ASSESSMENT OF UPPER BODY SEGMENT TO LOWER BODY SEGMENT RATIO AND ARM SPAN TO HEIGHT RATIO AMONG CHILDREN WITH SICKLE CELL ANAEMIA

Abstract

Sickle cell disease is one of the commonest single gene disorders in man. The burden of SCD is highest in sub-Saharan Africa, especially in Nigeria (West Africa), where approximately 6 million people are believed to be afflicted.71 Though much is known about the disease presentation, patterns of affection of growth have not received enough attention, especially locally. The study therefore
aimed mainly to study upper body segment to lower body segment ratio and arm span to height ratio among children with sickle cell anaemia who present at the sickle cell disease clinic of the Department of Paediatrics of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria.
The prospective, analytical, cross-sectional study was conducted between October 2009 and December 2009, using healthy age and sex matched controls with haemoglobin genotype AA. Measurements taken included height, sitting height and arm span, using standard techniques. From these measurements was derived lower body segment length, upper body segment to lower body segment ratio, arm-span to height ratio and arm span – height difference.
A total of 200 children, 100 each with genotype SS and AA were studied over a three month period. Overall, the age of the subjects ranged from eight months to 15 years, with a mean of 75.27 (±50.276) months. The mean age of the SS subjects was comparable to that of the HbAA controls.
The mean height/length of controls was higher than that of HbSS subjects but the difference was not statistically significant (115.38 ± 27.845 cm Vs 113.31 ± 25.887 cm, p = 0.586). The mean heightfor-age Z score of the AA controls was significantly higher than the mean height-for-age Z score of the SS subjects (0.521 ± 1.469 Vs -0.444 ± 1.861, p = 0.000).
The height/length-for-age Z-scores was significantly lower among male children with sickle cell anaemia than their haemoglobin AA counterparts except >2 years to 5 years. For the females, the height-for-age Z-scores was lower among sickle cell anaemia subjects, but this difference between SS and AA subjects was not statistically significant for all age groups (p > 0.05).
The mean upper segment/lower segment ratio decreased with age among primary subjects (SS) and AA controls. Females with haemoglobin genotype AA had higher values than their SS counterparts while males with genotype AA had higher values than their SS counterparts except at the age group less than 2years and >5years to 10years. However, it was in female subjects older than 10years that the difference between SS and AA subjects was statistically significant. (p = 0.005).
The females with haemoglobin genotype AA had higher mean arm span/height ratio when compared with their SS counterparts across all age groups but the differences were not statistically significant (p > 0.05 in each case). For the males, HbSS subjects had higher values in children aged 5years and
below while HbAA controls had higher values in children aged more than 5 years. However, none of the observed differences was statistically significant (p > 0.05 in each case).
The overall prevalence of stunting was significantly higher among SS subjects than AA controls (10% Vs 3%, p = 0.045). The age-specific prevalence for stunting was highest among the age >10years to 15years in both SS subjects and AA controls (24%, 8.0% respectively).
In conclusion, children with sickle cell anaemia were shorter than AA controls but their body proportions showed variable trends. Stunting was more prevalent among sickle cell anaemia patients especially in the older age-group > 10years to 15 years.
There is a need for routine anthropometric and body proportions measurements during follow-up clinic attendance by children with sickle cell anaemia to ensure early detection of growth deficit as intervention such as zinc supplementation has been found to prevent or reduce this development.101

ASSESSMENT OF UPPER BODY SEGMENT TO LOWER BODY SEGMENT RATIO AND ARM SPAN TO HEIGHT RATIO AMONG CHILDREN WITH SICKLE CELL ANAEMIA