A case control study on the association of iron deficiency anaemia and first simple febrile seizure among children aged six months to five years at French Medical Institute for Mothers and Children and Mother, Kabul, Afghanistan

Background: Iron deficiency (ID) and iron deficiency anaemia (IDA) are widespread conditions in children. Moreover, febrile seizure is the most common convulsive disorder which occurs in 3-5% of children 6 to 60 months of age. This study determined the demographic characteristics and risk factor for first febrile seizure in children hospitalized at FMIC, which would help improve management and taking preventive measures in the children at risk of febrile seizures. Aim: To explore the association of iron deficiency and iron deficiency anaemia with first simple febrile seizure among children six to five years of age at FMIC, Kabul, Afghanistan. Material and Methods: This was a hospital based retrospective case-control study, carried out on 340 children (170 cases and 170 controls) at French Medical Institute for Children, Kabul. All patients from 6 months to 5 years of age fulfilling the inclusion criteria and having seizure were included as cases and were compared to same number of age matched controls who had no seizure. The patients with positive family history of epilepsy and patient with hemolytic anaemia, history of prematurity, history of difficult delivery and late cry, recurrent and complex febrile seizures, and electrolyte imbalance were excluded from the study. To determine lab result of iron status, Haemoglobin (Hb), Hematocrit (Hct), MCV and MCH levels were reviewed. Results: A total of 32 (18.8%) children had iron deficiency (ID) and 57 (33.5%) had iron deficiency anaemia (IDA), compared to 17 (10 %) and 33 (19.4 %) of controls respectively; p=0.003. The mean age for cases was 22.97± 9.52 months while that for controls was 22.77 ± 11.33 with a male predominance, both in cases (67.6%), and controls (56.5%). Male to female ratio in case group was 2.8. One to three-year-old children were more likely to be iron deficient [15](63.5% of total 140 cases) in comparison to pre-schoolers and infants. Infants were in the second rank of suffering from FS (25.3%) with Odd ratio of 2.16 (p-value=0.019). Family history of FS was found positive (18.8%) (OR=3.05) in cases compared to controls (7.1%). The majority of cases were presented with upper respiratory tract infections (56.5%) followed by AOM and LRTI (49%) and (14%) respectively. Haemoglobin level of less than 10.5 mg/dl and 11.5 mg/dl with MCV pg/cell less than 70 and 75 were considered IDA in children younger than 2 years and older than 2 years age respectively. MCHC level was considered abnormal if less than 25 gr/dl. Conclusion: The present study concludes that hypochromic microcytic anaemia, is a risk factor for the occurrence of first simple febrile seizure; in addition, male gender, and positive family history of febrile seizure in first degree relatives are independently associated with febrile seizure. The most suffering age group in this study is between one and three years of age. Therefore, timely and appropriate preventive measures are critically needed to address iron deficiency in high risk population which will result in declining incidences of iron deficiency and febrile seizures. Above all, optimal growth and cognitive development would also be attained