Anaemia in childhood in the guinea savanna of Nigeria

SUMMARYFifty-nine children (29 boys, 30 girls), aged three to 36 months, with haematocrit < 0·30, were compared to non-anaemic children matched for age and sex, at Zaria in the guinea savanna of Nigeria. Investigations included clinical examination, recording weight and height, red cell-indices, leucocyte-counts, thin and thick blood-films, reticulocyte-counts, haemoglobin-electrophoresis, glucose-6-phosphate dehydrogenase (G-6-P.D.) screening, serum protein and bilirubin estimation, bone-marrow aspiration, and microscopy and culture of faeces. The commonest age of presentation with anaemia was nine to 12 months: no ethnic group or family-rank was over-represented. Anaemic children came from families with high infant and childhood mortality. Anaemic children were frequently below the fifth percentiles of reference standards of weight for age (67%), height for age (48%) and weight for height (32%). Aetiology was always multiple: anaemia was associated with (i) viral or bacterial infections (71%), (ii) malaria (62%), (iii) sideropenia (60%), (iv) folate-deficiency (40%), (v) hypoproteinaemia (30%) and (vi) sickle-cell disease (25%). G-6-P.D. deficiency and hookworm were not contributory. Sideropenia was probably under-estimated, but only 25% of anaemias were hypochromic. These factors were not merely coincidental, but the anaemic children had entered a vicious cycle of infection, nutritional deficiency and depressed immunity. Recommendations are made as to laboratory investigation, prevention and treatment.