Skip to main content
  • Original article
  • Open access
  • Published:

Iron-deficiency anemia as a risk factor for acute lower respiratory tract infections in children younger than 5 years

Abstract

Background

Acute lower respiratory tract infection (ALRTI) is an important cause of morbidity in the developed world and both morbidity and mortality in the developing world. Moreover, iron-deficiency anemia (IDA) is a major health problem in children.

Aim

The aim was to evaluate IDA as a risk factor for ALRTIs in children.

Participants and methods

A total of 200 children were enrolled in this study, and they were divided into two groups: group I included 100 children with lower respiratory tract infections and group II included 100 apparently healthy children matched for age and sex as a control group. All enrolled children were subjected to history taking with stress on recurrent chest infection, clinical examination, and chest radiographs. Complete blood counting was done with measures of serum iron, serum ferritin levels, and total iron-binding capacity.

Results

Anemia was found in 74% of cases and 38% of controls. IDA was present in 60% of cases and 24% of controls. There was a statistically significant increased incidence of anemia [odds ratio (OR) was 4.64] and presence of IDA (OR was 4.75) in group I compared with group II. Regarding recurrent chest infections, there was a statistically significant increased incidence in children with anemia compared with those without anemia (OR was 27.60) and between non-IDA and IDA, as it was significantly higher in children with IDA (OR was 10.26).

Conclusion

Children with IDA were found to be four times more susceptible to ALRTI and ten times more susceptible to recurrent chest infections when compared with children without anemia.

References

  1. Peiris JS, Tang WH, Chan KH, Khong PL, Guan Y, Lau YL, Chiu SS. Children with respiratory disease associated with metapneumo virus in Hong Kong. Emerg Infect Dis 2009;9:628–633.

    Article  Google Scholar 

  2. Barson WG, Kaplan SL, Torchia MM. Epidemiology, pathogenesis, and etiology of pneumonia in children. Available at:http://www.Up To Date [3 November 2016].

  3. Zuo XF, Li JX, Zhou WD. The nutrient status of Chinese infants with pneumonia. Biomed Res 2014;25:317–320.

    CAS  Google Scholar 

  4. Bruno de B, McLean E, Egli I, Cogswell M. Worldwide prevalence of anaemia 1993 –2005 :WHO global database on anemias. Geneva:World Health Organization; 2008.

    Google Scholar 

  5. Ramakrishnan K, Harish PS. Hemoglobin level as a risk factor for lower respiratory tract infection. Indian J Pediatr 2006;73:881–883.

    Article  CAS  Google Scholar 

  6. Lerner NB, Sills R. Iron deficiency anemia. In:Kliegmen RM, Stanton BF St, Geme JW, Schor NF, Behrman RE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia:Elsevier; 2011. 1655–1658.

  7. Bont L, Heijnen C, Kavelaars A, van Aalderen W, Brus F, Draaisma J, et al. Local interferon-levels during respiratory syncytial virus lower respiratory tract infection are associated with disease severity. J Infect Dis 2009;184:355–358.

    Article  Google Scholar 

  8. Carroll K, Wu P, Gebretsadik T, Griffin M, Dupont W, Mitchel T, Hartert T. The severity-dependent relationship of infant bronchiolitis on the risk and morbidity of early childhood asthma. J Allergy Clin Immunol 2009;123:1055–1061.

    Article  Google Scholar 

  9. Christi MJ, Tebruegge M, LaVincente S, Graham SM, Duke T. Pneumonia in severely malnourished children in developing countries-mortality risk, etiology and validity ofWHOclinical sings:a systemic review. Trop Med Int Health 2009;14:1173–1189.

    Article  Google Scholar 

  10. World Medical Association. Declaration of Helsinki-Ethical Principles for Medical Research Involving Human Subjects. Seoul, South Korea:the 59th WMA General Assembly; 2008.

    Google Scholar 

  11. Gruppo di Studio di ImmunologiadellaSocietàItaliana di Pediatria. Le infezioniricorrentinel bambino:definizioneedapproccio diagnostic. Rivista di Immunolgia e Allergologia Pediatrica 1988;2:127–134.

  12. Paetzel M. Respiratory distress syndrome (grade 1-4) of the premature and newborn (IRDS). PedRad (serial online). Available at:http://www.PedRad.info/?search=20021110223558. [Last accessed on 2017 May 15].

  13. Park K. Nutrition and health. Park ’s text book of preventive and social medicine. 21st ed. Premnagar, Jabalpur, (M.P.), India:Banarasidas Bhanot Publishers Publication; 2011. pp. 561-617.

  14. Burtis CA, Edward RA. Principles of colorimetric determination of unsaturated iron binding capacity in serum. In:Burtis CA, Edward RA, David EB, editors. Tietz textbook of clinical chemistry. 4th ed. Philadelphia:Elsevier Saunders; 2006. 2195–2197.

  15. McPherson RA, Pincus MR. Iron deficiency anemia:diagnosis and management. In:McPherson RA, Pincus MR, editors. Henry ’s clinical diagnosis and management laboratory methods. 21st ed. Philadelphia:WB Saunders; 2007. 455–482.

  16. Sipahi T, Köksal T, Tavil B, Akar N. The effects of acute infection on hematological parameters. Pediatr Hematol Oncol 2004;21:513–520.

    Article  Google Scholar 

  17. Cherian T, Mulholland EK, Carlin JB, Ostensen H, Amin R, Campo M, et al. The WHO Radiology Working Group. Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ 2005;83:353–359.

    PubMed  PubMed Central  Google Scholar 

  18. Roma KM, Gupta V, Ahmad S, Ranhotra S, Issrani R, Prabhu N. Assessment of anemia as a risk factor for acute lower respiratory tract infections in children:a case-control study. Int J Clin Pediatr 2015;4:149–153.

    Article  Google Scholar 

  19. Sheikh HQ, Ashraf M, Wani JG, Ahmed J. Low hemoglobin level a risk factor for acute lower respiratory tract infections (ALRTI) in Children. J Clin Diagn Res 2014;8:1–3.

    Article  Google Scholar 

  20. Ganong WF. ‘Gas transport between the lungs and tissues ’. Review of medical physiology. 22nd ed. New York:McGraw-Hill; 2005. 666–669.

  21. Rashad MM, Fayed SM, El-Hag AM. Iron-deficiency anemia as a risk factor for pneumonia in children. Benha Med J 2015;32:96–100.

    Article  Google Scholar 

  22. Abdel-Maksoud HM, Hasan AK, Mohamed Ahmed Helwa MA. Evaluation of iron deficiency anemia as a predisposing factor in the occurrence of pneumonia in children. Trends Med Res 2016;11:69–75.

    Article  CAS  Google Scholar 

  23. Maurad S, Rajab M, Alameddine A, Fares M, Ziade F, AbdouMerhi B. Hemoglobin level as risk factor for lower respiratory tract infections in Lebanese children. North Am J Med Sci 2010;2:461–466.

    Article  Google Scholar 

  24. Ghio AJ. Disruption of iron homeostasis and lung disease. Biochim Biophys Acta 2009;1790:731–739.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Osama I. Mohammad MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Behairy, O.G., Mohammad, O.I. & Elshaer, O.S. Iron-deficiency anemia as a risk factor for acute lower respiratory tract infections in children younger than 5 years. Egypt J Bronchol 12, 352–357 (2018). https://doi.org/10.4103/ejb.ejb_67_17

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_67_17

Key Words