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IJCRR - 5(13), July, 2013

Pages: 37-50

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HAEMATOLOGICAL STATUS AND ANAEMIA PREVALENCE AMONG CHILDREN AGED 5 TO 11 YEARS IN SCHOOL CANTEENS IN ABIDJAN (CÔTE D'IVOIRE)

Author: Baudouin A. Kokore, Mathieu N. Bleyere, Dinard Kouassi, Paul A. Yapo, Leandre K. Kouakou

Category: Healthcare

Abstract:In Côte d'Ivoire, as in most developing countries, anaemia is a public health problem. The country possesses 5259 canteens in more than 8000 primary schools. Children attending schools with canteens are they concerned with public health problem that is anaemia? Their haematological profile conforms to the standards set by international organizations? To answer these questions, a study was conducted and aimed to determine the prevalence of anaemia in a school population and to study the typology. The work has focused initially on 350 subjects and 310 children (172 girls and 138 boys) aged 5 to 11 years were selected from three municipilities of Abidjan. Blood samples were taken from each child in order to search for the parameters of the blood count and the electrophoretic profile of hemoglobin. The results of study revealed that 82.9 % of children have indicated abnormal haematological status. The prevalence of anaemia (hemoglobin < 11.5 g/dl) was 30.3 % with 33.3 % of males and 29.1 % for girls. Moreover, the mean values parameters of the blood count were compared in accordance with standards established by international organizations. In addition, haemoglobinopathies was found in these children (16.1 %), including sickle cell trait and hemoglobin C traitThe prevalence of anemia among school children selected in Abidjan is more considerable. This could be explained by a deficiency of micronutrients. In view of the results obtained, it is important to extend the work to all school canteens in order to assess the factors of anaemia and to determine normal values parameters of the blood count of children in such environment.

Keywords: Anaemia, Typology, Norms of Blood Cells Count, Children, School Canteens/Abidjan (Côte d’Ivoire)

Full Text:

