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

Tsang, Becky (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/td96k262r?locale=zh
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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

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