AbstractBackground: Vitamin A deficiency (VAD) is an important public health problem in many developing countries where anaemia, undernutrition (stunting, underweight and wasting) and infection prevalence are high, but has not been investigated in Aboriginal and Torres Strait Islander communities in Australia where there is also a high prevalence of anaemia, undernutrition and childhood infections.
Primary Aim: To identify the association of VAD with anaemia, undernutrition and infection in Aboriginal and/or Torres Strait Islander children aged six months to six years in the Northern Territory (NT), Australia.Secondary Aim: To identify the association of anaemia with VAD, undernutrition and infection in Aboriginal and/or Torres Strait Islander children aged six months to six years.
Methods: A prospective cohort study was conducted with Aboriginal children enrolled in the Rapid Iron Infusion Study (RIIS) who were tested for vitamin A and anaemia whilst inpatients at Royal Darwin Hospital (RDH), NT, between April 2018 and September 2019. Venous blood samples were collected to measure vitamin A levels, haemoglobin, mean corpuscular volume (MCV), ferritin and C-reactive protein (CRP). Children’s weight-for-age z score, height-for-age z score and weight for height z score were calculated using World Health Organization (WHO) standard growth tables. Admission diagnoses were categorized as infectious or not infectious.Fisher’s exact was used for assessing pairs of categorical variables and scatter plots were used to visualise the associations between pairs of continuous variables. Linear regression was used to calculate the correlation coefficients between pairs of continuous variables and bivariate logistic regression analysis was used for measuring the associations between the outcomes of VAD and anaemia and the other variables of interest.
Results: There were 76 children tested for Vitamin A. Prevalence of VAD (<0.7 umol/L) was 29% of which 4.0% has severe VAD (<0.4 umol/L). Anaemia by FBC (OR 2.8, 95% CI 1, 8.2, p = 0.053) and elevated CRP (CRP >5 mg/L) (OR 7.6, 95% CI 1.9, 30, p = 0.004) were significantly associated with VAD but no association was found with undernutrition or infection. In the presence of infection and an elevated CRP, Vitamin A was associated with haemoglobin, but no association was found between Vitamin A and haemoglobin in the absence of infection or CRP ≤5 mg/L. Anaemia prevalence was 40% when measured from full blood count (FBC) and 47% by haemocue. Female gender (OR 3.8, 95% CI 1.4, 11, p = 0.01), VAD and elevated CRP (OR 5, 95% CI 1.5, 17, p = 0.008) were associated with anaemia. Other abnormal measures among the children included: 75% with a low MCV, 16% with a low ferritin, 3% with a high ferritin, 19% underweight, 35% stunted and 20% wasted. Infection diagnosis at admission was 64% and 54% had an elevated CRP level.
Conclusion: This is the first study among Aboriginal and Torres Strait Islander children aged six months to six years to explore the association of VAD with anaemia, undernutrition and infection. This study found that VAD is associated with anaemia and an elevated CRP level but not undernutrition. Further investigations are warranted to determine if VAD prevalence is as high in rural and remote communities as it was in this sample of hospitalised children; and to establish if VAD has adverse outcomes affecting the health and wellbeing of Aboriginal and Torres Strait Islander children.
|Date of Award||May 2020|
|Supervisor||Therese Kearns (Supervisor) & Linda Ward (Supervisor)|