BJA Open · Published 2026-01-20 · DOI 10.1016/j.bjao.2025.100524
Background: Paediatric anaemia is a major public health problem affecting millions of children globally, with a high prevalence in low- and middle-income countries. There is limited data on the prevalence of preoperative anaemia in healthy paediatric surgical patients presenting for routine surgery. The primary aim of the study was to describe the prevalence and severity of anaemia. Secondary aims were to describe the association between anaemia and demographic variables, nutritional status, and deworming status in these children. Methods: This was a prospective, cross-sectional study and included children aged 6 months to 11 years, American Society of Anaesthesiologists (ASA) physical status classification 1 and 2, presenting for elective surgical and diagnostic procedures performed under sedation or general anaesthesia at two tertiary hospitals in Johannesburg between January and May 2024. Anaemia was defined using age-specific cohorts according to the 2001 World Health Organization (WHO) definition of paediatric anaemia. Screening was done using the point-of-care haemoglobin device HemoCue®. Univariate statistical associations were performed using χ2 tests for categorical variables, and Wilcoxon rank sum tests for continuous variables. Multivariable logistic regression was used to assess associations between demographic variables (age, sex, nutritional status, deworming status) and the presence of anaemia. In addition, Spearman’s correlation was performed as an exploratory test. P-values <0.05 were considered statistically significant. Results: A total of 290 children with a median age of 4.2 (2.2–7.1) years were included in the study. The prevalence of anaemia was 31.4% (95% confidence interval [CI] 26.1–37.1). Anaemia was classified as mild in 57.1% (95% CI 46.3–67.5), moderate in 40.7% (95% CI 30.5–51.5), and severe in 2.2% (95% CI 0.3–7.7). A significant association was found between age and the likelihood of anaemia (adjusted odds ratio 0.61, 95% CI 0.35–1.05). There were no significant associations found with sex, nutritional status, and deworming status. Conclusions: There is a notable prevalence of preoperative anaemia in paediatric patients in this South African middle income country. Children under the age of 5 years have the highest prevalence overall. The majority of patients have mild anaemia. Identifying anaemia at the surgical visit provides a valuable opportunity for health education and promotion.
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