Abstract
BackgroundHaematologic abnormalities are features in Plasmodium falciparum infection, and anaemia is an inevitable outcome. This study examines the influence of malaria status and altitude on haematologic parameters in school-aged pupils.MethodsA cross-sectional study was conducted among 728 school pupils aged between four and 15 years at three different altitudinal ranges along the slope of the Mount Cameroon region. The investigative methods included the use of questionnaire, clinical evaluation and laboratory investigations. Blood sample collected from each child was used for the preparation of blood films for detection of malaria parasites and assessment of malaria parasite density as well as full blood count determination using an automated haematology analyzer.ResultsThe prevalence of malaria in the study population was 33.8% and 64.2% (158/246) of these were asymptomatic (AM). Pupils in lowlands had a significantly (P <0.05) prevalence (95% confidence interval, CI) of malaria (60.6%, CI = 54.6–65.9%) than those in middle belt (29.1%, CI = 23.9–34.8%) and highlands (7.7%, CI = 6.1–9.8%), while those in middle belt had significantly higher geometric mean parasite density (475) than those in lowlands (233) and highlands (388). The prevalence of malaria was significantly higher in children that presented with fever (40.4%, CI = 33.8–47.2%) when compared with afebrile subjects (31%, CI = 27–35.2%). Pupils with AM had a higher prevalence of leucopaenia (43.7%, CI = 35.8–51.8%), microcytosis (27.2%, CI = 20.5–34.9%), hypochromasia (27.8%, CI = 21–35.5%) and thrombocytopaenia (14.9%, CI = 8.9–22.8%) when compared with those with clinical malaria (CM). All mean haematological parameters were comparable in pupils with CM and AM, except for the mean white blood cell (WBC) counts. Pupils with AM had significantly lower (P = 0.02) mean WBC counts (5.1 ± 2.5 × 109/L) than those with CM (5.9 ± 2.3 × 109/L). Age, altitude and malaria parasitaemia was of significant influence on several haematological parameters.ConclusionAltitude influenced the distribution and density of malaria parasites and was of confounding influence on the haematologic profiles. These results highlight the insidious effects of AM on the haematologic components.
Highlights
Haematologic abnormalities are features in Plasmodium falciparum infection, and anaemia is an inevitable outcome
Baseline characteristics of the study population Of the 728 pupils with a mean age of 8.62 ± 2.23 (CI = 8.5 – 8.9) years evaluated for the prevalence of malaria and their haematological parameters at different altitudes, 246 were positive for malaria
Malaria parasite and altitude The prevalence of malaria parasites in pupils varied with altitude
Summary
Haematologic abnormalities are features in Plasmodium falciparum infection, and anaemia is an inevitable outcome. Fever usually has a high sensitivity but poor specificity for the diagnosis of malaria, it still serves as the entry point for presumptive treatment of malaria in African children who, if left untreated, run the risk of severe complications and even death. Haematologic abnormalities are considered a feature in Plasmodium falciparum infection. The severity of haematologic disease caused by Plasmodium is related to the ability of the parasites to invade and grow in different red cell populations as well as the intrinsic growth rate of the parasite [4]. Anaemia is an inevitable outcome of malaria infection, but the haematocrit (Hct) in some patients with high parasite densities does not decrease as much as would be expected from the destruction of the parasitized red blood cells [5]. The impact of asymptomatic malaria (AM) on haematological parameters in schoolaged children is unclear
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