.

Pedro R, Akech S, Fegan G, Maitland K - Malar. J. (2010)

Cases with severe anaemia by age group and year of admission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2991344&req=5

Figure 2: Cases with severe anaemia by age group and year of admission.
Mentions: Concurrent with the decline in malaria there was a marked decline in the prevalence of severe anaemia (Figure 2) from 2002 to 2009 (chi2 for trend = 134, P < 0.0001). Overall, 8% of admissions in 2002 had severe anaemia which decreased to < 4% by 2009. The effect was the most dramatic in infants and young children where proportions with severe anaemia declined from 10% of admissions to 2%. A steep decline was present in most age groups except children 5-12 years who showed an initial steep decline in prevalence in the years 2002-2005, which plateaued then rose again in 2008.

Bottom Line: A decline in malaria and paediatric admissions to the Kilifi District Hospital has been reported recently.The number and proportion of admissions transfused also declined significantly over this time (chi2 for trend = 152, P < 0.0001).The impact of reduced malaria transmission on child morbidity has positive public benefits on the demand and use of blood for paediatric transfusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Kenya Medical Research Institute-Wellcome Trust Programme, PO Box 230, Kilifi, Kenya.

ABSTRACT

Background: Severe anaemia is a common cause for hospitalization in children in sub-Saharan Africa. Malaria plays an important aetiological role, resulting in a substantial burden of paediatric transfusion in hospitals. A decline in malaria and paediatric admissions to the Kilifi District Hospital has been reported recently. This study aimed to investigate whether this trend affected clinical burden, clinical severity of anaemia and requirements for paediatric transfusion.

Methods: Eight-year retrospective review of paediatric admissions to Kilifi District Hospital, Kenya describing the frequency of moderate and severe anaemia, blood transfusion and case fatality over time. Definitions for severe anaemia were Hb <8 g/dl for newborns and <5 g/dl for other age groups and for moderate anaemia was Hb 8 to <11 g/dl for newborns and 5 to <9.3 g/dl for other age groups. Life threatening anaemia was defined as severe anaemia (Hb <5 g/dl) complicated by either deep breathing or prostration or profound anaemia (Hb <4 g/dl) alone.

Results: Of the 35,139 admissions 13,037 (37%) had moderate anaemia and 2,265 (6%) had severe anaemia; respiratory distress complicated 35% of cases with Hb <5 g/dl. Concurrent with the decline in malaria there was a marked decline in the prevalence of severe anaemia between 2002 (8%) and 2009 (< 4%) (chi2 for trend = 134, P < 0.0001). The number and proportion of admissions transfused also declined significantly over this time (chi2 for trend = 152, P < 0.0001). Of the 2,265 children with severe anaemia 191 (8%) died. Case fatality remained unchanged during this period (P < 0.26) and was largely explained by the unchanged proportion with life-threatening anaemia, present in 58-65% of cases throughout the study period.

Conclusion: The impact of reduced malaria transmission on child morbidity has positive public benefits on the demand and use of blood for paediatric transfusion. Despite an overall reduction in paediatric transfusion requirement, case fatality of severe anaemia remained unchanged over this decade. Further research is required to improve outcome from severe anaemia, particularly in the high-risk group with life threatening features.

Show MeSH
Related in: MedlinePlus