Socio-emotional and adaptive behaviour after severe anaemia in pre-schoolers at Lira Regional Referral Hospital, Uganda: a cross sectional study.

Abstract Background: Severe anaemia is a global public health challenge commonly associated with morbidity and mortality among children <5 years of age in Sub-Saharan Africa. However, less is known about the behavioural performance of preschool children surviving severe anaemia in low resource settings. We investigated social-emotional and adaptive behaviour in preschool children diagnosed with severe anaemia in Northern Uganda. Methods: We conducted a hospital based cross-sectional study among children 6 - 42 months who were treated for severe anaemia (n=171) at Lira Regional Referral Hospital, Uganda. Social emotional and adaptive behaviour were assessed 14 days post discharge using the Bayley Scales of Infant and Toddler Development, 3rd edition. Age-adjusted z-scores for each domain were calculated using scores from healthy community children (n=88) from the same environment for each age category. Multiple linear regression was used to compare z-scores in the social-emotional and adaptive-behaviour scales between the two groups after adjusting for weight-for-age z-score, social economic status, mother’s education, father’s education and father’s employment on all the scales.Results: Compared with healthy community pre-schoolers, children with severe anaemia had poorer [adjusted mean scores (standard error)], social emotional [-0.29, (0.05) vs. 0.01, (0.08), P=0.002]; but not overall/ composite adaptive behaviour [-0.10, (0.05) vs. -0.01, (0.07), P=0.343]. Within the adaptive behaviour subscales, children with SA displayed significantly poorer scores on the community use [adjusted mean score (standard error)], [-0.63, (0.10) vs. -0.01, (0.13), P<0.001]; and leisure [-0.35, (0.07) vs. -0.02, (0.07), P=0.036] skills. Conclusion: This study demonstrates that severe anaemia in the preschool period is associated with poor social-emotional scores in the short-term post clinical recovery in Northern Uganda. We recommend long-term follow-up to determine the course of these problems and appropriate interventions to reduce the behavioural burden among pre-schoolers surviving severe anaemia in Uganda.