Anaemia in young children living in the Surinamese interior: the influence of age, nutritional status and ethnicity

OBJECTIVE: Anaemia may lead to poor motor development and impaired neurocognitive function and affects 43% of children 1–5 years worldwide. Currently, there is little information on the prevalence of anaemia in young children living in the interior of Suriname. This study investigates the prevalence of anaemia in these children and the influence of the associated factors of age, nutritional status and ethnicity. SUBJECTS AND METHODS: Haemoglobin levels and anthropometric measurements of children aged 1–5 years were collected, after informed consent was provided, in three different interior regions of Suriname in the period September–October 2015. World Health Organization(WHO) standards for anaemia and underweight assessment were applied. Logistic regression models were computed to examine independent associations between the anaemic and non-anaemic groups and were expressed as odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: Six hundred and six children were included: 330(55%) very young (1–3 years) and 276 older (4–5 years). Younger age was associated with anaemia (OR = 2.45;95% CI 1.75, 3.45). Anaemia was less prevalent in Amerindian than in Maroon children (OR = 0.51; 95% CI0.34, 0.76). Haemoglobin level was not influenced by nutritional status. CONCLUSIONS: The prevalence of anaemia in children 1–5years old living in Suriname’s interior is high (55%) compared to similar aged children in Latin America and the Caribbean (4–45%). Children 1–3 years of age were more affected than 4–5-year old children, as were Maroon children compared to Amerindian children. Nutritional status was not of influence. These findings call for further studies and may support adaptation of anaemia prevention and control programmes in young children in Suriname.

Anaemia in pregnancy: associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago

OBJECTIVE: To determine the prevalence of anaemia in antenatal clinic attendees; to investigate the effects of parity, age, gravidity, previous abortions, child spacing and other factors on the prevalence of anaemia in pregnancy. METHODS: This was a retrospective and cross-sectional study. Antenatal records of 2287 pregnant women attending 40 public healthcare centres from January 2000 to December 2005 in Trinidad and Tobago were used. Data pertaining to the investigated variables were recorded. The national prevalence of anaemia was calculated and chi-square tests, odds ratios and logistic regression were used to assess the relationship between anaemia and each variable. RESULTS: The prevalence of anaemia was 15.3% (95% CI 13.4%, 16.6%). No significant difference in the prevalence of anaemia was found among the different clinics or counties. At the first haemoglobin reading, age was inversely related to the presence of anaemia, whereas gestational age at first visit was directly related. At the final haemoglobin reading, parity, gravidity, and previous spontaneous abortions were directly related to the prevalence of anaemia, while the number of visits was inversely related. Age was inversely associated to the severity of anaemia while gravidity was directly related. CONCLUSION: The prevalence of anaemia decreased by 18.7% from 1967. Despite this positive indication, women under 24 years and those commencing antenatal care after the first trimester are still at a higher risk for developing anaemia. Early commencement of antenatal care and close monitoring of the risk groups identified should be strongly advocated.

Parasitological and clinical responses of lambs experimentally infected with Haemonchus contortus (L3) with and without ivermectin treatment

Haemonchus contortus is one of the most important parasites that infects sheep and exerts its pathogenic effects by sucking blood, causing disturbances of organ-functions and thus inducing alterations in various normal physiological parameters. Changes in live body weight, faecal egg count, kinetics of circulating eosinophils and PCV value were studied at weekly interval for a period of 84 days in 18 lambs of local breed after infection with a single dose of 5000 H. contortus (L(3)). In the two groups of lambs infected with nematodes both non-treated and treated with ivermectin (HcNT and HcIT), similar egg excretion patterns was observed starting from third week after infection, with a regular increase in FEC. Examination of whole abomasum of each animal revealed no developmental stage of nematode from treated and control lambs on day 84. The total mean number of H. contortus worms recovered at necropsy from abomasa of untreated infected lambs (group HcNT) was 2576.2 (+/-221.0). The significant loss of body weight, development of heavy worm burden and severe anaemia as indicated by reduced PCV in untreated infected lambs indicated high susceptibility of the lambs to H. contortus. On the other hand, complete absence of the parasite, improved PCV value and body weight after treatment of infected animals (HcIT) proved 100% efficacy of ivermectin against H. contortus.

