Plasmodium Falciparum-Associated Anemia in Children at a Large Urban Hospital in Zaire

Abstract

Chloroquine-resistant Plasmodium falciparum malaria and human virus (HIV) infection through blood transfusions used to treat malaria-associated anemia are causes of increasing morbidity and mortality among children in Africa. To evaluate the role of malaria and other risk factors for pediatric anemia, we conducted a study of children brought to the emergency ward of a large urban hospital in Kinshasa, Zaire. A total of 748 children ages six through 59 months were enrolled; 318 (43%) children were anemic (hematocrit < 33%), including 74 (10%) who were severely anemic (hematocrit < 20%). Plasmodium falciparum parasites were detected in 166 children (22%); hematocrits for these children (mean 25.8%) were significantly lower than for aparasitemic children (mean 33.7%; P < 10(-6)). Fever with splenomegaly (odds ratio [OR] = 6.5, P = 0.02), parasitemia (OR = 3.5, P < 0.001), lower socioeconomic status (OR = 2.0, P = 0.004), and malnutrition (OR = 1.8, P = 0.06) were independently associated with anemia in a multivariate model. Recent antimalarial therapy was also associated with a lower hematocrit, suggesting that chloroquine may have aggravated the anemia. A reassessment of the effectiveness of strategies to diagnose and treat malaria and malnutrition is necessary to decrease the high prevalence of anemia and the resultant high rate of blood transfusions in areas endemic for malaria and HIV.

Prevalence of and risk factors for anemia in young children in southern Cameroon.

“…Forty-three percent of the children less than five years of age who were brought to the emergency ward of a hospital in Kinshasa, Zaire were anemic. 3 Moreover, in a three-year longitudinal survey with a half-year follow-up, our results specified the age-related decrease in the prevalence of anemia in children from six to 60 months of age. Our study clearly showed a decrease in the prevalence of anemia after 30 months of age (42% versus 21% before and after 30 months of age, respectively; P Ͻ 10 -8 ).…”

“…Several previous studies have demonstrated an association between anemia and symptomatic malaria. 3,4 Since most of the children in our study were asymptomatic, we suggest that asymptomatic malaria is also a strong risk factor for anemia in children. 16,[18][19][20][21][22] The frequency of parasitemia was not a significant risk factor in the multivariate model, suggesting that the mechanism responsible for malaria-related anemia involved predominantly acute hemolysis as compared with dyserythropoiesis or ineffective erythropoiesis due to recurrent parasitemia.…”

“…1,5 Similarly, parasitic diseases such as malaria and ankylostomiasis have been reported to lead to a high prevalence of anemia during childhood. [3][4][5][6] Sickle cell disease has been also recognized as an important risk factor for anemia in sub-Saharan countries. 5,7 However, the relative contributions of these etiologies remain unclear.…”

“…1,2 In sub-Saharan Africa in children less than five years of age, the prevalence of anemia varies from 43% in Zaire to 74% in Tanzania. 3,4 Its etiology in tropical countries is multifactorial: thus, the most important risk factors need to be identified for prevention strategy. Anemia is commonly associated with nutritional deficiencies such as iron deficiency, the main factor responsible for microcytic anemia, while folate or vitamin B 12 deficiencies are responsible for macrocytic anemia.…”

Randomized intervention study comparing several regimens for the treatment of moderate anemia among refugee children in Kigoma Region, Tanzania.

“…[1][2][3][4] The World Health Organization estimates that the prevalence of anemia, defined by a hemoglobin concentration of less than 11.0 g/dL in African children less than five years of age, is approximately 33%. 5 Individual studies have estimated the prevalence of anemia to be from 24% in western Africa to almost 80% in western Kenya.…”