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THE IMPACT OF SOCIOECONOMIC STATUS AND STEADY STATE HAEMATOCRIT ON THE GROWTH PARAMETERS OF NIGERIAN CHILDREN WITH SICKLE CELL ANAEMIA
Abstract
Figure 5: Mean weight of female children with SCA and Control
Figure 6: Mean PCV of male children with SCA and
Sickle cell anaemia (SCA) is a common inherited haematological disorder in
Nigeria. Children with SCA have chronic haemolytic anaemia, are susceptible to
recurrent infections and manifest growth retardation.
Previous studies have shown growth impairment in children with SCA. This
cross-sectional study is an attempt to document the variations in height and
weight in children with SCA in Kano, Nigeria. The influence of socioeconomic
status (SES) and steady state PCV on these growth parameters was also
studied.
One hundred and fifty-four children (79 males and 75 females) with
haemoglobin genotype SS (HbSS) between the ages of 6 months and 12 years
were studied between August 2003 and December 2003. These included
consecutive children who attended the Sickle Cell Clinics of Aminu Kano
Teaching Hospital and Murtala Mohammed Specialist Hospital within this
period, and who satisfied the inclusion criteria. One hundred and fifty-four age
and sex matched healthy relations of these patients, who had haemoglobin
genotype AA were used as controls. In both SCA and controls, the height,
weight and PCV were measured. The socioeconomic status of the family of
each child was also determined.
The study confirmed that, children with SCA between the ages of 6 and 144
months were shorter and lighter than age and sex matched controls. Male SCA
children were significantly shorter than the controls in the age groups 6-12
months (p = 0.003), 13-24 months (p = 0.001), 25-36 months (p = 0.000),
37-48 months (p = 0.002), 61-72 months (p = 0.023), 97-108 months (p =
0.017), 109-120 months (p = 0.012) and 133 to 144 months (p = 0.003). In
females, children with SCA were significantly shorter than the controls in the
age group 25-36 months (p = 0.011), 85-96 months (p = 0.030), and 133
144 months (p = 0.003).
Children with SCA were found to be lighter in weight than age and sex
matched controls. Male children with SCA were significantly lighter than
controls in all the age groups except in the age groups 6-12 months (p =
0.080), 85-96 months (p = 0.087), 109-120 months (p = 0.111), and 121
132 months (p = 0.243). Similarly, female SCA patients were lighter than the
controls. However, a significant difference in weight between the two groups
was observed only in the age groups 85-96 months (p = 0.015), 121-132
months (p = 0.044) and 133-144 months (p = 0.011).
When compared with Nigerian reference growth charts published by Janes et
al,70 children with SCA in this study were shorter and lighter than the reference
population. The height of 56.16% of all males and 43.08% of all females was
less than the 3rd percentile of the respective Janes’ height charts. Similarly,
69.86% of all males and 58.46% of all females in the SCA group weighted less
than the 3rd percentile of the respective Janes’ weight charts. The study
showed that male children with SCA were more retarded in height than
females (2 = 5.31, p = 0.0212).
In all the age group studied, the PCVs of SCA patients were significantly lower
than that of controls. The mean PCV of children with SCA was 25.92 ± 0.96%.
However, the severity of anaemia in children with SCA in steady state did not
have significant influence on their achieved height or weight (2 = 0.70, p =
0.4037 for height and 2 = 1.86, p = 0.1722 for weight). Socioeconomic status
was found to have a significant influence on weight only. The weight of children
with SCA in socioeconomic class I was less affected than that of children in
socioeconomic classes II and III (2 = 6.77, p = 0.0338).
It was concluded that children with SCA in Kano were growth retarded when
compared with age and sex matched siblings and unrelated normal children.
Males were more stunted than females. Their PCV was lower than that of the
controls. However, the severity of anaemia in steady state did not influence
their height or weight. Socioeconomic status had influence on weight. It is
recommended that growth and PCV of children with SCA be monitored
regularly so that those who need further evaluation can be recognized early.
