Master of Public Health

Underweight risk factors in older children with sickle cell anemia: a comparison of low- to high-income countries

AUTHORS

ABSTRACT

Previously, we demonstrated that older children with sickle cell anemia (SCA) living in a low-income setting are at increased risk of death if they are underweight (weight-for-age z-score <-1). We now conducted a cross-sectional study in both low- and high-income settings to determine the consistent biological risk factors for being underweight across both low- and high-income settings for children aged 5-12 years old with SCA. The children from low- and high-income settings were eligible participants for the Primary Prevention of Stroke in Children with Sickle Cell Disease in Nigeria (SPRING, n=928) and the Silent Cerebral Infarct (SIT, North America/Europe, n=1,093) trials, respectively. The median age in the SPRING and SIT cohorts was 8.1 (IQR 6.3-10.3) and 8.5 (6.8-10.6) years, respectively (p=<0.001), and approximately half were male (49.0% and 50.8%, respectively, p=0.434). A total of 87.9% (n=816) of participants in SPRING (low-income) met the study criteria for underweight (weight-for-age z-score <-1) and 22.7% (n=211) for severely underweight (weight-for-age z-score <-3), significantly higher than the SIT (high-income) cohort at 25.7% (n=281) underweight and 0.7% (n=8) severely underweight (p<0.001 for both comparisons). In the combined cohort, older age (OR 1.24, p<0.001, 95% CI 1.17-1.31) and lower hemoglobin level (OR 0.67, p<0.001, 95% CI 0.60-0.75) were associated with being underweight. Age and hemoglobin level remained statistically significant in separate models for the SPRING and SIT cohorts. Older age and lower hemoglobin levels in children aged 5-12 with SCA are associated with increased odds of being underweight in both low- and high-income settings.

Tags: 2023 Alumni Publications