ORIGINAL ARTICLE

Changes in haemoglobin levels in infants in Malawi: effect of low birth weight and fetal anaemia

S le Cessie¹, F H Verhoeff², G Mengistie¹, P Kazembe³, R Broadhead⁴, B J Brabin⁵

¹ Department of Medical Statistics, Leiden University Medical Centre, The Netherlands
² Department of Paediatrics
³ Department of Paediatrics, Lilongwe Central Hospital, Lilongwe, Malawi
⁴ Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
⁵ Emma Kinderziekenhuis, Academic Medical Centre, Amsterdam, The Netherlands and Tropical Child Health Group, Liverpool School of Tropical Medicine, Liverpool, UK

Correspondence to:
Correspondence to:
S le Cessie, Department of Medical Statistics, Leiden University Medical Centre, PO Box 9604, 2300 RC Leiden, The Netherlands;
cessie{at}lumc.nl

Objectives: To examine the effect of low birth weight (LBW) and fetal anaemia (FA) on haemoglobin (Hb) patterns in infancy. To study the additional contribution of other risk factors known at birth. To examine the effect of iron supplementation during infancy on Hb levels.

Methods: A stratified cohort of infants in Malawi (83 with LBW (< 2500 g), 111 with FA (cord Hb < 125 g/l), 31 with both LBW and FA, and 176 controls) was followed during infancy. Hb levels were measured at about 2, 4, 6, 9, and 12 months of age. Repeated measures models were used to describe the changes in Hb levels over time.

Results: The mean Hb concentration in the control group was 95.5 g/l (95% confidence interval (CI) 92.5 to 98.5) at 2 months, 86.9 g/l (95% CI 84.4 to 89.4) at 9 months, and 898 g/l (95% CI 874 to 92.2) at 12 months. Differences between LBW infants and controls increased over time (difference at 12 months: 5.5 g/l (95% CI 1.3 to 9.7)). Infants with FA had borderline significantly lower Hb at 2 months (p = 0.07), but at 6 months their levels were similar to those of controls. The LBW infants and those with FA had the lowest Hb levels (difference from controls at 12 months 7.9 g/l). Parity, placental and maternal malaria at delivery, and sex significantly affected Hb levels after adjustment for LBW and FA. After iron supplementation, Hb significantly increased.

Conclusions: Antimalarial control and iron supplementation throughout pregnancy should be increased to reduce the incidence of infant anaemia and improve child development and survival.

Keywords: haemoglobin; anaemia; developing country; low birth weight; malaria

Abbreviations: Hb, haemoglobin; LBW, low birth weight; FA, fetal anaemia; CI, confidence interval

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