Hematological Abnormalities and Associated Factors Among Undernourished Under-Five Children Attending University of Gondar Specialized Referral Hospital, Northwest Ethiopia

Abstract

Introduction

The hematopoietic system is one of the systems which can be affected by malnutrition, leading to impaired production of all blood cell lines. Undernourished children with hematological abnormalities like anemia are at higher risk of mortality. Therefore, this study aimed at determining the magnitude and associated factors of hematological abnormalities among undernourished under-five children attending at the University of Gondar Specialized Referral Hospital, Northwest Ethiopia.

Methods and Materials

An institution-based cross-sectional study was conducted on a total of 251 undernourished under-five children at University of Gondar Specialized Referral Hospital from January to May 2020. A convenient sampling technique was employed to select study participants. Data were collected using a pretested structured questionnaire. Blood samples were collected for complete blood count which were determined by Sysmex KX-21N analyzer. Stool sample was processed via direct wet mount. Thin and thick blood films were examined to assess malaria parasite. The data were entered to EpiData version 4.6.0.0 and analyzed using SPSS version 23 software. Bi-variable and multi-variable binary logistic regression model were fitted to identify factors associated with hematological abnormalities. A p-value <0.05 in the multivariable analysis was considered as statistically significant.

Results

The overall magnitude of anemia, leukocytosis, thrombocytosis, thrombocytopenia, and leukopenia was 53.4%, 26.7%, 23.9%, 8%, and 2.8%, respectively. Being male, age 6–23 months, high birth order, intestinal parasite infection, edema, not eating vegetables and fruits, and paternal occupation were found to be associated with anemia. Only the age of a child was associated with leukocytosis in undernourished children.

Conclusion

The current study demonstrated the predominant existence of anemia, leukocytosis, and thrombocytosis among undernourished under-five children. Therefore, early diagnosis, monitoring and setting intervention strategies for anemia especially among children under two years old are required to prevent further complication.

Keywords:

• anemia
• leukocytosis
• thrombocytosis
• leukopenia
• thrombocytopenia
• children
• undernutrition
• Ethiopia

Acknowledgments

We would like to acknowledge University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology for their financial support to conduct the study. We would like to thank children and their parents/guardians for their willingness to participate in this study. Finally, our special thanks goes to laboratory and nutritional rehabilitation center nursing staff members of the University of Gondar Specialized Referral Hospital for their cooperation during data collection.

Abbreviations

AOR, adjusted odd ratio; CD, cluster of differentiation; CI, confidence interval; COR, crude odd ratio; EDTA, ethylene diamine tetra acetic acid; HAZ, height for age Z-score; Hb, hemoglobin; Hct, hematocrit; IQR, interquartile range; MCH, mean hemoglobin concentration; MCHC, mean cell hemoglobin concentration; MCV, mean cell volume; OR, odd ratio; PEM, protein energy malnutrition; RBC, red blood cell; SAM, severe acute malnutrition; SD, standard deviation; WAZ, weight for age Z-score; WBC, white blood cell; WHO, World Health Organizations; WHZ, weight for height Z-score.

Data Sharing Statement

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethical Approval

The study was approved by the Ethical Review Committee of the School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar. The study was also done as per the declaration of Helsinki.

Author Contributions

All authors made substantial contributions to conceptualization and design, data acquisition, data analysis and interpretation, took part in drafting of the initial manuscript and revising it critically for final approval of the version to be published. All authors agreed to submit to the current journal and agreed to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest.

Additional information

Funding

University of Gondar.