Growth in children and adolescents with sickle cell disease in Yemen

Background: Physical growth is known to be impaired in children with sickle cell disease (SCD) and the prevalence and severity vary with geographical location. The factors which contribute to this sub-optimal growth are poorly understood. Objectives: To describe the growth status of children and adolescents with SCD in Yemen using the new WHO reference values and to assess correlation of growth indicators with disease severity and with haematological and biochemical parameters. Methods: A cross-sectional study of children <16 years with SCD was conducted at Al-Wahda General Teaching Hospital, Aden. Anthropometric measurements of weight, length/height, mid-upper-arm circumference (MUAC) and body mass index (BMI) were collected. Disease severity was assessed using a severity index (SI) score. Results: A total of 102 children (56 male) were included and their mean age was 7.2 years (range 6 months to 15 years). Low weight, height and BMI-for-age Z-scores (< - 2 SD) were observed in 45%, 54% and 35% of children, respectively. Regression analyses indicated an association of low height-for-age with male gender (p=0.02), low weight-for-age and weight-for-height with increased age (both p<0.001), low weight-for-age with raised alkaline phosphatase (p=0.04), and low BMI with reduced plasma albumin (p=0.04). There was no correlation between growth deficits and SI or anaemia severity. Conclusion: Growth is severely impaired in children and adolescents with SCD in Yemen. Growth monitoring and nutritional support should be included in their comprehensive care package.