Anaemia and kidney dysfunction in Caribbean type 2 diabetic patients.

BACKGROUND: Anaemia has been shown in previous studies to be a risk factor for cardiovascular disease in diabetic patients with chronic kidney disorder. This study was aimed to assess the prevalence of anaemia and kidney dysfunction in Caribbean type 2 diabetic patients that have been previously shown to have a high prevalence of the metabolic syndrome. METHODS: 155 type 2 diabetic patients and 51 non-diabetic subjects of African origin were studied. Anthropometric parameters were measured and fasting blood samples were collected for glucose, creatinine, glycated hemoglobin and complete blood count. Anaemia was defined as haemoglobin < 12 g/dl (F) or < 13 g/dl (M). Kidney function was assessed using glomerular filtration rate (GFR) as estimated by the four-variable Modification of Diet in Renal Disease (MDRD) study equation. Subjects were considered to have chronic kidney disease when the estimated GFR was < 60 ml/min per 1.73 m2. Comparisons for within- and between-gender, between diabetic and non-diabetic subjects were performed using Student's t-test while chi-square test was employed for categorical variables. RESULTS: The diabetic patients were older than the non-diabetic subjects. While male non-diabetic subjects had significantly higher red blood cell count (RBC), haemoglobin and hematocrit concentrations than non-diabetic female subjects (p < 0.001), the RBC and hematocrit concentrations were similar in male and female diabetic patients. Furthermore, irrespective of gender, diabetic patients had significantly higher prevalence rate of anemia than non-diabetic subjects (p < 0.05). Anaemic diabetes patients had significantly lower GFR (67.1 +/- 3.0 vs. 87.9 +/- 5.4 ml/min per 1.73 m2, p < 0.001) than non-anaemic patients. CONCLUSION: A high prevalence of anaemia was identified in this group of type 2 diabetic patients previously shown to have a high prevalence of the metabolic syndrome.

The clinician's guide to the cardiovascular examination

A detailed examination of the cardiovascular system is indispensable to the full appreciation of the cardiac status. Yet, because this fundamental aspect of cardiology is so inadequately presented by many of the major texts, students often fail to grasp the essentials. The author not only brings a rich knowledge of the subject to his task, but also a wide experience of teaching and a firm conviction that the prime purpose of the undergraduate pre-clinical curriculum is to provide information on which the student may build. The student who masters this information will be well prepared for the clinical years and suitably equipped for more advanced studies

A comparative study of pregnancy outcome in anaemic and non-anaemic women attending government health facilities in St. Ann, Jamaica

Worldwide 50 percent of pregnant women are reported to be anaemic, with 18.6 percent and 14.6 percent anaemic during 1998 in Jamaica and St. Ann respectively. A study was designed to describe and compare pregnancy outcome for 176(1:1 match)women with and without anaemia on first visit to antenatal clinic attending government health facilities in St. Ann during 1998, and to assess and compare the physical growth and developmental milestones in 46(1:1 match) of their offspring at various age intervals. Sources from which data were obtained were secondary (records), primary (community visits) and qualitative (focus group). The hypotheses proposed were that (1) anaemic women have poorer pregnancy outcome that non-anaemic women, (2) babies born to anaemic women have slower growth and development milestones and (3) the problem of anaemia in pregnancy persist due to poor knowledge, attitude and practices among pregnant women. Significant differences found between pregnancy outcome of the groups being compared were: mean first visit ... Weight of babies assessed was lower for the anaemic group (P,0.01); mom's age for babies assessed in the community were lower of the anaemic group (p<0.02); and babies born to anaemic women were 3.8 times more likely to be stunted i.e. low length for age (p,0.05). Mean age for first pregnancy was lower for the anaemic group (p<0.05). From the qualitative data it was found that only a few of the pregnant women were knowledgeable about anaemia. Most had positive attitudes towards taking iron supplements but did not seem to practice it as expected. These findings have implications for the level of health and nutrition education offered in government health facilities and the educational level of women in the society. Health measures taken in pregnancy and early life have potential long-term effectiveness and health impact. Haemoglobin levels of pregnant women need to be assessed at the ANC for each trimesters of pregnancy to ensure appropriate and early interventions. More research is needed to assess impact of anaemia on women during lacation, and also on the later growth, development and academic attainment of children born to anaemic women (AU)

