PREVALENCE OF IRON DEFICIENCY AND IRON DEFICIENCY ANAEMIA IN 6-59... CHILDREN WITH PNEUMONIA AT KENYATTA NATIONAL HOSPITAL: A COMPARISON

PREVALENCE OF IRON DEFICIENCY AND IRON DEFICIENCY ANAEMIA IN 6-59 MONTHS OLD
CHILDREN WITH PNEUMONIA AT KENYATTA NATIONAL HOSPITAL: A COMPARISON
BETWEEN TWO DIAGNOSTIC PARAMETERS
Wakonyo Gicheru
ABSTRACT
Background
Iron deficiency (ID) is one of the most common and widespread nutritional disorder in the world. ID
manifests late when adverse effects on cognitive development, attention, behavior, school
performance, physical activity and immunity have already set in. There is therefore need for a simple,
accurate and cost-effective method for diagnosing ID early. WHO/CDC (2004) recommends the use of
serum transferrin receptor levels (sTfR) while AAP (2010) recommends the use of reticulocyte
haemoglobin content (CHr) for use assessing iron status.
In Kenya, pneumonia accounts for 16% of deaths in children under 5 years and for more than 50% of all
hospital admissions. Pneumonia and ID/IDA often coexist in children below 5 years. Periods of
hospitalization are an important opportunity to screen for ID and IDA.
Objectives
To determine the prevalence of iron deficiency and iron deficiency anaemia in 6- 59 months old children
with pneumonia at Kenyatta National Hospital(KNH) using serum transferrin receptor levels and
reticulocyte haemoglobin content and to compare the level of agreement between this two tests.
Methodology
This was a hospital-based cross sectional study conducted in the general paediatric wards at KNH.
Children aged 6-59 months old with pneumonia were enrolled after informed parental/guardian
consent. Their nutrition status was determined using WHO weight-for height z-score. Blood samples
were collected and analysed for xii
malaria parasite using Fields stain, blood film morphology using rapid differential stain, complete blood
counts and CHr using Symex XT2000 and sTfR using the Cobas Integra Roche platform.
Anaemia was defined as haemoglobin <11g/dL. ID was defined as CHr level of ≤27.2pg or sTfR level of
≥8.3mg/L. Prevalence of ID and IDA was determined. The level of agreement between the two tests in
detecting ID and IDA was then determined using k statistics.
Results
One hundred and three children with pneumonia were enrolled. The median age was 11 months (IQR 8,
15 months) with 52 (51%) of the children being male. Sixty children (58%) had severe pneumonia while
34 (33%) had very severe pneumonia. Thirty five children had normal nutrition while 38 (37%) had
moderate malnutrition.
The prevalence of anaemia was 66%. Based on the sTfR level, the prevalence of ID was 58.3% while that
of IDA was 43.7%. Based on the CHr level, the prevalence of ID was 61.2% while that of IDA was 46.6%.
The level of agreement between CHr and sTfR in diagnosing ID was 0.83 and in diagnosing IDA was 0.84.
Conclusions
The prevalence of iron deficiency in the study population was 58.3% as per sTfR level and was 61.2% as
per CHr level. The prevalence of iron deficiency anaemia in the study population was 46.6%% as per sTfR
level and was 43.7% as per CHr level. The level of agreement between the two tests in diagnosing ID was
0.83 and was 0.84 in diagnosing IDA, which is an excellent level of agreement