Abstract
OBJECTIVES: To examine the burden of anemia and malnutrition in children presenting with suspected dengue virus infection, as part of our ongoing surveillance program for acute febrile illnesses in Ecuador. METHODS: A total of 58 children (6 months to 5 y) were recruited in 2018 as part of the surveillance program. Sociodemographic characteristics, clinical signs and symptoms, and anthropometric data were obtained using structured interviews and standardized assessments. Venous blood samples were collected, and hemoglobin was assessed via the sodium lauryl sulfate method. Suspected dengue cases were identified using the World Health Organization dengue severity classification guidelines. Anemia was defined as hemoglobin <110 g/L. Stunting, underweight, and wasting were defined based on their corresponding z-scores: height-for-age z-score (HAZ) <-2, weight-for-age z-score (WAZ) <-2, and weight-for-length z-score (WHZ) <-2, respectively. Overweight and obesity were defined as BMIZ >1 SDs, and BMIZ >2 SDs, respectively. Binomial and linear regressions were used to examine the associations of hemoglobin, anemia, and anthropometric variables with clinical variables among patients presenting with suspected dengue infection. RESULTS: Approximately 33% of children were classified as suspected dengue cases and 43% of the children were anemic (median [IQR]: 111 [103, 118] g/L). Additionally, 26% of the cohort presented a fever and the most prevalent symptoms were rash (67%), nausea (43%) and vomiting (31%). Further, 7% of the children were stunted, 3% were underweight, and 5% of children were wasted. Approximately 19% were overweight and 12% were obese. Anemia was associated with an increased likelihood of presenting a rash (P = 0.04) overall as well as within the subset of children not suspected of having dengue viral infection. There were no significant associations noted between nutritional factors and other clinical variables. CONCLUSIONS: Findings suggest that the prevalence of anemia and overweight were high in children presenting with suspected dengue virus infection in coastal Ecuador. FUNDING SOURCES: NIH.