A "Study of Anemia" Among children in Mansoura University Children's Hospital. It involved 30 male and female children aged from 5 to 120 months old, who were hospitalized in Mansoura University Children's Hospital. The study was performed in the period between 19 March 2018 and 18 April 2018.

1. A Study of Anemia Among children in Mansoura
University Children's Hospital
Kareem Fisal Alnakeeb 1
Kawther Ahmed zaki 2
Abstract
Introduction
Anemia is a nutritional problem of global importance. It is estimated that at least one-third of the
population has been at one time anemic.
Objectives:
To evaluate causes and associated factors of anemia among study population in Mansoura
University Children's Hospital
Materials and Methods:
A combined prospective and retrospective study was developed involving 30 male and female
children aged from 5 to 120 months old, who were hospitalized in Mansoura University
Children's Hospital in 2018. The study was performed in the period between 19 March 2018 and
18 April 2018.
Results:
Children with a hemoglobin concentration less than 11 g/dL were considered anemic.The
predominant age group was between 24 and 71 months (33.3%). Renal diseases were the most
frequent reasons for hospitalization (23.3%). The predominant type of anemia in the study was
microcytic hypochromic (66.7%). 33.3 of children were under-nourished

2. Conclusions:
This study makes us think about the necessity of expanding coverage of supplementation
programs in order to help a larger number of at-risk individuals.
Introduction
Globally, 1.62 billion people and an estimated 293 million children of preschool age are affected
by anemia [1].
Although anemia has a variety of causes, it is generally assumed that 50% of cases are caused by
iron deficiency [2].
The main risk factors for iron deficiency among young children are low intake
and the high requirement of iron during child growth. The adverse effects of iron deficiency
anemia (IDA) in children as well as adults include poor growth and development [3, 4],
and mental
and neuro-motor malfunction [5, 6].
In resource-poor areas, the effects of IDA are frequently
exacerbated by infectious diseases [7–12].
In addition to nutritional factors, several studies have shown that socioeconomic factors such as
low parental education levels, low household incomes [13–15]
, and demographic factors including
age, sex, and family size [16, 17]
affect anemia.
According to EDHS 2014, more than 1/4 children under 5 years in Egypt suffers from some
degree of anemia. 10 % were found to be moderately anemic. Rural children are more likely to
be anemic than urban children (29 % and 23 %, respectively).

3. Girls aged 5-19 years are somewhat more likely than boys in the age group to be anemic (21 %
and 18 %, respectively). Regardless of sex, the majority of anemic children aged 5-19 years are
only mildly anemic. [18]
Thus, this study aimed to estimate the prevalence of anemia and its relationship with biological
and pathological factors in children who were admitted to Mansoura University Children's
Hospital in Egypt.
Methods
A combined prospective and retrospective study was developed in Mansoura University
Children's Hospital. The charts of 30 child aged between 5 months and 10 years old who had
been hospitalized in 2018 and who had performed at least one blood test were analyzed. Data
pertaining to gender, age, weight, serum hemoglobin levels and the diagnosis that led to
admission were collected.
Patients were categorized by age as follows: 1 - 11 months, 12 - 23 months, 24 - 71 months and
72 - 144 months.
Routine procedures of the hospital were followed to measure hemoglobin with levels being
determined. Only the first complete blood count (CBC) test was taken into account. The WHO
criterion (hemoglobin < 11 g/dL) was used to diagnose anemia.(19)
To categorize the degree of
anemia, the following cut-off points were used: 10.0-10.9 g/dL - mild anemia; 7.0-9.9 g/dL -
moderate anemia; < 7 g/dL - severe anemia.
Using mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean
corpuscular hemoglobin concentration (MCHC), anemia was classified into : Microcytic

4. hypochromic, Microcytic normochromic, Normocytic hypochromic, Normocytic normochromic
and Macrocytic.
A weight-for-age indicator was used to evaluate nutritional status. Weight was measured
according to the routine procedures of the hospital. To analyze this variable, the z-score was
used, with classification based on WHO standards: very underweight for age (z-score < -3);
underweight for age (z-score ≥ -3 and < -2); adequate weight (z-score ≥ -2 and < +2) and
overweight for age (z-score ≥ +2).(20)
Patients were categorized by Hospitalization length as follows: 1-7 days, 8-14 days, 15-21 days,
22-28 days, 29-60 days.
IBM SPSS Software version 25 was used for data analysis.
The health, and nutrition characteristics of the study population were summarized as the mean
for continuous variables and as the frequency for categorical variables.
Results
Characterization of hospitalized children
This study included 30 children, whose characteristics are described in Table 1. The group was
comprised of 53.3% boys and 46.7% girls. The predominant age group was between 24 and 71
months (33.3%). The majority of children were well-nourished (66.7%) and 33.3% were
hospitalized for 29 or more days. Renal (23.3%), Gastrointestinal (16.7%) and cardiac (16.7%)
diseases were the most frequent reasons for hospitalization.

