STEADY STATE HAEMOGLOBIN, ANTHROPOMETRIC MEASUREMENTS AND SOCIO-ECONOMIC STATUS OF CHILDREN WITH SICKLE CELL ANAEMIA AT THE LAGOS UNIVERSITY TEACHING HOSPITAL

Abstract

Sickle cell anaemia is the commonest haemoglobinopathy affecting people
of the Negroid race. It has multisystemic manifestations and is associated with
severe morbidity and high mortality. It commonly affects growth, leading to
wasting and stunting. The present study which was carried out at the Lagos University Teaching
Hospital (LUTH), between the months of October 2005 and January 2006 aimed
to determine the relationship between the steady state haemoglobin concentration,
nutritional status and socio-economic status of children with homozygous sickle
cell anaemia (SCA) in steady state, aged one to ten years. It was a cross-sectional
study involving 100 children with SCA and 100 age, sex-and social class-matched
controls who fulfilled stated criteria. Nutritional status was assessed using
anthropometry (weight, height, weight-for-height, and body mass index). Social
class was assessed using educational attainment and occupation of parents.
Haemoglobin concentration was determined using the oxy-haemoglobin method.
The mean weight [18.8 + 5.3 Kg] and weight-for-height [16.4 + 3.7 Kg/m]
of the SCA patients were significantly lower than those of controls [21.3 + 0.5Kg]
and [17.7 + 0.4 Kg/m] respectively [p < 0.001] . Mean weights in both subjects and
controls were below the National Centre for Health Statistics (NCHS) standards.
The trend was more pronounced in sickle cell anaemia patients.

By contrast, this study did not demonstrate any statistical significant
difference in the mean height of SCA patients (1.13+0.2m) and controls
(1.25+.0.8m) (p=0.06) but both were consistently below those of the NCHS
standards. The magnitude of the difference from the NCHS standard was also
more pronounced in the subjects, increased with advancing age and affected male
subjects more than females. Similarly, there was no significant difference between
the body mass index of subjects (14.6+3.2kg/m2) and controls (15.1 + 0.3kg/m2)
(p=0.12): Both were likewise below the NCHS standards. Further analysis showed
that the mean height of male SCA patients and controls were comparable with
those of the NCHS standards until eight years of age when a fall in the height of
SCA patients and controls was observed. The male controls caught up with the
NCHS standard at nine years but the male SCA patients remained consistently
smaller than controls and NCHS standards. The mean weight and body mass index
of male and female SCA patients was persistently lower than those of the controls,
and both were lower than those of the NCHS standards. There was a tendency for
the differences in heights, weights and body mass indices to become more
pronounced with advancing ages, particularly after age 5.

Significantly more female SCA patients than controls had weight-for-age
below the 50th centile (=4.2 p=0.04) but there was no significant difference
between the number of male SCA patients and controls with weight-for-age below
the 50th centile (=2.8 p=0.1). On the contrary, male SCA patients were more

often below the 50th centile for height-for-age (=7.6 p=0.006) compared with
controls. Both male and female SCA patients than controls fell below the 50th
centile for weight-for-height (=14.9 p<0.001.and =4.2 p=0.04 respectively)
On the other hand, there was no significant difference between SCA patients and
controls for body mass index (>0.1 p>0.3).
Significantly lower z score for height-for-age, and weight-for-age were also
found in SCA patients (-0.46+1.0 and -0.56+0.6) compared with controls (
0.11+0.1 and -0.29+0.1) (p< 0.001), the trend being worse in males. Also a
significantly lower z score for body mass index in male SCA patients (-0.50+ 0.8)
compared with controls (-0.33+ 0.1) (p=0.04) was observed.
The mean steady state haemoglobin concentration in SCA patients (76.9 +
19.5g/l) was significantly lower than those of controls (118.1 + 2.0g/l), (p
<0.00001). The haemoglobin concentration was neither significantly correlated
with age nor with any of the anthropometric measurements.

Progressive declines in the anthropometric attainment and haemoglobin
concentration were observed from social class 1 to 4; this was statistically
significant in controls (p=0.00) but not in subjects (p>0.1). However, SCA patients
had significantly lower values than controls in each of the social classes.

There is a need for improvement in standards of living of the family. Early
diagnosis and care should be encouraged and special attention should be paid to
patients with sickle cell anaemia above the age of 4 years.

STEADY STATE HAEMOGLOBIN, ANTHROPOMETRIC MEASUREMENTS AND SOCIO-ECONOMIC STATUS OF CHILDREN WITH SICKLE CELL ANAEMIA AT THE LAGOS UNIVERSITY TEACHING HOSPITAL