Anemia Among Hospitalized Children in a Ghanaian Pediatric Emergency Unit: A Prospective Observational Study of Prevalence, Associated Factors, and Hematologic Patterns

Abstract

Background and Aims: Anemia remains a major contributor to pediatric morbidity and mortality in sub-Saharan Africa, yet contemporary data from tertiary pediatric emergency settings are limited, particularly among children older than 5 years. This study assessed the prevalence, factors associated with anemia, hematological characteristics, and short-term clinical outcomes among children admitted to a pediatric emergency unit (PEU) in Kumasi, Ghana. Methods: This prospective observational study enrolled children aged 2 months to 17 years admitted to the PEU of Komfo Anokye Teaching Hospital, Ghana, between November 2024 and January 2025. Sociodemographic, dietary, and clinical data were obtained through caregiver interviews and medical record review. Anemia was defined and graded using age- and sex-specific World Health Organization hemoglobin thresholds. Red cell indices were used to describe anemia morphology. Logistic regression analysis was employed to identify factors independently associated with anemia. Results: Among 318 children enrolled, 66.7% had anemia. Mild, moderate, and severe anemia accounted for 14.8% (47/318), 34.6% (110/318), and 17.3% (55/318) of cases, respectively. Among children aged 6-59 months, 65.3% (113/173) were anemic. Moderate anemia predominated across age groups, while severe anemia was more frequent among older children. Microcytic anemia with elevated red cell distribution width was the most common morphological pattern, suggesting a high burden of iron deficiency. Anemia was independently associated with clinically presumed iron deficiency, sickle cell disease, and malaria rapid diagnostic test positivity. Nearly one-quarter of participants required blood transfusion, reflecting the severity of presentations. Conclusion: Anemia was highly prevalent among children admitted to a tertiary pediatric emergency unit in Ghana and was frequently associated with severe disease requiring blood transfusion. Strengthened strategies focusing on early identification of hemoglobinopathies, prompt malaria control, and improved nutritional assessment and counseling are urgently needed within emergency and inpatient pediatric care.