Factors contributing to anaemia in pregnancy in the parish of Westmoreland, Jamaica

The prevalence of anemia in pregnancy is 24 percent in the parish of Westmoreland. By using the World Health criteria for measuring anaemia in the community, it can be said that the problem is at a level of moderate severity in the parish. An analytic study was conducted to identify factors that are associated with this phenomenon. The sample consisted of 142 women who had initiated antenatal care at health centres in 1998. Anaemics(n=71) were women identified with haemoglobin levels<10g/dl. Non-anaemics(n=71) were women identified with haemoglobin levels less than or equal to 10g/dl. Results: 26.8 percent of the study population were in the <20 years and 25-29 age groups. Sixty two point six percent were either in a visiting or common-law relationship while 62.7 perecent were unemployed. Anaemic multigravidae were significantly more likely than non-anaemics to have given birth within 2 years of their last delivery. A history of anaemia in previous pregancies was significantly correlated with being presently anaemic, OR 4.56, 95 percent CI. Pica (eating of stones) was significantly correlated with anaemia Odds Ratio 10.07, 95 percent CI. On repeat Hb in third thimester cases who experienced a fall in Hb levels were women who reported high pica levels, consuming more than three meals. While most respondents gave correct answers to knowledge and practice questions as it related to nutrition education, there is a gap between nutrition knowledge and actual practice. The problem of anaemia in pregnancy is multifaceted. Socio-economics, child spacing of less than 2 years, a previous history of anaemia, pica and a gap between knowledge and actual practice, were the main factors found to be associated with anaemia in this study. An intersectoral approach among the various ministries, private sector and community organizations needs to be forged to solve this problem that impacts on the health and well being of mothers and their offsprings (AU)

A comparative study of pregnancy outcome in anaemic and non-anaemic women attending government health facilities in St. Ann, Jamaica

Worldwide 50 percent of pregnancy women are reported to be anaemic, with 18.6 percent and 14.6 percent anaemic during 1998 in Jamaica and St. Ann respectively. A study was designed to describe and compared pregnancy outcome of 176 (1:1 match) women with and without anaemia on first visit to antenatal clinic attending government health facilities in St Ann during 1998, and to assess and compare the physical growth and developmental milestones in 46 (1:1 match) of their offspring at various age intervals. Sources from which data were obtained were secondary (records), primary (community visits) and qualitative (focus group). The hypotheses proposed were that: (1) anaemic women have poorer pregnancy outcome than non-anaemic women, (2) babies born to anaemic women have slower growth and developmenal milestones and (3) the problem of anaemia in pregnancy persist due to poor knowledge, attitude and practices among pregnant women. Significant differences found between pregnancy outcome of the groups being compared were: mean first visit haemoglobin levels was 8.9 and 11.8 gm/dl for the anaemic and non-anaemic groups respectively (p<0.00). The adverse pregnancy outcome in terms of stillbirths, abortion and perinatal deaths occurs in the non-anaemic group (p<0.01). The mean age at which infants were taken to postnatal clinic was lower for the anaemic group (p<0.01), and less of the babies born to the anaemic group were ill (p<0.01). At age 3 months, the mean weight of babies born to the anaemic group was lower (p<0.03). Weight of babies assessed was lower for the anaemic group (p<0.01); mom's age for babies assessed in the community were lower for the anaemic group (p<0.02); and babies born to anaemic women were 3.8 times more likely to be stunted i.e. low length for age (p<0.05). Mean age for first pregnancy was lower for the anaemic group (p<0.05). From the qualitative data it was found that only a few of the pregnant women were knowledgeable about anemia. Most had positive attitudes towards taking iron supplements but did not seen to practice it as expected. These findings have implications for the level of health and nutrition education offered in government health facilites and the educational level of women in the society. Health measures taken in pregnancy and early life have potential long-term effectiveness and health impact(Au)

