Malnutrition and associated factors in school-age children with sickle cell anemia

Introduction Sickling of erythrocytes in childhood sickle cell anemia (SCA) is associated with an increase in resting energy expenditure and malnutrition. Factors in these patients have been shown to have an influence on malnutrition. Aim To determine the prevalence of types of malnutrition and their relationships with factors in children with SCA. Patients and methods This cross-sectional study enrolled 5–17-year-olds in their steady state of health. Information obtained were age, sex, weight, height, BMI, and vital signs. Others included number of painful crises, blood transfusion, admissions, and packed cell volume (PCV) among others, which were used in SCA severity classification. Results Ninety participants with a male: female ratio of 1.3: 1. Fifty-nine (65.6%) had malnutrition, including acute malnutrition (28.9%), chronic malnutrition (stunted) (24.4%), stunted with acute malnutrition (6.7%), overweight (2.2%), and stunting with overweight (3.3%). Male 10–17-year-olds were most severely stunted ( P =0.001). The 10–17-year-olds had more acute malnutrition than the 5–9-year-olds ( P =0.33). Acute malnutrition was associated with advancing age [odds ratio (OR) 1.297; 95% confidence interval (CI): 1.044–1.611] and PCV (OR 0.58; 95% CI: 0.381–0.883). Those stunted were also associated with increasing age (OR 1.535; 95% CI: 1.206–1.955) and systolic blood pressure (OR 0.887; 95% CI: 0.803–0.979). Furthermore, overweight participants were likely to have increased respiratory rate (OR 1.567; 95% CI: 1.031–2.381) and systolic blood pressure (OR 0.646; 95% CI: 0.434–0.962). Those stunted with acute malnutrition were likely to have mild SCA (OR 6.43; 95% CI: 2.29–9.30) and moderate SCA (OR 6.19; 95% CI: 6.19–8.19). PCV predicted (area under curve 0.609; P= 0.091) malnutrition at less than 23.5% (51% sensitivity; 71% specificity). Conclusion The prevalence of malnutrition in childhood SCA is 65.6%. No one had obesity. Majority were undernourished, which was associated with progressive age, systolic hypertension, low PCV, and mild and moderate disease severity. Feeding of appropriate calorie diet may help reduce this morbidity.