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Anemia among Children Aged 1 month -12 Years at Al-Wahda Hospital,Derna-Libya

Anemia is one of the main public health issues among children in the world. The causes of anemia are multifactorial, but iron deficiency is the most common one. There are direct proportions between iron and body mass. The paper aimed at determining anemia prevalence in children aged 1-144 months in Al-wahda Hospital in Derna city during the first quarter of 2017, as well as determining the type of anemia. A sample of 129 children aged 1-144 M was tested for hemoglobin levels to diagnose anemia. Mean corporal values were measured to determine the type of anemia, and data were collected based on independent variables such as age and sex. The frequency was created, and comparisons were tested using chi-square. Anemia prevalence of overall sample was 65.11%. It was significantly higher in children aged (1-3 months) than those aged (4-6 months), and (7-144 months) (p =.001). Significant differences were found in anemia prevalence among boys and girls, where prevalence was higher in girls than in boys (P=.008). Prevalence of Microcytic hypochromic anemia was higher (69.4 %) compared to Normocytic normochromic (28.57%), and Macrocytic hyperchromic anemia (2.38%). Prevalence of anemia of the overall sample is considered as sever based on World Health Organization anemia classification. In addition, increased anemia prevalence in children less than 3 months shud be taken care of the Libyan government to prevent and control anemia in pregnant women. The high prevalence of Microcytic hypochromic in the overall sample was observed. Further estimation of iron and ferritin should do, and further evalution is needed to identify the causes of anemia in children under 12 years


INTRODUCTION
Anemia remains a public nutritional problem throughout the world (Habib et al., 2016;Ngesa & Mwambi, 2014). There are >1.5 billion people affected by anemia worldwide (Li et al., 2017). Anemia is common in infants young children-, and pregnant.(Li et al., 2017). Prevalence of anemia in children under 5 years is 24% in developing countries (Li et al., 2017). Most children with anemia are asymptomatic. Anemia is classified as microcytic, normocytic, and macrocytic based on the mean corpuscular volume. The etiologies of anemia are multifactoral. The most prevalence form of anemia throughout the world is iron-deficiency anemia, it is estimated as 50% of anemia cases worldwide, and it particularly affects women and children.
Iron is an essential mineral in infancy where it plays a significant role in the stages of neurogenesis and cell differentiation in various areas of the brain (Al-Qaoud, Al-Shami, & Prakash, 2015;Pita et al., 2014). There is a direct proportional between iron and body mass, so infants with low birth weight have less total iron than infants with normal birth weight. This may lead to irreversible body development including that for the brain and may lead to serious problems such as cognitive, motor, and behavioral problems (Al-Qaoud et al., 2015;Li et al., 2017).
WHO has developed a classification system to facilitate international comparisons of anemia as a public health problem. The problem is considered severe if anemia prevalence is ≥ 40%, moderate from 20 to 39.9%, and mild from 5 to 19.9% (Pita et al., 2014).
Hemoglobin may not always be the most appropriate indicator for anemia because of its low sensitivity to iron deficiency and individuals health. Since iron, deficiency is only one of many disorders that can cause anemia.
In Libya, as in many other developing counties, hemoglobin levels can be an appropriate, inexpensive, and simple indicator of both iron status and anemia (Pita et al., 2014).
The objective of our research was to determine the prevalence of anemia in children under 12 years who were admitted to Derna's Al-wahda hospital and to determine which type is more common to provide more insights to the nature and types of policies that we can put up to prevent and treat anemia.

MATERIALS AND METHODS
The research was conducted in the period from January-March 2017. 129 children under 12 years, who were admitted to the pediatric department of Al-wahda hospital in Derna city, were included in this study. 5ml of blood were collected from all children in EDTA containers. By using automated cell counter (SYSMEX 21), hemoglobin and RBC indices were estimated. The dependent variable was anemia, Mean corpuscular volume, and the independent variables were sex and age (Table1).
The prevalence of anemia was significantly high among children aged 1-3 months than those observed in the group aged 4-6 months and the group aged 7-144 months (P=.001) ( Table 2). Female children were found to have a higher prevalence rate than male children (P =.008) ( Table 3).

DISCUSSION
The present study showed that the overall prevalence of anemia among hospitalized children was 65.11%. This rate is markedly higher than the prevalence data reported by industrial countries such as Austria 10.5% and Belgium 8.7%. However, it is still lower than the prevalence data reported by south Asian countries such as India 74.3% (Al-Qaoud et al., 2015).
The distribution of anemia by age in the present study showed that in the prevalence rate was high in group aged 1-3 months than other groups. This results were consistent with findings from other study in other countries (Li et al., 2017). Increased anemia prevalence in group aged 1-3 months could be due to the low hemoglobin level in the mother during pregnancy. This was consistent with a study in Brazil which found that one of the factors contributing to low levels in a child was maternal anemia, highlighting the need to prevent anemia before, during, and after pregnancy (Pita et al., 2014).
Boys are reported to be more susceptible to iron deficiency than girls due to their more rapid growth in the first months of life (Pita et al., 2014), but this was inconsistent with our finding where the prevalence was significantly higher in girls than in boys.
The present study showed a high prevalence rate of Microcytic hypochromic anemia among anemic children. This result is consistent with World Health Organization which shows that iron deficiency is the most common cause of anemia (Pita et al., 2014).

CONCLUSION
Based on World Health Organization classification of anemia, the prevalence of anemia in our study is considered as severe (> 40). Anemia prevalence in group aged 1-3 months was high compared with those aged 4-6 months and 7-144 months. There was an Increased prevalence of Microcytic Hypochromic anemia of overall anemic samples. Further research is needed to know the exact causes of anemia in children under 12 years among this area. We recommend taking more action to control anemia in women of childbearing age.

ACKNOWLEDGMENT
The authors express sincere thanks to Prof Waal-Belaid and Dr. Ashraf Elzieer who have contributed to statistical analysis ,and to medical lab technicians in the hematology laboratory at Al_Wahada hospital.