Severe Megaloblastic Anemia Secondary to Folate Deficiency in a 2-Year-Old Boy with Prolonged Predominant Goat Milk Feeding: A Case Report from a Low-Resource Setting

Abstract

Introduction: Megaloblastic anemia in young children is a significant but preventable condition, commonly caused by deficiencies in folate or vitamin B12. Prolonged predominant feeding with nutritionally inadequate milk substitutes, such as unfortified goat milk, increases the risk of severe nutritional anemia, particularly in low-resource settings. Case Presentation: We report a 2-year-old Somali boy who presented with a 5-month history of fatigue, recurrent fever, poor appetite, abdominal distension, progressive weight loss, and cough. The child had a history of prolonged predominant goat milk feeding with limited dietary diversity. On admission, he was critically ill, severely pale, tachycardic, tachypneic, and hypoxic, with an oxygen saturation of 78% on room air. Clinical examination also revealed bilateral pedal edema, tender hepatomegaly, and a gallop rhythm, suggesting cardiac compromise secondary to profound anemia. Laboratory evaluation showed severe anemia with a hemoglobin level of 2.4 g/dL, thrombocytopenia, megaloblastic changes on peripheral smear, profoundly reduced serum folate (<0.8 ng/mL), normal vitamin B12 and ferritin levels, and positive Plasmodium antigen testing. The child was managed with oxygen support, packed red blood cell transfusions, folic acid and iron supplementation, intravenous artesunate, nutritional rehabilitation, and caregiver counseling. His clinical condition improved, and follow-up showed hematologic recovery with hemoglobin increasing to 11 g/dL and serum folate improving to 4 ng/mL. Discussion: This case highlights the systemic impact of folate deficiency in children and the dangers of Prolonged predominant goat milk feeding can lead to life-threatening megaloblastic anemia in young children, especially in low-resource environments. The condition is preventable through early recognition, supplementation, and caregiver education. Public health strategies should promote culturally sensitive nutrition awareness programs to prevent similar cases in at-risk communities. Conclusion: Exclusive goat milk feeding can lead to life-threatening megaloblastic anemia in young children, especially in low-resource environments. Early identification, nutritional intervention, and caregiver education are essential to prevent severe complications and ensure optimal growth and development.