INTRODUCTION In Côte d’Ivoire for several years, children benefit from meals at schools like some nations in the world. The number of school canteens to 5259, is for these children a strong opportunity which should guarantee good nutrition in over 8000 primary schools in the country. To this end, school canteens should resolve the concerns of nutritional deficiency and overload. Nutritional deficiencies and overloads represent in school children a real concern for public health (ElHioui et al., 2008a). They may lead to anaemia and obesity (Kuyumcu et al., 2007; Handa et al., 2008; Mohamed, 2008; Ramzan et al., 2009; Mirhosseini et al., 2011). Anaemia is the most common health problem in the world (Maitland et al., 2005; Al-Assaf, 2007). It is the greatest common nutritional disorder worldwide and particularly in Africa, where pregnant women, infants and young children are most affected (Dillon, 2000; Gur et al., 2005; Hazarika et al., 2012; Chhabra et al., 2012). The prevalence of anaemia in the world is 24.8 % (WHO, 2008). The preschool children are most affected with a prevalence of 47.4 %, followed by pregnant women (41.8 %), non pregnant women (30.2 %) and school age children (25.4 %). In each age group and sex studied, the highest prevalence is found in Africa (McLean et al., 2006). Anaemia has multiple consequences which can be extremely severe (Goudarzi et al., 2008; WHO, 2008; Ahmadi et al., 2010). This is the disturbance of physical and mental development often irreversible in infants and children, of least resistance to infections, tiredness and decreased physical and intellectual abilities (Colomer et al., 1990; Scholl and Hediger, 1994; Sakande et al., 2004; Unsal et al., 2007; Hadipour et al., 2010). Despite the multiple consequences of this disease, few investigations are conducted at schools in Côte d'Ivoire. The aim of this study was to determine the prevalence of anaemia and its typology in a population of children aged 5 to 11 years in three municipalities of Abidjan. The study has also conducted the possible changes in the complete blood count of these children in schools. Studies have equally indicated the sex was most exposed to anaemia. In addition, the investigations have proposed standards for parameters blood cell counts among this fringe of school children. Moreover, the investigations have evenly presented hemoglobin profile of these children. MATERIALS AND METHODS Setting and study population In total of 350 school children were selected to achieve a definitive size of 310 pupils including 172 girls and 138 boys (Figure 1). The mean age of the study population was 7.7 ± 0.1 years and ranged from 5 to 11 years (Table 1). The investigation was a cross sectional and descriptive study in school children living in three municipalities in Abidjan. This study occurred at the school group "Libanais Yopougon Ananeraie", primary school "BAD Cocody Belle Côte" and the School Group "Agbékoi Abobo" (Figure 1). This work was carried out during a period from September 2010 to December 2012. The collection of anthropometric data of this study was done from a questionnaire sent to children with free and informed consent of parents, following an explanation of the interest of the study. For the requirements of handling, criteria for inclusion and exclusion have been applied for subject selection. It comes to mainly haematological and gastrointestinal complications and inflammation in the three months preceding the study. All these observations were carried out by a medical team from the National Institute of Public Health (INSP) in Abidjan (Côte d'Ivoire). Blood samples and determination of biological parameters Samples of venous blood from each child are taken into tubes containing an anticoagulant, ethyl diamine tetra acetic acid (EDTA) in the morning. The determination of haematological parameters was performed immediately after homogenization to Coulter, by an automatic analyzer “Sysmex KX 21N”. Moreover, in order to establish the standards parameters of the blood count, all anaemic children were excluded in the second phase of data processing. Criteria defined by the World Health Organization (WHO) were used to estimate different prevalences of the main haematological parameters. In addition, an electrophoretic profile of hemoglobin for each child was conducted from a volume of packed red blood cells at alkaline pH to cellulose acetate by“Helena”. Statistical analysis For statistical analysis, data were entered and analyzed by the STATISTICA software (Windows version 7.1). The mean values of different investigated parameters in school children were compared using the non parametric Mann Whitney U. The comparisons of different proportions of the main obtained biological parameters from the blood count and hemoglobin electrophoresis were performed by the test Loglikelihood ratio (Test "G") with the statistical software "R" version 2.0.1 Windows. p < 0.05 was considered as indicative of significance. RESULT Changes in haematological parameters The values were in accordance with the normal physiological reference values from the literature except for the rate of lymphocytes which is higher overall and by sex. All the parameters did not indicate significant differences between girls and boys (Table 2). In contrast, mean corpuscular volume and mean corpuscular hemoglobin have been statistically different by sex. These two haematological parameters were higher in girls compared to boys. All of 216 non anemic school children showed normal mean values compared with the standards established by international organizations (Table 3). However, the proportion of lymphocytes has been sufficiently high relative to the reference value. Furthermore, no significant differences were observed between girls and boys for all the parameters of the blood count. Conversely, a significant difference was shown at the mean corpuscular hemoglobin between the two sexes. In this context, girls reported a mean value of mean corpuscular hemoglobin more increased compared to boys. Prevalence, typology of anaemia and hemoglobin phenotype The results of the study showed that 82.9 % of school children reported that at least one parameter of the blood count, was abnormal (Table 4). The haematological status was the same for girls (82.6 %) than in boys (83.3 %) with no statistically significant difference between these two groups of children. The prevalence of anaemia was 30.3 % in total population. It was observed in 33.3 % of boys and 28.1 % of girls with no statistically significant difference. Among these anaemias, 57.5 % are hypochromic (18.1 % microcytic hypochromic anaemia and nornocytic hypochromic anaemia 39.4 %), 18.1 % are microcytic (microcytic hypochromic anaemia) and 4.3 % macrocytic (macrocytic normochromic anaemia). In addition, normocytic anaemia was observed in 77.7 % of children and normochromic anaemia in 42.6 %. Microcytic hypochromic anaemia in boys (25 %) was significantly higher compared to girls. Normocytic hypochromic anaemia and macrocytic normochromic anaemia were also more observed in boys than girls with no significant difference. However, normocytic normochromic anaemia was higher among girls than boys with a significant difference. Macrocytosis and microcytosis were indicated respectively in 5.2 % and 10.3 % of subjects with no significant difference between the two sexes. But hypochromia was observed in 35.5 % of children with a significant difference between girls and boys. The proportion of subjects whose hematocrit was below 36 % is 29.4 %. These rates do not change significantly by sex. The results of studies have also shown in Table 5 that 4.2 % and 0.7 % respectively of the children had leukopenia and leukocytosis. Similarly, high neutropenia, lymphocytosis, and thrombocytosis were reported respectively in 44.8 %, 88.7 % and 20 % of study subjects. In contrast, the total