The prevalence of intestinal nematodes at the Adelphi All-age school in Saint James

A cross-sectional study of these rural school children was done to determine the level of infection in the school, and the types of geohelminths present. Data was collected through the use of one hundred and sixty-six (166) close-ended questionnaires, and the analysis of one hundred and nineteen (119) stool samples, and eighty (80) blood samples. A high prevalence of 22.3 percent was demonstrated in the school's population, with prevalence in the 10-12 age group reaching a high of 44 percent. Trichuris (13.4 percent), Ascaris (8.9 percent), and eosinophilia (6.4 percent), all showed significant prevalence. However, the prevalence of Hookworm (3.6 percent), and anaemia (2.6 percent), were not significant among the group. Infection strongly correlated with the eating of chalk and marl (a type of soil, composed chiefly of clay and limestone). The source of infection was identified as two marl pits located near the school, which are obviously used for indiscriminate defaecation. The construction of more latrines at the school, school health education, and public health education were recommended, to help eradicate worms from the school.(Au)

Medical admissions of oncology patients to the University Hospital of the West Indies

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7 percent of total admission to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62 percent were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7 percent of admissions, the commonest being renal and/or hepatic impairment: anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35 percent of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).(AU)

Factors contributing to anaemia in pregnancy in the parish of Westmoreland, Jamaica

The prevalence of anaemia in pregnancy is 24 percent in the parish of Westmoreland. By using the World Health criteria for measuring anaemia in the community, it can be said that the problem is at a level of moderate severity in the parish. An analytic study was conducted to identify factors that are associated with this phenomenon. The sample consisted of 142 women who had initiated antenatal care at health centres in 1998. Anaemics (n=71) were women identified with haemoglobin levels <10g/dl. Non-anaemics (n=71) were women identified with haemoglobin levels > or = 10g/dl. Results: 26.8 percent of the study population were in the <20 years and 25 - 29 age groups. Sixty two point six percent were either in a visiting or common-law relationship while 62.7 percent were unemployed. Anaemic multigravidae were significantly more likely than non-anaemics to have given birth within 2 years of their last delivery. A history of anaemia in previous pregnancies was significantly correlated with being presently anaemic, OR 4.56, 95 percent CI. Pica (eating of stones) was significantly correlated with anaemia Odds Ratio 10.07, 95 percent CI. On repeat Hb in third trimester cases who experienced a fall in Hb levels were women who reported high pica levels, consuming more than three items. While most respondents gave correct answers to knowledge and practice questions as it related to nutrition education, there is a gap between nutrition knowledge and actual practice. The problem of anaemia in pregnancy is multifaceted. Soci-economics, child spacing of less than 2 years, a previous history of anaemia, pica and a gap between knowledge and actual practice, were the main factors found to be associated with anaemia in this study. An intersectoral approach among the various ministries, private sector and community organizations needs to be forged to solve this problem that impacts on the health and well being of mothers and their offsprings.(Au)

Factors contributing to anaemia in pregnancy in the parish of Westmoreland, Jamaica

The prevalence of anaemia in pregnancy is 24 percent in the parish of Westmoreland. By using the World Health criteria for measuring anaemia in the community, it can be said that the problem is at a level of moderate severity in the parish. An analytic study was conducted to identify factors that are associated with this phenomenon. The sample consisted of 142 women who had initiated antenatal care at health centers in 1998. Anaemics (n=71) were women identified with haemoglobin levels <10g/dl. Non-anaemics (n=71) were women identified with haemoglobin levels >10g/dl. Results: 26.8 percent of the study population were in the <20 years and 25 - 29 age groups. Sixty two point six percent were either in a visiting or common-law relationship while 62.7 percent were unemployed. Anaemic multigravidae were significanty more likely than non-anaemics to have given birth within 2 years of their last delivery. A history of anaemia in previous pregnancies was significantly correlated with being presently anaemic, OR 4.56, 95 percent CI. Pica (eating of stones) was significantly correlated anaemia Odds Ratio 10.07, 95 percent CI. On repeat Hb in third trimester cases who experienced a fall in Hb levels were women who reported high pica levels, consuming more than three items. While most respondents gave correct answers to knowledge and practice questions as it related to nutrition education, there is a gap between nutrition knowledge and actual practice. The problem of anaemia in pregnancy is multifaceted. Socio-economics, child spacing of less than 2 years, a previous history of anaemia, pica and a gap between knowledge and actual practice, were the main factors found to be associated with anaemia in this study. An intersectoral approach among the various ministries, private sector and community organizations needs to be forged to solve this problem that impacts on the health and well being of mothers and their offsprings.(Au)

