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

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