population of the investigations has reported normal levels of eosinophils, low proportions of lymphopenia (0.3 %), of monocytopenia (6.5 %) and thrombocytopenia (1.9 %). In the two groups of children, no significant differences were reported for all proportions of leukocyte and thrombocyte parameters. However, girls presented slightly higher proportions of leukocytosis, neutropenia, lymphocytosis and thrombocytosis compared to boys. In contrast, boys reported more or less elevated rates of leukopenia and monocytopenia compared to girls. Screening for hemoglobin disorders in school children revealed that 16.1 % of them are carriers of these anomalies (Figure 2). The most observed abnormalities were the sickle cell trait AS, hemoglobin C trait and sickle cell trait. The observed deficiencies have not significantly different between sex. DISCUSSION This study examined the extent of anaemia and its typology in a population of school children aged 5 to 11 years and attending school canteens in three municipalities of Abidjan. This work also helps to design appropriate monitoring in order to avoid the early onset of anaemia among school children. In this context, different mean values of haematological parameters are similar to physiological values reported in literature by standards of World Health Organization (WHO) except for lymphocytes. These different means are similar to those obtained in Saudi Arabia among children of school age (El-Hazmi and Warsy, 2001). According to these Saudis authors, no significant differences between girls and boys for all parameters of the blood count were observed. Mean value of hemoglobin obtained in this study is similar to that indicated in a rural population of school children of Vietnam (Le et al., 2007). Same results were also reported on a similar population of children with the same age group in Dublin (Ireland) (Taylor et al., 1997). From data available in accordance with the literature, anaemia is very common among school age children and these investigations confirm this. Prevalence of anaemia in this study population was 30.3 %. This rate is relatively lower than that obtained in Côte d’Ivoire in children with same age (46 %) (Asobayire et al., 2001). This decrease could be explained by the fact that study was extended to rural population with different demographic characteristics from those of these subjects. In addition, other studies reported higher prevalences of anaemia in school children (Gomber et al., 1998; Verma et al., 1998; Sudhagandhi et al., 2011). In the same vein, urban African Cameroon recorded a rate of anaemia (42.8 %) among children aged 5-10 years by considering the pathological rate of hemoglobin to 11g/dl (Mbanya et al., 2008). Conversely, the prevalence of anaemia in this study is higher than that specified elsewhere. Such is the case from work which indicated a lower rate of anaemia (12.2 %) in a population of children in Morocco, but no significant difference between girls and boys as in this study (El-Hioui et al., 2008b). This could be explained by the socioeconomic and cultural development of children in each study areas (UNICEF/WHO/UNU/MI, 1998; Singh and Sachan, 2011). Moreover, the presence of canteens in selected schools for needs of our study may reflect low observed prevalence in children. Mean values of MCV and MCH are statistically different by gender. These values are higher for girls than for boys. This result is contrary to that which revealed no significant difference between girls and boys (Rakoto et al., 2000). There is no severe anaemia in this study group. This result is similar to that carried out among school children in India (Sudhagandhi et al., 2011). The hypochromia and microcytosis in this population are higher in boys than in girls. This decrease in MCV and MCH might indicate a deficiency in micronutrients including iron and vitamins in this population (Ugwuja et al., 2007; Ramzan Ali and Salam, 2009). Anaemia has multifactorial causes (Veghari et al., 2007; Porniammongkol et al., 2011). The main reason for the onset of anaemia is of a food (Dillon, 2000). Food in populations of developing countries is deficient in micronutrients (Oguntona and Akinyele, 2002; Yapi et al., 2005a; Mohamed, 2008). The content and composition of meals in canteens could explain reduction in prevalence of anaemia in subjects of this study compared to work above mentioned (Zaidi et al., 1999; El-Hioui et al., 2008a; Mamat et al., 2012). All nutrients (macronutrients and micronutrients) that could include daily diet are the cause of decline in rate of hemoglobin in children of these investigations (Kuyumcu et al., 2007; Amuta and Houmsou, 2009; Kooshki et al., 2010). However, changes in leukocyte and thrombocyte parameters are modified compared to standards. Côte d’Ivoire is situated in an area with high malaria endemicity (Yapi et al., 2005a et b; Mfonkeu et al., 2008; Yapi et al., 2010). Furthermore, influence of malaria on anemia in populations is demonstrated (Umar et al., 2007). Infectious and inflammatory syndromes and haemoglobinopathies degrade haematological status of populations (Ahmed et al., 2006; Shehu et al., 2006; Singotamu et al., 2006; Odebunmi et al., 2007; Inocent et al., 2008; Pourfallah et al., 2011). In this same way, screening for haemoglobinopathies in children revealed that 16.1 % of children are carriers of these anomalies in this study. This is lower than that observed respectively 19 % and 22.5 % in Côte d’Ivoire (Asobayire et al., 2001; Sakande et al., 2004). This could explain alteration of haematological parameters of children in this study. In addition, the proposed standards parameters of the blood count should consider all these factors and represent those obtained in the case of the study. It would be judicious to extend this study to 5259 canteens in over 8000 primary schools in Côte d’Ivoire. CONCLUSION The investigations carried out among school children in Abidjan indicate that the prevalence of anaemia is significant with established standards. However, the rate of anaemia is low compared to previous work by other authors in Côte d'Ivoire. It is also clear from this study that the haematological status of these children is strongly altered. In selected circumstances of the study, the different blood count parameters of children in school canteens should be better than the results reported in other investigations elsewhere in developing countries. The crisis that the country has experienced since 2002 has had to reduce the efforts of officials in charge of school meals supported by international agencies (World Food Programme, World Bank). It is suitable for us to regain the growth dynamics of school meals which should be maintained in any school in the Côte d’Ivoire. Moreover, it must be determined through several work standards parameters of blood count, even if we have given up only those children in three municipalities of Abidjan. We intend to participate in a larger project including all 5259 school canteens for one hand to obtain a true prevalence of anaemia involving the standards of the blood count and also to indicate the micronutrient status (minerals and vitamins), nutritional status and the bioavailability of nutrients in the meals served to children. This advised us to avoid the early onset of nutritional deficiency and overload in children that can impede their physical and intellectual capacity. ACKNOWLEDGEMENTS The authors are grateful to Dr Léonie Clémence KOUONON, all laboratory managers and staff of National Institute of Public Health Abidjan/Côte d’Ivoire (INSP) for their support during our investigations. Our thanks are also due to the children and their parents, also the inspectors, directors and headmasters of schools in which our study has been realized. Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.

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