Serum immunoreactive erythropoietin levels and associated factors amongst HIV-infected children

OBJECTIVES: To determine the spectrum of serum immunoreactive erythropoietin (SIE) levels amongst HIV-infected children aged <13 years in relation to the levels among healthy children as well as those with renal failure; to examine the relationship between clinical and laboratory parameters and SIE levels. DESIGN: A cross-sectional study with a descriptive non-interventional format. HIV-infected Canadian subjects were recruited through four tertiary Canadian and one Bahamian centre. Children with renal failure and healthy children were recruited from one of the Canadian centres. METHODS: Study subjects had clinical and laboratory profiles determined at baseline and at each of five follow-up periods over 1 year. SIE levels were measured by radio-immunoassay with a normal range of 12-28 IU/I. Data handling and statistical functions were performed by the Canadian HIV Trials Network. RESULTS: Ths study enrolled 133 HIV-infected subjects and 38 controls. Of these, 117 HIV-infected subjects, 24 healthy controls, and 11 controls with renal failure were eligible for analysis. The median age of infected subjects was 44 months, whereas that of healthy controls was 56 months, and 95 months for controls with renal failure. The median SIE levels were 14 and 11 IU/I for subjects with renal failure and healthy subjects, respectively. The median SIE level was 61 IU/I among zidovudine (ZDV)-treated subjects and 22 IU/I among ZDV-naive HIV-infected subjects. HIV-infected children almost invariably had SIE levels < 200 IU/I. The median SIE levels amongst HIV-infected subjects whose hemoglobin levels were < 100 g/l were 98 and 31 IU/I for ZDV-treated and ZDV-naive subjects, respectively (P = 0.002). This difference in median SIE levels between ZDV-treated subjects and ZDV-naive subjects was also observed among subjects whose hemoglobin levels were > 100 g/l (median, 58 and 15 IU/I, respectively; P < 0.001). Hemoglobin level was the most important predictor of log10 SIE (P < 0.001 for ZDV-treated and ZDV-naive subjects). CONCLUSIONS: SIE levels amongst HIV-infected children were affected by HIV infection, use of ZDV, and presence or absence of anemia. SIE levels amongst HIV-infected children were generally lower than 200 IU/I. This characterization of SIE levels will facilitate clinical trials of exogenous recombinant human erythropoietin in HIV-infected children with anemia.(Au)

Nutrition, anaemia, geohelminth infection and school achievement in rural Jamaican primary school children

OBJECTIVE: To determine whether nutritional status, anaemia and geohelminth infections were related to school achievement and attendance in Jamaican children. DESIGN: A cross-sectional study using a randomly selected sample. SUBJECTS: Eight hundred children aged 9-13 years randomly selected from those enrolled in grade 5 in 16 primary schools in rural Jamaica. RESULTS: The mean height for age of the children was -0.37 z-score +/-1.0 s.d. with 4.9 percent having the heights for age < -2 s.d. of the NCHS references. Anaemia (Hb < 11 g/dl) was present in 14.7 percent of the children, 38.3 percent were infected with Trichuris trichiura and 19.4 percent with Ascaris lumbricoides. Achievement levels on the Wide Range Achievement Test were low, with children performing at grade 3 level. In multilevel analyses, controlling for socioeconomic status, children with Trichuris infections had lower achievement levels than uninfected children in spelling, reading and arithmetic (P < 0.05). Children with Ascaris infections had lower scores in spelling and reading (P < 0.05) Height for age (P < 0.01) was positively associated with performance in arithmetic. Ascaris infection (P < 0.001) and anaemia (P < 0.01) predicted poorer school attendance. CONCLUSION: Despite mild levels, undernutrition and geohelminth infections were associated with achievement, suggesting that efforts to increase school achievement levels in developing countries should include strategies to improve the health and nutritional status of children(AU)

