Hemoglobin Levels and the Risk of Malaria in Papua New Guinean Infants: A Nested Cohort Study

Abstract

Studies are available that assess the risk of malaria in accordance to the body's iron store and the systematic iron supplementation of preschool children. However, only a few studies evaluated the temporal association between hemoglobin and malaria and their results are opposing. A total of 1,650 3-month-old Papua New Guinean infants were enrolled in this study and followed-up for 12 months. The risk of malaria was assessed in all children every 3 months and with each episode of fever. The incidence of clinical malaria between 3 and 15 months of age was 249 cases per 1,000 infants per year. After adjustment for potential confounding factors, a decrease of 1 g/dL of hemoglobin was associated with a nonsignificant increase of 11% for risk of malaria infection (hazard ratio, 1.11, 95% confidence interval; CI, 0.99-1.25, = 0.076). Only children with severe anemia (hemoglobin< 8.0 g/dL) at baseline were at higher risk of malaria infection (hazard ratio, 1.72, 95% CI, 1.08-2.76, = 0.023) during the follow-up year compared with the control group (Hemoglobin> 10.0 g/dL). This association was not statistically significant if only clinical malaria episodes were taken into account (hazard ratio, 1.42, 95% CI, 0.77-2.61, = 0.26). Our study suggests that infants with lower hemoglobin levels are not protected against malaria infection. Further research that examines the risk of malaria in relation to both hemoglobin and iron store levels would be important to better understand this complex interaction.

Factors Associated with Anemia Status Among Children Aged 6–59 months in Ghana, 2003–2014

“…nutrient supplementation) and exposure to infectious disease (i.e. fever, malaria, intestinal parasites) (Mueller et al 2017;Paganini and Zimmermann 2017). Secondly, there are underlying causes at the household/family level, such as access to water and sanitation, availability of health services, childcare practice (e.g.…”

Iron Status and Associated Malaria Risk Among African Children

“…Similar observations from 2 previous studies have been reported. A recent longitudinal study in Papua New Guinean infants aged 3 months and followed for 1 year reported a nonsignificant association between lower hemoglobin concentrations and subsequent malaria infection [19]. Ghosh et al made a similar observation in Indian children [20].…”

“…In mouse models, hepcidin has been shown to play a role in preventing superinfection by depriving the Plasmodium liver stage of iron [16], but studies in children have reported mixed findings [17, 18]. Two previous studies have reported that hemoglobin concentrations do not influence malaria risk [19, 20], while in vitro culture indicates otherwise [21]. There are no specific reports of the influence of sTfR and TSAT on malaria in humans.…”

Risk Association, Linkage Disequilibrium, and Haplotype Analyses of β-Like Globin Gene Polymorphisms with Malaria Risk in the Sabah Population of Malaysian Borneo

“…This clearly explains that individuals who carried the variant GG genotype confer a protective risk effect against P. vivax infection by 0.5-fold, as observed in the present study. However, a recent study reported that infants with lower hemoglobin levels are not protected against malaria infection in a Papua New Guinean population [ 30 ]. Since the present study only involved adults and the hemoglobin level of the subjects is not assessed, further studies that investigate the risk of malaria in relationship with age differences and hemoglobin levels would be important for a better understanding of this complex interaction.…”