"Determining the point prevalence and etiology of anemia among children under the age of five at Thohoyandou Health Center, Thohoyandou, Limpopo Province, South Africa."
Objective:
The primary objective of the project was to determine the prevalence of anemia among a sample of the pediatric population in a primary care setting in rural South Africa. Several causes of anemia were also investigated in an attempt to begin to understand root causes as a means of focusing further research. These included malnutrition, hookworm infection, and the gastric bacteria, Helicobacter pylori.
Methods:
Nintey-three mothers with children under the age of five receiving care at Thohoyandou Health Center consented to their children being in the study. The study consisted of two visits for data collection with one possible follow up for treatment as needed. During the first visit demographic data was obtained consisting of name, gender, age, weight, height, purpose of visit to clinic, history of previous treatment for anemia and/or hookworms, breast feeding status, household size, number of siblings of the same mother, age of closest sibling, distance traveled to clinic, chief complaint and contact information. The patient was also given a 50mL screw-top sample jar and told to collect and return a stool sample as soon as possible. Initially, visit two consisted of stool sample collection and testing of Hemoglobin levels from capillary blood sample to determine presence of anemia using the HemoCue 201+ point-of-care hemoglobin testing system. The child's nutritional status was also evaluated at this time through the administration of a food security questionnaire[1].
Not all patients were returning for visit two so the first visit was expanded to include hemoglobin testing and administration of the questionnaire and if possible stool collection. All patients were reimbursed for travel costs at the time of visit two regardless of the data collected at that time. In the event that a patient still had not returned a sample within one week the parents were contacted by phone and encouraged to return sample. If the parent was unreachable, or could not easily return the sample on their own investigators traveled into the communities to locate and collect the samples from the patient's homes.
Once samples were collected they were stored in the clinic's freezer until they could be transported back to the microbiology laboratory at the University of Venda where they were then stored at -20C until analysis could begin. Stool samples were screened for enteric pathogens by microscopy using the Oocyst concentration method. DNA was then extracted and purified from each sample by using the QIAGEN Stool DNA Purification Kit. Polymerase Chain Reaction (PCR) analysis was then carried out on each DNA sample to determine the presence or absence of Helicobacter pylori infection in the patient. Once testing was complete patients were informed of their anemia and/or hookworm status by mail or phone and told to contact Thohoyandou Health Center for treatment as needed. Patients were not informed of the presence of H. pylori infection given that known risks of treatment are far greater than known benefits at this time.
Results:
Preliminary data analysis can be found in the appendix of this report. Anemia was observed in 80.6% of subjects. Complete statistical analysis will be carried out in the following weeks and months at the University of Venda by Mr. Samie Amidou and at the University Of Virginia School Of Medicine by Mr. James Heckman.
Future recommendations:
Communication will be kept open with the staff at Thohoyandou Health Center and the possibility of a pediatric anemia screening and treatment program will be explored. A major obstacle to this would be that the treatment prescribed for anemia in children (Ferrous Sulfate) is not readily available for dispensing at the health center. This and other issues will be discussed at a meeting between James Heckman, Samie Amidou and the staff of Thohoyandou Health Center to be held on Wednesday 25th July 2007.