Haemoglobin concentration and anaemia in young West African (Gambian) children

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Abstract
Haemoglobin and haematocrit values were determined at approximately quarterly intervals during 2 years (1962–1963) in children under 5 years of age, in 4 adjacent rural villages in the Gambia, West Africa. Haemoglobin concentrations fell progressively from high levels (mean over 14·0 g. %) in the first month of life to low levels (mean, 9·0 g. %) at the 18th month. They remained low for the remainder of the second year and thereafter climbed slowly to reach a mean value of 10·5 g. % at 4 years of age. Values for haematocrit and MCHC behaved in a similar fashion. More detailed analysis showed that haematological characteristics varied substantially by season and place of residence. In 3 of the villages haemoglobin concentrations and haematocrit values varied with season in a regular and predictable way. Values rose throughout the dry season (December to May) into the early part of the rains (July), only to fall sharply in the latter part of the wet season (November). Season had less effect on MCHC values, although these were found to be higher in children with malaria parasitaemia. Severe anaemia was common and was usually of the “iron deficiency” type. In the children of the fourth village anaemia was less common and less severe and haemoglobin levels showed no distinct change with season. The haematological findings are discussed in the light of medical knowledge of the area studied. Malaria is probably the most important single factor responsible for both the frequency of severe anaemia and the seasonal variations in haematological indices. Many other factors may also contribute, notably the effect of a rapidly expanding blood volume in an infant whose birth weight was low, the frequency of infectious disease with attendant clinical illness, and the dietary limitations imposed partly by the influence of season upon agriculture and partly by haphazard care of young children.