Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in southeast Iran: implications for malaria elimination

Abstract

Introduction: Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked genetic disorder with a relatively high frequency in malaria-endemic regions. It is an obstacle to malaria elimination, as primaquine administered in the treatment of malaria can cause hemolysis in G6PD-deficient individuals. This study presents information on the prevalence of G6PD deficiency in Sistan and Balouchetsan province, which hosts more than 90% of Plasmodium vivax malaria cases in Iran. This type of information is needed for a successful malaria elimination program. Methodology: A total of 526 students were randomly recruited through schools located in southeast Iran. Information was collected by interviewing the students using a structured questionnaire. Blood samples taken on filter papers were examined for G6PD deficiency using the fluorescent spot test. Results: Overall, 72.8% (383/526) of the subjects showed normal G6PD enzyme function. Mild and severe G6PD deficiency was observed in 14.8% (78) and 12.2% (64) of subjects, respectively. A total 193/261 males (73.9%) and 190/265 (72%) females had normal enzyme activity. Mild G6PD deficiency was observed in 10.8% (28) and 18.9% (50) of male and female subjects, respectively. However, in comparison with females, a greater proportion of males showed severe enzyme deficiency (15.3% versus 9.1%). All these differences were statistically significant (p < 0.006). Conclusions: G6PD deficiency is highly prevalent in southeast Iran. G6PD-deficient individuals are susceptible to potentially severe and lifethreatening hemolytic reactions after primaquine treatment. In order to achieve malaria elimination goals in the province, G6PD testing needs to be made routinely available within the health system.

Prevalence and hematological indicators of G6PD deficiency in malaria-infected patients

“…This indicates that malaria and G6PD deficiency share similar geographical distributions. This study showed that 6.9 % of malaria-infected patients were diagnosed with a G6PD deficiency, which is lower than reported by previous studies conducted in southeast Iran (27 %) [ 13 ], Cambodia (13.9 %) [ 14 ], and southwest Ethiopia (7.3 %) [ 15 ]. However, it was higher than that reported in Eastern Indonesia (5.1 %) [ 16 ] and the Brazilian Amazon (4.5 %) [ 17 ].…”

Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in malaria endemic region of Iran (Sistan and Baluchestan Province): Epidemiological profile and trends over time

“…According to the previous epidemiologic studies, the prevalence rate of G6PD deficiency is higher among males than females [11,27,[30][31][32][33][34][35]. In line with these studies, the current study also revealed a higher prevalence rate of G6PD deficiency among males compared to the females.…”

“…Several epidemiological studies demonstrated that G6PD deficiency is mainly distributed in areas of the world where malaria was previously or is currently endemic [11,21,25,26,32,35]. Similarly, there is various geographic distribution of G6PD deficiency in the study regions with the highest prevalence rate observed in Chahbahar District as one of the previously malaria endemic areas in contrast to the lowest prevalence rate seen in Zahedan District as non-malaria endemic region, although low/high prevalence of G6PD deficiency in endemic/non-endemic part can be due to some factors such as immigration of healthy or malarious individuals and method of sampling.…”

Glucose-6 Phosphate Dehydrogenase Deficiency in terms of hemolysis indicators and management

“…(8,9) Number of factors can precipitate hemolysis in G6PDdeficient subjects; such as certain drugs, infections, and some metabolic conditions, like diabetic ketoacidosis. (10)(11)(12)(13)(14)(15)(16)(17) Clinical signs and symptoms of hemolysis typically arise within 24 to 72 hours of drug dosing, and anemia worsens until about day (7). This makes it difficult for the health practitioner to identify a hemolytic crisis in patients who undergo outpatient or short hospital stay (less than 24 hour) procedures.…”