Severe anaemia in childhood in Sokoto, Nigeria

Background: Blood transfusion still remains the standard treatment of severe anaemia despite the dangers or risk of transmission of HIV and Hepatitis B and C viruses asso iated with it. Objectives : To determine the prevalence, aetiology, presentation, severity and outcome of severe anaemia among the children admitted into Emergency Paediatrics Unit (E.P.U.) of our Teriary Hospital in Sokoto, Nigeria . Methods : This was a 3-year prospective study conducted in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, of severe anaemia cases admitted into E.P.U. (i.e. between January, 2000 and December, 2002). Information from the study proforma included date of admission, age, gender, symptoms and signs at presentation , complication(s) developed, haemotocrit (PCV), causes of anaemia, haemoglobin (Hb) electrophoresis and outcome of treatment. Severe anaemia was defined according to WHO criterion of Hb concentration of less than 5gm/dl or PCV :S 15%. Results: One hundred and twenty seven (127) of the 4,717 (2.7%) patients were diagnosed with severe anaemia over the study period. The M:.F ratio identified was 1.8:1; with a significant male preponderance. The mean age ΁ (SD) was 4.6 ΁ (2-95) years (ranges, 3 months- 15 years) . The majority (73.3%) of cases were under 5 year of age. Also, majority of the cases presented during the rainy season (May to September) , with an annual rise in prevalence rates; 28.3%, 2000; 29.1%, 2001 and 42.6%, 2002. The main symptoms at presentation was fever (88.2%) whilst the physical sign of pallor was seen in all patients. The PCVs (degree of anaemia) were :S 5% in 6/127 (4.7%); 6- 10% in 48 (37.8%) and 11 - 15% in 73 (57.5%) of our cases. Malaria was the leading cause; with malaria parasite being present in 80 (62.9%) cases. Hb electrophoresis pattern revealed 70 (55·% ) as AA; 42 (33.1%), SS; 6 (4.7%), SS + F and 8 (6%), AS. Anaemic heart failure and convulsion were the main complications encountered in this study. 110 (86.6%) of the patients were transfused with fully screened packed red cells blood. 99 (77.9%) of them were discharged home and to be seen at out-patient clinic, 8 (6.3%) signed against medical advice, and 20 of them died; yielded a case-fatality rate of 15.7% . Conclusion: The increasing incidence of severe anaemia in childhood necessitating blood transfusion, with the associated risk of HIV and Hepatitis B and C transmission, is a major health problem. Therefore, more aggressive measures at prevention and early detection, and appropriate treatment of malaria , as the leading cause of severe anemia in our environment, should be vigorously pursued promoted , supported and sustained.