Abstract
BackgroundMost malarious countries outside of Africa are co-endemic for Plasmodium falciparum and Plasmodium vivax. The comparative burden of anaemia in the community caused by these two species is incompletely characterized.MethodsA three-stage, cross-sectional, community survey was used to determine the proportion of moderate or severe anaemia (haemoglobin <7 g/dL) attributable to patent P. vivax, P. falciparum and mixed parasitaemia in Papua, Indonesia. Adjusted population-attributable fractions were calculated from multivariable logistic regression models. Eight hundred and twenty-five households were surveyed with a total of 5255 occupants, 3890 (74 %) of whom were present and provided a blood sample. Plasmodium falciparum parasitaemia was present in 8.1 % (n = 315) of participants, P. vivax in 6.4 % (n = 250) and mixed infections in 1.9 % (n = 72). Overall, P. falciparum was associated with a mean reduction in haemoglobin of 1.16 g/dL compared to those without patent parasitaemia [95 % confidence interval (95 % CI) 0.91, 1.41 g/dL]. The corresponding values for P. vivax and mixed infections were 0.66 g/dL (95 % CI 0.35, 0.96) and 1.25 g/dL (0.71, 1.80), respectively. Overall, 16.7 % (95 % CI 8.52, 24.2 %) of haemoglobin concentrations <7 g/dL in the community were estimated to be attributable to patent parasitaemia. The fractions for infants and 1–5 years old were 34.4 % (95 % CI −3.30, 58.3 %) and 23.2 % (95 % CI 3.34, 39.0 %), respectively. Plasmodium vivax was associated with a greater than threefold higher attributable fraction of anaemia in infants compared with P. falciparum [27.6 % (95 % CI −3.20, 49.2 %) versus 7.94 % (−5.87, 20.0 %)].ConclusionDespite comparatively low-level endemicity, malaria is associated with a significant proportion of all cases of community anaemia in southern Papua. Contrary to its benign reputation, P. vivax is an important and preventable risk factor for anaemia during infancy—a probable consequence of relapsing disease prior to the development of immunity.
Highlights
Most malarious countries outside of Africa are co-endemic for Plasmodium falciparum and Plasmodium vivax
Patent parasitaemia was detected in 17.0 % of the participants, with P. falciparum present in 8.1 % (n = 315), P. vivax in 6.4 % (n = 250) and mixed infections in 1.9 % (n = 72) (Table 1)
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Summary
Most malarious countries outside of Africa are co-endemic for Plasmodium falciparum and Plasmodium vivax. Its impact is most apparent in the hospital setting where it accounts for a substantial proportion of malaria morbidity and, to a lesser extent, mortality [3,4,5,6]. The burden of malarial anaemia outside of healthcare facilities is less well understood and its contribution to ‘indirect’ malaria morbidity and mortality is largely unknown [7]. The adverse effects of mild or moderate anaemia per se are not clearly understood. Haemoglobin concentrations below 7 g/dL probably confer an increased risk of poor pregnancy outcomes such as haemorrhagic shock [5], low birth weight [8, 9] and poor neurocognitive development [10, 11] but other, less tangible, effects such as decreased resilience to infectious
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