Health effects of human T-lymphotropic virus type I (HTLV-I) in a Jamaican cohort

BACKGROUND: Other than adult T-cell leukaemia (ATL) and HTLV-I associated myelopathy (HAM), the health effects of infection with human T-lymphotropic virus type I (HTLV-I) are not well defined. METHOD: A cohort of 201 confirmed HTLV-I seropositive Jamaican food service workers and 225 seronegative controls of similar age and sex from the same population was examined. A health questionnaire, physical examination, and laboratory tests were performed at enrollment into the cohort in 1987-1988. RESULTS: One of 201 HTLV-I seropositives, but no controls were diagnosed with HAM, for a prevalence of 0.5 percent (95 percent confidence interval) (CI) 0.01-2.7 percent); no cases of ATL were diagnosed. While there was no difference in current symptoms, the HTLV-I seropositive group was more likely to report a past medical history of hepatitis or jaundice (OR = 3.49, 95 percent CI: 0.93-13.08), malaria (OR = 2.13, 95 percent CI: 0.96-4.73), and dengue fever (OR = 1.37, 95 percent CI 0.82-2.29); however, these differences were of borderline statistical significance. Low income HTLV-I seropositive women had lower body weight (P , 0.01) and body mass index (P < 0.009) than their seronegative counterparts; similar differences were seen in the smaller male group. A trend toward higher prevalence of severe anaemia (haemoglobin < 10 g/dl) (12.6 percent verus 7.7 percent, P < 0.105) and a significantly lower prevalence of eosinophilia (1.0 percent verus 6.3 percent, P < 0.004) was seen among HTLV-I seropositives are asymptomatic, HAM may be diagnosed in approximately 0.5 percent of carriers. Chronic HTLV-I infection may also subtle effects on body mass and haematological parameters.(AU)

Reduction in antenatal anaemia over a 10-year period in Montserrat

Anemia during pregnancy is associated with adverse outcomes including maternal and perinatal mortality. However, health education and other public health strategies seeking to reduce its prevalence have usually met with only limited success. The study reported here surveyed anemia of pregnancy on the island of Montserrat in 1980, 1985, and 1990. This involved examination of clinic and hospital records for over 90 percent of all women giving birth in 1990. This examination showed a dramatic reduction in the prevalence of anemia at the time of the first prenatal visit (a drop from 82 percent of the study women in 1980 to 23 percent in 1985 and 19 percent in 1990) and also a marked drop at three days postpartum (from 91 percent in 1980 to 41 percent in 1985 and 39 percent in 1990). Logistic regression analyses indicated that after controlling for three possible confounding factors (maternal age, parity, and weeks of gestation at first prenatal visit) the difference between the risk of developing anemia during pregnancy in 1980 as compared to 1985 or 1990 was still highly significant. The reasons for the observed drop in anemia's prevalence during the survey period are not entirely clear, partly because of the retrospective nature of study. However, better nutrition resulting from improvement in the standard of living on Montserrat during the survey period could have been important, as could changes in health education and food supplementation activities (AU)

Human T cell lymphotropic virus (HTLV-1): cutaneous manifestations

Skin manifestations are a common feature of HTLV-1 associated disorders and of HTLV-1 infection itself. These include the lymphomatous skin infiltrates in adult T-cell lymphoma/leukaemia, most commonly manifesting as persistent, generalised papules, nodules and plaques with later ulceration, acquired ichthyosis and xeroderma in HAM/TSP, infective dermatitis of children, dermatomyositis, crusted (Norwegian) scabies, psoriasiform rashes which may precede one of the more serious disease associations, and possibly also seborrhoeic dermatitis. Disorders typically associated with immunosuppression such as disseminated herpes zoster, and ulcerative non-healing herpes simplex may also be seen occasionally both in ATK as well as in other wise asymptomatic HTLV-1 infection (AU)