Nutritional Status of Young Children with Inherited Blood Disorders in Western Kenya Open Access

Abstract

Abstract
"Nutritional Status of Young Children with Inherited Blood Disorders in Western Kenya"

There is demonstrated high prevalence of inherited blood disorders in Africa; however, it is uncertain how these disorders affect nutrition status. To determine the burden of anemia, iron and vitamin A deficiency (VAD), stunting, wasting, and underweight amongst young children in western Kenya with one or more blood disorders (haptoglobin 2-2, glucose-6-phosphate dehydrogenase [G6PD] deficiency, sickle cell disease [SCD], and α-thalassemia), we conducted a cross sectional survey of 882 children aged 6-35 months, randomly selected from 60 villages. Hemoglobin (Hb), ferritin, transferrin receptor (TfR), C-reactive protein (CRP), α-1-acid glycoprotein (AGP), retinol binding protein (RBP), anthropometry, and blood disorders using PCR were measured. Of 861 children with Hb results, 71.7% were anemic (Hb<11 g/dL), 27.2% iron deficient (serum ferritin<12μg/L and CRP <5), 16.8% vitamin A deficient (RBP<0.7 μmol/L and CRP<5). In crude analysis of the four blood disorders, anemia burden only differed between α-thalassemics: homozygote (-α/-α) (82.3%), heterozygotes (-α/αα) (75.6%), or normal (αα/αα) (66.8%) (p=0.002). Compared to αα/αα individuals, homozygous thalassemics were less likely to have VAD (p=0.05). There was no relationship between α-thalassemia and iron deficiency, stunting, wasting, and underweight. Logistic regression was conducted to assess the relationship between anemia and low RBP levels with α-thalassemia; after adjusting for all significant independent, confounding, and interaction variables, α-thalassemia remained significantly associated with anemia (OR=1.77, p<0.01) but not low RBP (OR=0.61, p=0.07). The results suggest that in young children in rural western Kenya, α-thalassemia is associated with anemia, while haptoglobin 2-2, G6PD deficiency and SCD are not associated with poor nutrition status.

Table of Contents

Table of Contents

Notice to Borrowers...vii
List of Tables...viii
List of Figures...ix
Abbreviations...x
Chapter 1: Introduction...2

Background...2
Nyando Integrated Child Health and Education Project (NICHE)...4
Literature Review Methodology...7

Chapter 2: Comprehensive Review of the Literature...8

Overview of Inherited Blood Disorders...8
G6PD Deficiency...8
Sickle Cell Hemoglobin...12
Thalassemia Syndromes...17
Haptoglobin Polymorphism...21

Chapter 3: Manuscript...26

Abstract...27

Introduction...28
Methods...29
Results...35
Discussion...44

Chapter 4: Discussion...50
References...55
Tables and Figures...63

Table 1: PubMed Search Terms...63
Table 2: Drugs/Substances at Risk for G6PD-deficient Individuals [27]...63
Table 2: Thalassemia Variants [47]...63
Table 3: Sociodemographic status, household assets, and other characteristics of children aged 6-35 months and their caregiver households (n=861)...64
Table 4: Anthropometry, morbidity, and health indicators of children aged 6-35 months (n=861)1...65
Table 5: Sex, inflammation and malaria infection of participant children by blood disorder, n=8611...66
Table 6: Nutrition, and anthropometry indicators of participant children by blood disorder, n=8611...67
Table 7: Odds of anemia; ORs and 95% CI with anemia as the dependent variable and α-thalassemia as the primary exposure among young children aged 6-35 months in western Kenya1, n=739...68
Table 8: Odds of low RBP; ORs and 95% CI with low RBP as the dependent variable and α-thalassemia as the primary exposure among young children aged 6-35 months in western Kenya1, n=756...68
Figure 1: Nyando Division (pop. 80,000), in rural Nyando District in Nyanza Province - Kenya, 2007 [10]...69
Figure 2: Selection of Survey Participants in Nyando Division, Kenya...69

Appendices...70

Survey Instrument...70
Variable definitions...84
Logistic regression modeling steps...85

Model: Association Between α-Thalassemia and Anemia...85
Model: Association Between α-Thalassemia and low RBP...88

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	nutrition status thalassemia sickle cell anemia haptoglobin g6pd deficiency
Committee Chair / Thesis Advisor	Suchdev, Parminder S, Emory University
Committee Members	Sullivan, Kevin M, Emory University Ruth, Laird, CDC
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) CDC

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