Abstract
BackgroundMalaria control interventions have led to a decline in transmission intensity in many endemic areas, and resulted in elimination in some areas. This decline, however, will lead to delayed acquisition of protective immunity and thus impact disease manifestation and outcomes. Therefore, the variation in clinical and haematological parameters in children with malaria was assessed across three areas in Ghana with varying transmission intensities.MethodsA total of 568 children between the ages of 2 and 14 years with confirmed malaria were recruited in hospitals in three areas with varying transmission intensities (Kintampo > Navrongo > Accra) and a comprehensive analysis of parasitological, clinical, haematological and socio-economic parameters was performed.ResultsAreas of lower malaria transmission tended to have lower disease severity in children with malaria, characterized by lower parasitaemias and higher haemoglobin levels. In addition, total white cell counts and percent lymphocytes decreased with decreasing transmission intensity. The heterozygous sickle haemoglobin genotype was protective against disease severity in Kintampo (P = 0.016), although this was not significant in Accra and Navrongo. Parasitaemia levels were not a significant predictor of haemoglobin level after controlling for age and gender. However, higher haemoglobin levels in children were associated with certain socioeconomic factors, such as having fathers who had any type of employment (P < 0.05) and mothers who were teachers (P < 0.05).ConclusionsThe findings demonstrate significant differences in the haematological presentation and severity of malaria among areas with different transmission intensity in Ghana, indicating that these factors need to be considered in planning the management of the disease as the endemicity is expected to decline after control interventions.
Highlights
Malaria control interventions have led to a decline in transmission intensity in many endemic areas, and resulted in elimination in some areas
Children between the ages of 2–14 years who had lived in the community for at least 6 months and presented with symptoms of malaria were screened for malaria with rapid diagnostic tests (RDTs) using a drop of blood from a finger prick
Comparison of clinical and demographic parameters across transmission areas To investigate the variation in clinical presentation of malaria as transmission reduces, a total of 568 malaria positive children aged between 2 and 14 years, who were exposed to different intensities of P. falciparum transmission (Kintampo > Navrongo > Accra) were enrolled
Summary
Malaria control interventions have led to a decline in transmission intensity in many endemic areas, and resulted in elimination in some areas. This decline, will lead to delayed acquisition of protective immu‐ nity and impact disease manifestation and outcomes. Mensah‐Brown et al Malar J (2017) 16:96 artemisinin combination therapy (ACT), have significantly decreased malaria transmission This has led to a greater than 50% decline in malaria-related mortality in the last decade, from over a million deaths to under 500,000 annually [1, 5]. As many countries deploy malaria elimination strategies, a comprehensive analysis of the impact of decreasing malaria transmission on clinical and haematological indicators of disease is necessary to inform appropriate management of a changing malaria phenotype
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