Severe anaemia in African children: look beyond under-fives

In The Lancet Global Health, Kelvin M Abuga and colleagues1 report a 26-year hospital surveillance study of severe anaemia and invasive bacterial infection in 84 348 paediatric admissions at Kilifi County Hospital, on the coast of Kenya. The analysis spans the introduction of Haemophilus influenzae type b (in 2001) and 10-valent pneumococcal (in 2011) conjugate vaccines, a marked decline in Plasmodium falciparum transmission, and the establishment of a dedicated sickle cell disease (SCD) clinic. Severe anaemia was identified in 19·8% of admissions and was associated with greater odds of in-hospital death (adjusted odds ratio 2·1) and bacteraemia (adjusted odds ratio 2·7) than with those for mild or no anaemia. As malaria transmission declined, the age distribution of severely anaemic children shifted upwards: the proportion aged 5 years or older rose from 16·4% in the high-transmission era (1998–2003) to 44·7% in the low-transmission era (2010–24).