Plasmodium vivax infection: a major determinant of severe anaemia in infancy

Journal article

Most malarious countries outside of Africa are co-endemic for Plasmodium falciparum and Plasmodium vivax. The comparative burden of anaemia in the community caused by these two species is incompletely characterized.A three-stage, cross-sectional, community survey was used to determine the proportion of moderate or severe anaemia (haemoglobin <7 g/dL) attributable to patent P. vivax, P. falciparum and mixed parasitaemia in Papua, Indonesia. Adjusted population-attributable fractions were calculated from multivariable logistic regression models. Eight hundred and twenty-five households were surveyed with a total of 5255 occupants, 3890 (74 %) of whom were present and provided a blood sample. Plasmodium falciparum parasitaemia was present in 8.1 % (n = 315) of participants, P. vivax in 6.4 % (n = 250) and mixed infections in 1.9 % (n = 72). Overall, P. falciparum was associated with a mean reduction in haemoglobin of 1.16 g/dL compared to those without patent parasitaemia [95 % confidence interval (95 % CI) 0.91, 1.41 g/dL]. The corresponding values for P. vivax and mixed infections were 0.66 g/dL (95 % CI 0.35, 0.96) and 1.25 g/dL (0.71, 1.80), respectively. Overall, 16.7 % (95 % CI 8.52, 24.2 %) of haemoglobin concentrations <7 g/dL in the community were estimated to be attributable to patent parasitaemia. The fractions for infants and 1-5 years old were 34.4 % (95 % CI -3.30, 58.3 %) and 23.2 % (95 % CI 3.34, 39.0 %), respectively. Plasmodium vivax was associated with a greater than threefold higher attributable fraction of anaemia in infants compared with P. falciparum [27.6 % (95 % CI -3.20, 49.2 %) versus 7.94 % (-5.87, 20.0 %)].Despite comparatively low-level endemicity, malaria is associated with a significant proportion of all cases of community anaemia in southern Papua. Contrary to its benign reputation, P. vivax is an important and preventable risk factor for anaemia during infancy-a probable consequence of relapsing disease prior to the development of immunity.

Authors: Kenangalem, E; Karyana, M; Burdarm, L; Yeung, S; Simpson, JA

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: Malaria Journal
• Volume: 15
• Pages: 321
• Publication date: 2017-06-16
• Acceptance date: 2017-06-04
• DOI: 10.1186/s12936-016-1373-8
• EISSN: 1475-2875
• ISSN: 1475-2875
• Pmid: 27306221
• Language: English
• Keywords: Humans; Pregnancy; Middle Aged; Anemia; Adult; Child; Male; Infant; Adolescent; Indonesia; Cross-Sectional Studies; Aged, 80 and over; Incidence; Malaria, Vivax; Young Adult; Coinfection; Female; Malaria, Falciparum; Infant, Newborn; Aged; Child, Preschool