The study included 49 children diagnosed with severe acute malnutrition, of whom 26 (53.06%) were girls and 23 (46.94%) were boys admitted to the CRINE of the N’Zerekore Regional Hospital, with a sex ratio of less than 1 (≈ 0.88), in favor of girls. The number of children in the 6 to 11 months age group (G1) was 10 (20.41%), from 12 to 23 months (G2) was 24 (48.98%), from 24 to 35 months (G3) was 13 (26.53%), and from 36 to 59 months (G4) was 2 (4.08%). The most affected group of children was those aged between 12 and 23 months (p < 0.0001). However, there were more boys in the first age group of 6 to 11 months. No boys older than 35 months were represented among the SAM children (Figure 1).

Figure 1. Graph showing the number of children studied by gender and age group at the CRENI of the regional hospital in N’Zérékoré, Republic of Guinea—G1: children aged 6 to 11 months, G2: children aged 12 to 23 months, G3: children aged 24 to 35 months, and G4: children aged 36 to 59 months.

Blood tests performed on all pediatric patients highlight the physiological effects of SAM. Hemoglobin, hematocrit, and platelet counts were lower in these children than usual values (Table 1). For hemoglobin (Hb), the average levels, according to gender (Figure 2(a1)) and age groups (Figure 2(a2)), were very heterogeneous with a statistically significant difference (p < 0.0001). The lowest hemoglobin level was observed in a girl (7.78 g/dL). The majority of them had levels between 6 and 10g/dL. However, among boys, where levels were higher, the majority had values between 8 and 10g/dL (Figure 2(a1)). According to age groups, the lowest mean was observed in children in group G3 (7.92 g/dL) and the highest mean in children in group G1 (9.02 g/dL) (Figure 2(a2)) with a significant difference.

Table 1. Average hematological values recorded in malnourished children by gender and age group.

Figure 2. Bar plots showing the difference between the mean hematological values recorded in malnourished children by gender and age group—Hemoglobin by gender (a1), hemoglobin by age group (a2); hematocrit by gender (b1), hematocrit by age group (b2); thrombocytes (platelets) by gender (c1), thrombocytes (platelets) by age group (c2).

For hematocrit (Hte), the values observed in all children were significantly below normal values (p < 0.0001). According to gender (Figure 2(b1)), there was no significant difference in the average rates observed in girls and boys (24.53% vs. 27.66%). By age group (Figure 2(b2)), the lowest average rate was observed among children in group G3 (23.84%) and the highest average rate among children in group G1 (28.96%).

For thrombocytes (or platelets, PLT), 41% (n = 20) of children had normal platelet counts. Thrombocytopenia was present in 51% (n = 25) of cases, of which 44% (n = 11) were severe, and thrombocytosis was present in 8% (n = 4) of cases. The values of this parameter observed in these children were statistically the same (p = 0.7144). The mean platelet count was higher in girls than in boys (216.98 g/L vs. 193.03 g/L), with no significant difference (Figure 2(c1)). According to age groups (Figure 2(c2)), the lowest average was observed in children in group G4 (100.00 g/L) and the highest average in children in group G2 (228.11 g/L), no statistically significant difference observed (p = 0.7144). However, extremely low values (2 - 19 g/L) were observed in 4 (8.16%) children and extremely high values in 4 children (500 - 896 g/L). The extremely low values were mostly observed in 3 girls, and the extremely high values were also observed in 3 girls. Among the children with very low values, 2 belonged to group G2, 1 child to G1, and 1 to G3. And, for children with high values, 3 were from group G2 and 1 from G1.

Among all hematological parameters studied in these patients, a strong correlation was observed between variations in hemoglobin levels and hematocrit levels (ρ = 0.55; p < 0.0001). However, no correlation was observed between thrombocytes and hemoglobin levels or hematocrit levels.

Biochemical tests performed on blood samples taken from children participating in this study revealed different values for the parameters studied (Table 2).

Table 2. Average biochemical values recorded in malnourished children by gender and age group.

With regard to blood glucose levels, the average values observed in all children (girls: 0.92 g/L and boys: 0.94 g/L) were below the upper pathological threshold. Overall, 16.33% of children had low blood glucose levels, including 21.74% (n = 5/23) of boys and 11.54% (n = 3/26) of girls. No significant differences were observed in blood glucose variation among these children based on gender and age group (p = 0.9600). There was no significant difference in these averages between girls and boys (Figure 3(a1)). Also, according to age, a slight, non-significant increase was observed in children in the G4 group (1.50 g/L) (Figure 3(a2)).

For transaminases, depending on gender, the average values were higher than the reference values. In girls, ALT and AST were 110.05 IU/L and 98.90 IU/L, respectively, and in boys, ALT and AST were 119.18 IU/L and 140.92 IU/L, respectively. Each of these two parameters shows statistically different values (ALT, p = 0.0069 and AST, p < 0.0001). According to age, the highest average was observed in children in group G4 (136.20 IU/L) for ALT transaminases (Figure 3(b1)) and in children in group G2 (138.33 IU/L) for AST transaminases (Figure 3(c1)). These averages did not show any statistically significant differences. However, a moderate correlation between the increase in ALT and AST values was observed (ρ = 0.48; p < 0.0001).

