Differences in palpable liver and spleen rates between men and women of the Sepik District, New Guinea: The effects of pregnancy and lactation

Abstract

1. 1) The palpable liver and spleen rates of children in the Maprik area, Sepik District, show no differences between the sexes and are characteristic of holoendemic malaria in the south-west Pacific. 2. 2) Women have significantly higher liver and spleen rates over the age of 20 years than men. 3. 3) Analysis reveals that this sex difference in liver and spleen rates occurs even with nulliparous women, but also that it becomes significantly increased further with increasing parity. 4. 4) Lactation, rather than pregnancy alone, appears to be related to this increase of liver and spleen rates with parity. 5. 5) Loss of weight among women during the child-bearing ages is very marked. Reasons are put forward for the assumption that this is due to a protein deficiency which most severely affects lactating mothers. 6. 6) No relationship was found between the palpable liver or spleen rates of adults, grouped by age, sex and racial origin, and their body heights or weights. It is concluded that malnutrition in childhood or any other experience that may have permanently affected their growth has had no observable effect on the incidence of hepatomegaly or splenomegaly among those individuals who survived to adult life. 7. 7) Malaria parasite rates in adults of both sexes do not differ significantly, but women in their first lactation have significantly higher rates than women of the same age who have never lactated. It is suggested that, owing to a relatively more severe protein deprivation, the livers of lactating women may produce more tissue reaction in response to malarial parasitaemia than those of men or nulliparous women, and that their state of premunition is temporarily decreased by the stress of lactation. However the possibility that other infective or toxic factors besides malaria are also operative cannot be excluded. 8. 8) Significantly lowered haemoglobin values have been found to be associated with hepatomegaly, but not with splenomegaly alone, in women over 30 years of age. It is suggested that this may indicate that there exists in the Sepik District, on a large scale, a syndrome of anaemia with hepatomegaly in multiparous women deprived of protein that has previously been found among patients in Nigerian maternity wards.