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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.

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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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Numbers of children receiving a blood transfusion by year and age group.
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Figure 3: Numbers of children receiving a blood transfusion by year and age group.

Mentions: Two thousand seven hundred and twenty two children received a transfusion (7.4%). The majority of transfusions, 55% (1,490), were received by children with severe anaemia, 29% (789) were received by children admitted with moderate anaemia (Hb 5.0-9.3 g/dl) and 14% (375) received by children who had mild or no anaemia (Hb >9.3 g/dl) at admission. Two percent of transfusions were given to children whose Hb values were not recorded on admission. These relative proportions were constant throughout the period of the study. The number and proportion of admissions transfused declined significantly over time (chi2 for trend = 152, P < 0.0001) mirroring the reduction in severe anaemia (Figure 3). In the 5-12 year age group, there was an increase in transfusions in 2007-2009 which was largely accounted for by the increase in severe anaemia.


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)

Numbers of children receiving a blood transfusion by year and age group.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Numbers of children receiving a blood transfusion by year and age group.
Mentions: Two thousand seven hundred and twenty two children received a transfusion (7.4%). The majority of transfusions, 55% (1,490), were received by children with severe anaemia, 29% (789) were received by children admitted with moderate anaemia (Hb 5.0-9.3 g/dl) and 14% (375) received by children who had mild or no anaemia (Hb >9.3 g/dl) at admission. Two percent of transfusions were given to children whose Hb values were not recorded on admission. These relative proportions were constant throughout the period of the study. The number and proportion of admissions transfused declined significantly over time (chi2 for trend = 152, P < 0.0001) mirroring the reduction in severe anaemia (Figure 3). In the 5-12 year age group, there was an increase in transfusions in 2007-2009 which was largely accounted for by the increase in severe anaemia.

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