With regard to creatinine levels, the mean values observed in our sample were statistically significantly higher than the reference values (p < 0.0001). However, there was no statistical difference between creatinine levels according to gender (Figure 3(d1)) and age (Figure 3(d2)).

Figure 3. Bar plots showing the difference between the mean biochemical values recorded in malnourished children by gender and age group—Blood sugar by gender (a1), Blood sugar by age group (a2); transaminases (ALT) by gender (b1), transaminases (ALT) by age group (b2); transaminases (AST) by gender (c1), transaminases (AST) by age group (c2); creatinine by gender (d1), creatinine by age group (d2).

Anemia is a hematological disorder that has direct and indirect consequences on a person’s health and development. These disorders are linked to nutritional deficiencies. Although anyone can be affected, women of childbearing age, children under 5, and the elderly are most at risk [29][30].

This study directly assessed the severity of anemia through targeted biological parameters, including hematological and biochemical parameters in children under 5 years of age. Of the 49 malnourished children identified for this study, the majority were in the 12 - 23 months (G2) and 24 - 35 months (G3) age groups. This could be explained by the fact that children become independent in terms of food at an early age, which is linked to their weaning being less or not compensated for in terms of nutrients, and also by the fact that breast milk alone is no longer sufficient to meet their iron, vitamin, and other micronutrient requirements. This period, which marks a transitional phase in a child’s diet, may be characterized by an insignificant and inadequate food intake, depending on the living conditions of the child’s parents.

The female sex was overrepresented among registered malnourished children, indicating that girls may be more vulnerable to this condition and consistent with findings from previous studies. [12][31]. Most of these girls were in the 12 - 23 months (G2) and 24 - 35 months (G3) age groups and were only represented in the 36 - 59 months (G4) age group. However, in the 6 - 11 months (G1) age group, boys were more represented than girls. This could be related to the vulnerability of male children aged 6 - 12 months, who have an increased risk of iron deficiency anemia [11][27].

In all children in our study, hemoglobin levels were significantly below the normal threshold, thus proving to be one of the main indicators of anemia [32][33]. According to age groups, the lowest hemoglobin levels observed in children in group G3 could be explained by the fact that at this age, children in developing countries are often exposed to poor-quality diets (in terms of diversity, protein intake, etc.) and associated infections, which can have a significant impact on hemoglobin levels [12][34]. However, among children in group G1, hemoglobin levels were higher than in other age groups. This could be related to the transition from fetal hemoglobin (FHb) to adult hemoglobin (AHb), whereby newborns are born with high levels of fetal hemoglobin (FHb) which has a stronger affinity for oxygen and then decreases over time (a few months) [35][36].

A significant decrease in hematocrit levels was observed in all children examined. This decrease clearly follows the distribution of hemoglobin levels according to gender and age group. A significant dependent correlation was observed between hemoglobin levels and hematocrit levels [37].

The platelet profile observed in our sample is heterogeneous, with normal platelet counts in 41% of children, thrombocytopenia in 51% of children, including 44% of children with severe thrombocytopenia, and thrombocytosis in 8% of children. This shows various pathologies associated with malnutrition in these children or a group subjected to significant physiological stress (malnutrition, infection, treatment, etc.). This confirms that malnutrition can significantly disrupt platelet levels (in both directions). These results are similar to those of several previous studies [38]-[40]. It should be noted that the a potentially disruptive disruptive effect of these hematological parameters was the presence of malaria infection, since more than 65% (n = 32) of children had been diagnosed with malaria.

Among all hematological parameters studied in these patients, a strong correlation was observed between variations in hemoglobin levels and hematocrit levels (p < 0.0001). However, no correlation was observed between thrombocytes and hemoglobin levels (p = 0.149) or hematocrit levels (p = 0.142).

Differences in levels were observed in the biochemical parameters used in this study. This could be related to the composition of the population of children examined.

Blood glucose levels were on average below the usual maximum threshold. The slight increase observed in three children, if the measurements were postprandial, could be tolerable. They could therefore reflect metabolic stress, liver damage, an endocrine abnormality, recent glucose intake or infusion (false positive). Otherwise, they could be considered hyperglycemic (abnormal).

The assessment of liver function showed a variety of responses in specific markers (transaminases, ALT, and AST) in the patients (children) concerned. These different responses could be linked to the nutritional status of these children. A comparison of the values obtained against the reference threshold made it possible to distinguish between slightly elevated values (40 - 100 IU/L), moderate values (101 - 300 IU/L) and severe values (>300 IU/L). These transaminase disturbances have been observed in malnourished individuals in previous studies [41][42]. These conditions are associated with malnutrition, mild infections, or liver damage. The significant correlation observed between increased ALT and AST values (p = 0.0176) would confirm this damage due to the presence of lesions [43][44].

The renal function test revealed no significant difference between the creatinine levels observed in the children in our study (p = 0.1322). The creatinine levels observed in the children in group G2 were very similar to those observed in the children in group G1 (p = 0.0229). For both age groups (G1 and G2), the values observed were very high compared to normal values. The vast majority of children (90%) had creatinine levels between 0.2 and 0.7 mg/dL. A few slightly higher values (0.85 - 1.1 - 1.47 mg/dL) are borderline or moderately elevated, which may indicate temporary mild dehydration or a normal biological effect and, in isolated cases, more rarely, the onset of kidney damage.