Owusu-Agyei Seth, Fryauff David J, Chandramohan Daniel, Koram Kwadwo A, Binka Fred N, Nkrumah Francis K, Utz Greg C, Hoffman Stephen L
Navrongo Health Research Center, Ministry of Health, Navrongo, Upper East Region, Ghana.
Am J Trop Med Hyg. 2002 Oct;67(4):371-7. doi: 10.4269/ajtmh.2002.67.371.
Severe anemia is thought to be the principal underlying cause of malaria death in areas of intense seasonal malaria transmission such as the Kassena-Nankana District of northern Ghana. Factors associated with severe anemia in young children, 6-24 months old, were elucidated by analyzing results of 2 malaria-associated anemia surveys (1996, 2000), separated by 4 years, but conducted in the same community and at the same seasonal time point. Age-adjusted comparison confirmed that the proportion of severely anemic children and overall mean hemoglobin (Hb) levels in the November 2000 sample were significantly improved over those of the 1996 sample (17.5 versus 26.4%, P = 0.03; Hb 7.5 versus 6.9 g/dL, P = 0.002). Weight-for-age Z-scores also indicated a significant improvement in the 2000 sample (-1.93 versus -2.20, P < 0.05). Independently, each survey identified statistically significant associations between severe anemia and age, parasite rate, fever, and sex. Relative to children with Hb > or = 6.0 g/dL, those with severe anemia (Hb < 6.0 g/dL) were older, more frequently parasitemic (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.08-2.35), more often febrile (OR, 2.44; 95% CI, 1.71-3.48), and predominantly male (OR, 1.50; 95% CI, 1.05-2.13). An association was identified in both surveys between severe anemia and residence in the northern part of the district, but no clear link was observed in relation to irrigation. Blood transfusions, a likely surrogate index of severe anemia in young children, followed a distinct seasonal pattern. Evidence suggests that dramatic peaks and troughs of severe anemia are regular and possibly predictable events that may be used to gauge the health and survival of young children in this area.
在季节性疟疾传播频繁的地区，如加纳北部的卡塞纳-南卡纳区，严重贫血被认为是疟疾死亡的主要潜在原因。通过分析两次间隔4年、在同一社区且同一季节时间点开展的与疟疾相关的贫血调查（1996年和2000年）结果，阐明了与6至24个月大幼儿严重贫血相关的因素。年龄调整后的比较证实，2000年11月样本中重度贫血儿童的比例和总体平均血红蛋白（Hb）水平相比1996年样本有显著改善（17.5%对26.4%，P = 0.03；Hb 7.5 g/dL对6.9 g/dL，P = 0.002）。年龄别体重Z评分也表明2000年样本有显著改善（-1.93对-2.20，P < 0.05）。每次调查独立确定了严重贫血与年龄、寄生虫感染率、发热和性别之间具有统计学意义的关联。与Hb≥6.0 g/dL的儿童相比，重度贫血（Hb < 6.0 g/dL）儿童年龄更大，寄生虫血症更频繁（优势比[OR]，1.60；95%置信区间[CI]，1.08 - 2.35），发热更频繁（OR，2.44；95% CI，1.71 - 3.48），且以男性为主（OR，1.50；95% CI，1.05 - 2.13）。两次调查均发现严重贫血与居住在该地区北部有关联，但未观察到与灌溉有明确联系。输血可能是幼儿严重贫血的替代指标，呈现出明显的季节性模式。有证据表明，严重贫血的急剧高峰和低谷是定期且可能可预测的事件，可用于评估该地区幼儿的健康和生存状况。
