Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency (Gd-) contributes to morbidity and mortality in sub-Saharan Africa but recent data on the interaction between Gd- and malaria among children is scarce. We hypothesised that, being a haemolytic factor, Gd- makes severe malarial anaemia (SMA) more common and even more severe. We selected 930 children aged 0.5-12 years attending a reference hospital with microscopically proven falciparum malaria. G6PD and haemoglobin were typed by the fluorescent spot test and electrophoresis, respectively. Molecular typing by PCR and restriction enzyme digestion was also performed on 15% of randomly selected samples. Haematocrit (PCV) values, haemoglobin type, blood group, presence of sickle cell trait (HbAS), and parasite counts were compared between G6PD-normal and deficient children. Prevalence of Gd- was 16.4% and 8.1% among boys and girls with malaria, respectively. Mean PCV was 22.8% in deficient children compared with 21.0% in normal children (p = 0.041). In boys, 2.7% of Gd- had PCV ≤ 10%, as compared to 13.6% in Gd+ (p = 0.005). Similarly, 21.3% of Gd- had PCV ≤ 15% compared with 39.4% in Gd+ (p = 0.003). No such difference was found among girls. Overall, HbAS was typed in 7.6% and was more common in Gd- (13.0%) than in Gd+ (6.8%), but the difference was not statistically significant (p = 0.058). The mean parasite counts were significantly lower in Gd- (15477.5/µl) than in Gd+ (19784.4/µl; p = 0.013), and it was independent from HbAS. Gd- males but not females were significantly less likely to develop severe malarial anaemia.
Highlights
Glucose-6-phosphate dehydrogenase (G6PD) deficiency (Gd–) contributes to morbidity and mortality in sub-Saharan Africa but recent data on the interaction between Gd– and malaria among children is scarce
[M:F = 1:1.03]) with symptomatic P. falciparum malaria were screened for G6PD deficiency
The age distribution of participants showed that the majority of the children with malaria was under five years
Summary
Glucose-6-phosphate dehydrogenase (G6PD) deficiency (Gd–) contributes to morbidity and mortality in sub-Saharan Africa but recent data on the interaction between Gd– and malaria among children is scarce. We hypothesised that, being a haemolytic factor, Gd– makes severe malarial anaemia (SMA) more common and even more severe. Haematocrit (PCV) values, haemoglobin type, blood group, presence of sickle cell trait (HbAS), and parasite counts were compared between G6PD-normal and deficient children. 21.3% of Gd– had PCV ≤15% compared with 39.4% in Gd+ (p=0.003) No such difference was found among girls. The co-existence of malaria and G6PD deficiency in the same sub-region constitute an even greater global health problem and threat to the life of children [1,2]. Acute haemolytic anaemia is the most frequent clinical manifestation of G6PD deficiency (Gd–) [7,8]. The haemolysis is precipitated most commonly by infections such as malaria but can occur after ingestion of drugs, including some antimalarials and foods that contain oxidants or in certain metabolic conditions such as diabetic ketoacidosis [9]
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