Abstract
Anaemia is amongst the major complications of malaria, a major public health problem in the Amazon Region in Latin America. We examined the haemoglobin (Hb) concentrations of malaria-infected patients and compared it to that of malaria-negative febrile patients and afebrile controls. The haematological parameters of febrile patients who had a thick-blood-smear performed at an infectious diseases reference centre of the Brazilian Amazon between December 2009-January 2012 were retrieved together with clinical data. An afebrile community control group was composed from a survey performed in a malaria-endemic area. Hb concentrations and anaemia prevalence were analysed according to clinical-epidemiological status and demographic characteristics. In total, 7,831 observations were included. Patients with Plasmodium falciparum infection had lower mean Hb concentrations (10.5 g/dL) followed by P. vivax-infected individuals (12.4 g/dL), community controls (12.8 g/dL) and malaria-negative febrile patients (13.1 g/dL) (p < 0.001). Age, gender and clinical-epidemiological status were strong independent predictors for both outcomes. Amongst malaria-infected individuals, women in the reproductive age had considerably lower Hb concentrations. In this moderate transmission intensity setting, both vivax and falciparum malaria are associated with reduced Hb concentrations and risk of anaemia throughout a wide age range.
Highlights
Most studies of malaria-related anaemia have focused on its occurrence in relation to Plasmodium falciparum in the African continent (Menéndez et al 2000), demonstrating that even asymptomatic infection leads to lower haemoglobin (Hb) values in children (Gansane et al 2013)
Data were obtained for subjects who participated in a Plasmodium infection survey and Hb survey performed in February 2010
After evaluation for inclusion, 6,282 observations that complied with the inclusion criteria were obtained, of which 4,631 (73.7%) tested negative for malaria, 1,067 (17%) were diagnosed P. vivax infection and 584 (9.3%) diagnosed with P. falciparum
Summary
Most studies of malaria-related anaemia have focused on its occurrence in relation to Plasmodium falciparum in the African continent (Menéndez et al 2000), demonstrating that even asymptomatic infection leads to lower haemoglobin (Hb) values in children (Gansane et al 2013). Since August 2009, the FMT-HVD has adopted an electronic medical record system (iDoctor®), which includes each patient’s clinical and laboratory data For this set, the inclusion criteria for patients was: (i) having a thick blood smear performed for Plasmodium sp. The second set of subjects comprised afebrile control individuals in two communities from a rural settlement area endemic for malaria located in the municipality of Careiro, AM (100 km from Manaus). This population is similar to the one seeking care at FMT-HVD. Laboratorial procedures and data extraction - In both sets of patients, malaria diagnosis was performed through Giemsa-stained thick blood smear read by trained microscopists. In a subsample of patients enrolled in the community, HemoCue results were compared with the automated cell counter, showing high consistency (Rippmann et al 1997)
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