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There is no study performed before inhospitalized children reported the incidence and risk factors of anemia among Lebanesechildren.

This study was performed in a tertiary care general hospital locatedin a rural area of south Lebanon and included 295 hospitalized childrenadmitted with different clinical diagnoses. The prevalence of anemia was 33.2%which goes in line with the WHO severity classification of anemia that must bebelow 40% but still so far higher than many developed countries like Australia,Canada and most of the European countries where the incidence is less than 15%and luckily lower than the 70% alarmingly high incidence in some Africancountries 1.Concerning the association with gender,we had a slightly higher incidence of anemia in male (54.2%) than in femalepatients without a significant statistical level, however, many authorsreported that anemia is more prevalent in boys an issue that may be due to thefaster growth of pre-school boys compared to girls, resulting in a high ironrequirement, so it is necessary to do more studies to better delineate thisconflicting results and gender factor relationship to anemia 2.

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The higher prevalence of anemia in theage group of infants below 12 month, which was found in our study (48.3%), isclose to the results reported by Neves et al. 2005 in children below 24month of age (55.1%) 3, and is likely to be a combined result of theincreased iron demands due to rapid growth, early weaning, and low availabilityof foods rich in iron that are common in this age group. Furthermore,unfavorable living conditions that make children more vulnerable to diarrhea,respiratory infections and intestinal parasites may negatively affect theintake, absorption and biological utilization of iron 2. The prevalence of anemia was positively correlatedwith the nutritional status of our patients evaluated as the z score of theweight for age of less than -2 Standard deviation to be malnourished and theywere found to have a 2.

6 higher relative risk of having anemia than theircomparable group of well-nourished patients which is comparable to the studyconducted by Rocha et al. in children cared for in day care centers ofRio de Janeiro that found means of z-score for height/age and weight/age thatwere significantly lower in anemic children, compared to non-anemic ones 4.It is difficult to interpret the role ofanemia on the length of hospitalization because other factors may play asignificant role such as the underlying medical condition, different medicalcare and the effect of the sample randomization 5, an exciting and importantfinding in our study was the positive correlation of anemia with the length ofhospitalization of more than five days (P = 0.05). This is explained by thedegree of immune system dysfunction and the predisposition to infection inchildren suffering from iron deficiency anemia that aggravated the primarydisease.In our study, anemia was most common inchildren suffering from acute gastroenteritis followed by respiratory tractinfections. Respiratory tract diseases possibly require greater utilization ofhemoglobin both due to the infectious process and increased respiratory effort,whereas gastrointestinal diseases lead to blood loss in vomitus and feces or bydegradation by parasites. Lima et al.

reported a higher prevalence ofanemia in infants with infectious diarrhea 6, as reported in our study.Microcytic anemia can be causedby a variety of conditions that include: iron deficiency, thalassemia, leadpoisoning, sideroblastic anemia, or anemia of chronic disease. The meancorpuscular volume (MCV), red blood cell distribution width (RDW), and thepatient’s history can exclude some of these etiologies. The MCV variesaccording to the age and it is usually less than 75 fl with thalassemia andrarely less than 80 fl in iron deficiency until the hematocrit is less than 30percent 7. We calculated the Mentzer Index as a hematological parameter to determinethe etiology of anemia, for children, the Mentzer index (MCV/red blood cellcount) can help distinguish between iron deficiency and thalassemia. In irondeficiency, the ratio is usually greater than 13, whereas thalassemia yieldsvalues less than 13. A ratio of 13 would be considered uncertain 8, and we found that in90.8% of cases it is more than 13 which means that the majority of our patientssuffered from iron deficiency anemia a finding that should be confirmed bydoing further blood testing like measuring the blood level of ferritin, ironlevel and total iron body capacity and performing hemoglobin electrophoresis.The only protective factors againstanemia was early iron supplementation the first year of rapid growth and highminerals demand, unlike other dietary acts of solid food introduction orprolonged breast feeding that were found to have no effect on anemiaprevention, a result that should be confirmed later in the future by a largerandomized multicenter study.The limitation of our study includes thesmall sample size obtained and it is a single center study, done over a shortperiod of time, also we did not include specific blood tests to determine theetiology of anemia as mentioned before and we based our results on the firstCBCD performed on admission.


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