Role of Iron Deficiency Anaemia as A Risk Factor for Wheeze Associated Respiratory Tract Infection in Children

Abstract

Introduction: Acute lower respiratory tract infections form a major portion of early childhood illnesses and infections. Iron deficiency anemia is an independent risk factor for lower respiratory tract infections (LRTI), however may also play an important role in wheeze associated respiratory tract infections. Wheezing is common in children with cumulative prevalence of almost 50% by the age of 6 yrs.  Objective: To assess the role of iron deficiency anemia as a risk factor for wheeze associated respiratory tract infection in children. Methods: This case control study was conducted at Department of Pediatrics, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January to June 2022. Total 60 patients from both groups were included in our study. Among children six months to five years and having ≥2 episodes of wheeze associated respiratory tract infections. The clinical presentation and laboratory profile were recorded on a predesignated proforma. Iron deficiency anemia was diagnosed by hemoglobin <11.0 gm%, serum ferritin<12 ng/ml and RDW>15%. The statistical analysis was done using SPSS, Version 21. Results: A total of 60 children were enrolled in the study, of which 30 were cases and 30 were matched controls. Majority of subjects in both groups were male (n=19;63.3%), with male to female ratio of 1.6:1. On clinical evaluation of   the   cases, pallor was observed in 17 (56.7%) cases, mild to moderate respiratory distress was observed in 8 (26.7%), chest in drawing in 7 (23.3%), audible wheeze on inspiration in 3 (10%), presence of rhonchi in 2 (6.7%), hyper resonant note on percussion in 6.7% and bilateral wheeze in 27 (90%) cases. Proportion of cases with iron deficiency anemia were higher among cases (33.3%) as compared to controls (23.3%) but the difference between two groups was not significant statistically (p=0.373) despite having higher risk (OR=1.49;95% CI=0.62-3.59). Mean monocyte, eosinophil and absolute eosinophil count was found to be significantly higher in cases as compared to controls (p<0.05).  Conclusion: The present study does not suggest a possible linkage between iron deficiency anemia and wheeze associated respiratory infection, however its role as causative factor needs to be explored through long-term prospective and intervention studies on a large population.