Epidemiology of malaria and anemia in high and low malaria-endemic North-Eastern districts of India

Abstract

Anemia and malaria are the two major public health problems that lead to substantial morbidity and mortality. Malaria infection destroys erythrocytes, resulting in low hemoglobin (Hb) levels known as anemia. Here we report the determinants of anemia in high and low malaria-endemic areas that would help understand which parasite densities, age, and gender-associated low Hb levels. Therefore, a cross-sectional mass survey (n = 8,233) was conducted to screen anemia and malaria in high and low malaria-endemic districts (HMED and LMED) of North-East India. Axillary body temperature was measured using a digital thermometer. The prevalence of anemia was found to be 55.3% (4,547/8,233), of which 45.1% had mild (2,049/4,547), 52.1% moderate (2,367/4,547) and 2.9% had severe anemia (131/4,547). Among anemic, 70.8% (3,219/4,547) resided in LMED and the rest in HMED. The median age of the anemic population was 12 years (IQR: 7–30). Overall, malaria positivity was 8.9% (734/8,233), of which HMED shared 79.6% (584/734) and LMED 20.4% (150/734) malaria burden. The village-wise malaria frequency was concordant to asymptomatic malaria (10–20%), which showed that apparently all of the malaria cases were asymptomatic in HMED. LMED population had significantly lower Hb than HMED [standardized beta (β) = −0.067, p < 0.0001] and low-density Plasmodium infections had higher Hb levels than high-density infections (β = 0.113; p = 0.031). Women of reproductive age had higher odds for malaria (OR: 1.42; 95% CI: 1.00–2.05; p = 0.04). Females (β = −0.193; p < 0.0001) and febrile individuals (β = −0.029; p = 0.008) have shown lower Hb levels, but malaria positivity did not show any effect on Hb. Young children and women of reproductive age are prone to anemia and malaria. Although there was no relation between malaria with the occurrence of anemia, we found low-density Plasmodium infections, female gender, and LMED were potential determinants of Hb.

Hematological Abnormalities Among Malaria Infected Adult Patients in Association with ABO Blood Groups at Jinella Health Center, Harar, Eastern Ethiopia

“…52 The odds of being anemic among female malaria-infected patients were 3.2 times higher than those of their male counterparts. This finding was supported by a study done in India, 53 and Cameroon. 54 The possible explanation might be due to chronic blood loss and abnormal menstrual function among female participants.…”

Prevalence and Associated Factors of Anemia in Children Aged 6 to 59 Months in the Eastern Region of Burkina Faso

“…This process lowers the amount of red blood cells and can in a severe stage cause severe anemia. 9 - 12 …”

Linkages between malaria and malnutrition in co-endemic regions of India

“…Cross-border malaria along with poor surveillance and high climatic suitability are major drivers of malaria transmission in these states 31. Recent studies have been unable to find a clear association between malnutrition and malaria in high malaria-endemic districts in the northeast 32…”

“…31 Recent studies have been unable to find a clear association between malnutrition and malaria in high malaria-endemic districts in the northeast. 32 The endemic states exhibited considerable districtwise heterogeneity in their malaria caseload/API. We observed that underweight children form high-high clusters and these clusters were spread uniformly in the eastern, central and western states of India, and overlapped with highly malaria-endemic districts (API >1)-Chhattisgarh, Jharkhand, Madhya Pradesh, Maharashtra and Odisha.…”