Prevalence And Factors Associated with Iron Deficiency Among Children with Sickle Cell Anaemia at Mulago Hospital Sickle Cell Clinic
Abstract
Background: Iron deficiency (ID) accounts for an estimated 42% of the global anemia burden.
In Uganda alone national estimates of 53% have been reported. Equally Uganda has a
significant sickle cell disease burden with 13.3% national gene prevalence. Some areas were
observed to have ≥ 20% sickle cell gene prevalence. We set out to examine the burden of ID
among children with sickle cell anemia (SCA) given the high national burden of both and the
fact that ID could potentially worsen the anemia picture in SCA.
Objectives: To determine the prevalence and factors associated with IDA in children with SCA
attending the Sickle Cell Clinic in Mulago hospital.
Methods: A cross-sectional study design was employed between September and November
2020 to enroll children with SCA between ages 6 months to 59 months. Children with HbSS
from the records whose caregivers consented were included. Data was collected using semistructured questionnaires that were administered to the parents/ caregivers. Physical
examination was done and samples of venous blood were drawn from the children. Full blood
count, C-reactive protein and iron studies (ferritin, iron levels) were done to determine iron
levels. The data collected was entered into the computer using Epi data and analysed using
STATA vs 13. Analysis for factors associated with iron deficiency was done using logistic
regression and both bivariate and multivariable analysis was reported.
Results: A total 196 children was studied and of those, 22/196 [(11.2%): 95% CI 7.2% to
16.5%] had Iron Deficiency (low serum iron levels <45 micrograms/L). Only one patient had
a low ferritin level and 18/196 (9.2%): 95% CI 5.5% to 14.1% of patients had a low MCV (<70
fL for 0.5 to 2 years and < 73fL 2 to 5 years). Almost all patients had anemia (< 11g/dl)
[186/196: 94.9%: 95% CI 90.8 to 97.5].
The odds of iron deficiency among children exclusively breastfed for six months or more was
9 times those among children who were exclusively breastfed for less than six months [Odds
Ratio (OR): 9.1: 95% CI 1.7 to 49.7]. Children who were previously transfused had 3.5 times
the odds of iron deficiency compared to children who had not been previously transfused [OR:
3.5, 95% CI 1.0 to 11.8]. Children who were taking hydroxyurea were less likely to have iron
deficiency [OR 0.33, 95% CI 0.11 to 0.99] and children with a MUAC ≥11.5cm were less
likely to have iron deficiency [OR 0.13, 95% CI 0.02 to 0.76].
Conclusion: In this study, slightly more than 1 in every 10 children with SCA had Iron
deficiency. Low nutritrional status defined by MUAC< 11.5cm, was associated with Iron
Deficiency. Exclusive breastfeeding beyond 6 months was associated with development of Iron
Deficiency while taking hydroxyurea was protective from Iron deficiency.
Recommendations:
We recommend hydroxyurea to all eligible children affected with sickle cell anaemia, as well
as nutritional counselling and support for breastfed infants with sickle cell anaemia aged ≥6
months of age. Further evaluation on the role of hepcidin levels to exclude functional anaemia
among these children is needed.