5. Table 1: Characterization of 30 children admitted to Mansoura University
Children's Hospital in 2018
variable Frequency %
Gender
male 16 53.3
female 14 46.7
Age (months)
1-11 months 7 23.3
12-23 months 7 23.3
24-71 months 10 33.3
72-144 months 6 20.0
Nutritional status
Adequate 20 66.7
Undernutrition 7 23.3
Very undernutrition 3 10.0
Hospitalization length (days)
1-7 days 4 13.3
8-14 days 8 26.7
15-21 days 7 23.3
22-28 days 1 3.3
29-60 days 10 33.3
Diagnosis
Allergic diseases 1 3.3
Neurological diseases 1 3.3
Cardiac diseases 5 16.7
Endocrinal diseases 1 3.3
others 1 3.3
Genetic disorders 1 3.3
GIT diseases 5 16.7
Hematological diseases 4 13.3
Malnutrition & infection 4 13.3
Renal diseases 7 23.3
Types of anemia and its associated factors
Tables 2 shows that the predominant type of anemia in the study was microcytic hypochromic
(66.7%). Tables 3 shows that the majority of children had moderate anemia (66.7%). Positive
consanguinity was detected in 40% of patients (Figure 1)

6. Table 2: Type of anemia
Frequency %
Microcytic hypochromic 20 66.7
Microcytic normochromic 2 6.7
Normocytic hypochromic 1 3.3
Normocytic normochromic 5 16.7
Macrocytic 2 6.7
Total 30 100.0
Table 3: Degree of anemia
Frequency %
Mild (Hb 10-10.9) 6 20.0
Moderate (Hb 7-9.9) 20 66.7
Severe (Hb < 7) 4 13.3
Total 30 100.0

7. Characterization of children in relation to hemoglobin levels
Figure 2 shows the distribution of hemoglobin levels. The average hemoglobin content was 8.68
g/dL. Severe anemia was found in 13.3% of children and the mildest form was found in 20%
Discussion
Most studies on anemia are population-based; those conducted using a hospitalized population
are scarce, which limits comparative analysis of results.
This study found a high prevalence of anemia, reflecting the magnitude of the disease among
hospitalized children. A high prevalence of anemia has been reported in Latin American
countries. A population study conducted by Rivera, which focused on pre-school children in
Cuba, reported a prevalence of 55.6%.(21)
Sanabria reported a prevalence of 52% in under 5-year-
old children in a referral hospital in Paraguay.(22)
The prevalence of anemia found in this study,

8. and in the abovementioned studies, was higher in specific population groups, indicating that the
condition is influenced by socioeconomic status.
The prevalence of the problem in under 24-month-old children is likely to be a combined result
of the increased iron requirements due to rapid growth, early weaning, low availability of foods
rich in iron and dietary monotony. These factors are prevalent in this age group. Furthermore,
unfavorable socioeconomic conditions impose living conditions that make children more
vulnerable to diarrhea, respiratory infections and intestinal parasites, and may markedly
compromise intake, absorption and biological utilization of iron.
The influence of gender on anemia shows conflicting results. This and other studies found no
association between anemia and gender,(23,24)
whereas other authors reported that anemia is more
common in boys.(25,26)
An association with boys may be due to the faster growth of pre-school
boys compared to girls, which results in a high iron demand that cannot be met by diet alone.
However, further studies are necessary to better understand this factor.
Anemia was found predominantly in underweight children, it can be also found in overweight
children. A lack of vitamins and minerals is commonly observed in both of these conditions. The
diet of obese or overweight children is often characterized by excessive calories and insufficient
intake of vitamins and minerals. In children with some degree of malnutrition, in addition to the
mineral deficiency, there is also a calorie and protein deficiency.
Anemia was, to a certain extent, associated with the reason for hospitalization. In this study,
anemia was most common in children suffering from Renal diseases, followed by
gastrointestinal diseases and cardiac diseases. Renal diseases are possibly associated with blood

9. loss in urine, whereas gastrointestinal diseases lead to blood loss in feces and vomit or by
degradation by parasites.
The diseases occurring in the study population raised questions about functional iron deficiency,
which occurs when sufficient iron is not released to meet the normal hemoglobinization of red
blood cells, either because of an absence of iron stores (iron-deficiency anemia) or by blocking
iron homeostasis (anemia of inflammation). Anemia of inflammation, which is common in cases
of inflammation and/ or infection, is an immune-mediated process in which cytokines and cells
of the reticuloendothelial system induce changes that interfere in different erythropoiesis
pathways leading to anemia.(27)
Therefore, patients with anemia of inflammation may present
associated iron deficiency, just as patients with iron deficiency anemia may develop anemia of
inflammation.
The role of anemia on the average time of hospitalization is difficult to interpret, given that the
length of stay may be related to other factors such as the severity of the clinical condition,
different medical procedures and care, and random errors.(28)
In this study, it is possible that
anemia resulting from nutritional and immunological conditions aggravated the primary disease,
thereby prolonging hospitalization.
Our results emphasize the importance of evaluating the overall nutritional status of patients,
especially children, because of their greater susceptibility. They also suggest that greater
preventive nutritional education during consultations and/or hospitalizations and more attention
from professionals at the primary care level, are needed to prevent nutritional deficiencies. This
study makes us think about the necessity of expanding coverage of supplementation programs in
order to help a larger number of at-risk individuals.

10. Notes
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