Epidemiology of Anemia at the Internal Medicine Department in Borgou Departmental Hospital Center (DHC) in Parakou (Benin)

Objective: To describe clinical and biological characteristics of anemia in the Internal Medicine department of Borgou Departmental Hospital Center (DHC). Methods: This was a transversal and descriptive study for an analytic purpose. All patients hospitalized in the Internal Medicine department of Borgou DHC who had a hemogram for their care were included in the study. Anemia was defined as a hemoglobin level lower than 12 g/dL for men and lower than 11.5 g/dL for women. Results: Frequency of anemia was 61.8% (76 of 123 patients). Anemia was moderate in 47.4% of the cases and severe in 27.6% of the cases. Basing on the mean corpuscular volume, microcytic anemia accounted for 36.8%, anemia was normocytic in 46.1% and macrocytic in 17.1% of cases. According to the mean corpuscular hemoglobin concentration, normochromic anemia accounted for 81.6% of the series and hypochromic in 18.4%. The most common pathologies found in anemic patients came from digestive origin (17%), the renal causes were also found in 17% of the cases. Cardiac pathologies were responsible for anemia in 13% of cases. Malaria and pulmonary pathologies were responsible for anemia in respectively 12% and 9%. The main factors associated with anemia were young age (young adult) and neurological pathologies. Conclusion: Anemia hospital prevalence is very high in the Internal Medicine Department of Borgou DHC. Awareness of populations and practitioners for the early management of various pathologies which provide anemia could improve this presentation.


Introduction
Anemia is a public health problem according to World Health Organisation.
Anemia is defined as a condition in which there is less than the normal hemoglobin (Hb) level in the body, which decreases oxygen-carrying capacity of red bloodcells to tissues. World Health Organization (WHO) definitions for anemia differ by age, sex and pregnancystatus as follows: children 6 months to 5 year anemia is defined as a Hb level < 11 g/dl, children 5 -11 years Hb < 11.5 g/dl, adult males Hb < 13 g/dl; nonpregnant women Hb < 12 g/dl and pregnant women Hb < 11g/dl. Anemia could be classified as mild, moderate and severe.
Anemia has many effects on individual health like a reduction in the productivity and the physical capacity [10] [11]. It is also linked to the elevation of morbidity in hospital. Anemia may be due to a single factor such as a nutritional deficiency or its cause may be multifactorial. Anemia results from one or more of the following events: loss of red blood cells, reduction in the production of red blood cells, increased destruction of red blood cells, and shorter life span of red blood cells. Multiple factors may contribute to the development of complex anemia in hospitalized patients, including nutritional deficiencies, suppression of RBC production bymedications, inflammatory cytokines (inflammatory anemia or anemia of chronic disease), and chronic or acute bleeding [12]. In northern Benin, the problem extent is unknown. The goal of this study was to describe anemia clinical and biological characteristics in the Internal Medicine Department of Borgou Departmental Hospital Center.

Patients and Methods
This transversal and descriptive study is aimed at analyzing with a prospective Anemia has been defined as a hemoglobin level under 12 g/dL in men and under 11.5 g/dL in women. The severity of the anemia has been assessed according to the following degrees: mild when hemoglobin level is at 10 g/dL or higher, moderate when the hemoglobin level is less than 10 g/dL and superior or equal to 7g/dL, severe when the haemoglobin level is less than 7 g/dL andde-

Risk Factors Associated with Anemia
Sex was not associated with anemia.
The younger age was associated with anemia (p = 0.043) ( Table 1).  Table 2 and Table 3 show respectively anemia prevalence according to the nutritional status and the diagnosis on leaving. The nutritional statuts was not associated with anemia (Table 2). According to the diagnosis on leaving, neurological pathologies were associated with anemia (Table 3).

Discussion
The lack of technical capacity means didn't allow to determine the reticulocyte rate in order to identify a regenerative or a non-regenerative anemia and the small sample of echantillon. This study allowed the description of anemia epidemiology according to the conditions for exercisingin the developing countries like Benin.  Among the main causes of hospitalization in Benin, Anemia was in second position (12.3%) aftermalaria (32.2%) [13]. Adingni reported a hospital frequency at 25.4% in Cotonou [14]. The anemia frequency in the internal department of Borgou DHC was 61.8%. That very high frequency was due to our study method. Over 3 months period, we realized a complete blood count in all the patients hospitalized in the service without prejudice of the reason for hospitalization. That method allowed us to diagnosis a larger number of anemic patients even the subclinical cases. That frequency is superior to 25.4% reported by Adingni [14] in Cotonou during a retrospective study on the records of the patients registered as the ones suffering from anemia in CNHU-HKM internal medicine department in Cotonou from 2006 to 2010. The high frequency of anemia in internal medicine department of Borgou DHC could be also justified by the fact that hospitalized patients come from several specialities: Nephrology, Cardiology and Infectiology. Shill [3] and Terrier [15] have reported a similar prevalence at respectively 53.3% and 65%. In people living with HIV, 44% of them are anemic in Tanzania. In Bangladesh, 32% of patients suffering from pulmonary diseases are anemic [16]. In United States, the prevalence of anemia in hospitalized patients is low at 22.8% [12]. That variance is due to socio-economic difference between developed countries and the developing ones [1].
The number of the patients suffering from a mild anemia was 19 (25%). The ones who had a moderate anemia were 36 (47.4%) and 21 (27.6%) had a severe anemia. Adingni [14] reported a higher number of severe anemia (40.4%), followed by mild anemia (31.4%) and moderate anemia (28.2%). In Maroc, El Hioui et al. [17] rather noted in their series that almost half of the investigated patients (45%) had a hemoglobin level inferior to 6.5 g/dL.
In our series, the pathologies found in anemic patients were digestive pa- Patients suffering from neurological problems are more anemic. The loss of autonomy and the alteration of consciousness could explain that association.

Conclusion
The frequency of anemia is high in the internal medicine department at Borgou DHC. Normocytic, normochromic and moderate anemia are the most encountered. The pathologies encountered the most in anemic patients were digestive, renal, cardiac, pulmonary and infectious and especially malaria. Awareness of populations and practitioners for early health care of the pathologies that create anemia could improve this presentation in order to avoid its harmful effects.