Malaria Anaemia Research Articles

Endemic Burkitt lymphoma: a complication of asymptomatic malaria in sub-Saharan Africa based on published literature and primary data from Uganda, Tanzania, and Kenya

BackgroundEndemic Burkitt lymphoma (eBL) is an aggressive B cell non-Hodgkin lymphoma associated with antigenic stimulation from Plasmodium falciparum malaria. Whether eBL risk is related to malaria parasite density is unknown. To address this issue, children with eBL, asymptomatic and clinical malaria, as a surrogate of malaria parasite density, were assessed.MethodsMalaria-related laboratory results (parasite density, haemoglobin, platelet count, and white cell count [WBC]) count) were compiled for 4019 eBL cases and 80,532 subjects evaluated for asymptomatic malaria or clinical malaria (severe malaria anaemia, hyperparasitaemia, cerebral malaria, malaria prostration, moderate malaria, and mild malaria) in 21 representative studies published in Africa (mostly East Africa) and 850 eBL cases and 2878 controls with primary data from the Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) case–control study in Uganda, Tanzania, and Kenya. The average values of malaria-related laboratory results were computed by condition and trends across single-year age groups were assessed using regression and spline models.ResultsOverall, malaria infection or malaria was diagnosed in 37,089 of children compiled from the literature. Children with eBL and asymptomatic parasitaemia/antigenaemia, but not those with clinical malaria, were closest in their mean age (age 7.1–7.2 vs. 7.4–9.8 years), haemoglobin level (10.0–10.4 vs. 11.7–12.3 g/dL), malaria parasite density (2800 vs. 1827–7780 parasites/µL), platelet count (347,000–353,000 vs. 244,000–306,000 platelets/µL), and WBC count (8180–8890 vs. 7100–7410 cells/µL). Parasite density in these two groups peaked between four to five years, then decreased steadily thereafter; conversely, haemoglobin showed a corresponding increase with age. Children with clinical malaria were markedly different: all had an average age below 5 years, had dramatically elevated parasite density (13,905–869,000 parasites/µL) and dramatically decreased platelet count (< 159,000 platelets/µL) and haemoglobin (< 7 g/dL).ConclusionseBL and asymptomatic parasitaemia/antigenaemia, but not clinical malaria, were the most similar conditions with respect to mean age and malaria-related laboratory results. These results suggest that children with asymptomatic parasitaemia/antigenaemia may be the population at risk of eBL.

Spatial and temporal patterns of nitric oxide diffusion and degradation drive emergent cerebrovascular dynamics.

Nitric oxide (NO) is a gaseous signaling molecule that plays an important role in neurovascular coupling. NO produced by neurons diffuses into the smooth muscle surrounding cerebral arterioles, driving vasodilation. However, the rate of NO degradation in hemoglobin is orders of magnitude higher than in brain tissue, though how this might impact NO signaling dynamics is not completely understood. We used simulations to investigate how the spatial and temporal patterns of NO generation and degradation impacted dilation of a penetrating arteriole in cortex. We found that the spatial location of NO production and the size of the vessel both played an important role in determining its responsiveness to NO. The much higher rate of NO degradation and scavenging of NO in the blood relative to the tissue drove emergent vascular dynamics. Large vasodilation events could be followed by post-stimulus constrictions driven by the increased degradation of NO by the blood, and vasomotion-like 0.1–0.3 Hz oscillations could also be generated. We found that these dynamics could be enhanced by elevation of free hemoglobin in the plasma, which occurs in diseases such as malaria and sickle cell anemia, or following blood transfusions. Finally, we show that changes in blood flow during hypoxia or hyperoxia could be explained by altered NO degradation in the parenchyma. Our simulations suggest that many common vascular dynamics may be emergent phenomena generated by NO degradation by the blood or parenchyma.

Burden, clinical manifestation and outcome of severe malaria in children at a tertiary hospital in Northeast, Nigeria

Background: Severe malaria is a life-threatening medical emergency and requires prompt and effective treatment to prevent death. The presentation of severe malaria varies depending on such factors as country, age, immunity, socioeconomic factors, drug resistance and type of intervention measures used. The aim of this study is to document the burden and forms of severe malaria in children in this region. Objective of this study was to determine the prevalence, clinical manifestation and outcome of children with severe malaria in Federal Teaching Hospital, GombeMethods: Case notes of patients admitted to the emergency Paediatric Unit and paediatric medical ward of Federal Teaching Hospital, Gombe with severe malaria from January 2014 to December 2018 (5years) were reviewed. Information sought included age, gender, use of ITN, parents’ education and occupation, criteria for diagnosis, treatment and outcome.Results: A total of 2,808 children were admitted during the period of study, out of these 237 (8.4%) had severe malaria. There were 140 (59.1%) male and 97 (40.9%) female with M: F of 1.4:1. Majority 129 (54.4%) of patients were aged more than 5 years. The most frequent modes of presentation were multiple convulsions 124 (52.3%), cerebral malaria 97 (40.9%) and severe anaemia 61 (25.7%). Some 45 (19.0%) of the subjects presented with multiple diagnostic criteria. Multiple convulsions, cerebral malaria and severe anaemia were significantly related to likelihood of mortality.Conclusions: The prevalence of severe malaria is high and multiple convulsions, cerebral malaria and severe anaemia are significantly associated with risk of mortality.

Prevalence and determinants of anaemia in women of reproductive age in Sudan: analysis of a cross-sectional household survey

BackgroundAnaemia is a global health problem and women in reproductive age (WRA) are amongst the most affected population. Its consequences include low birth weight and maternal mortality. This study aimed to assess the prevalence of anaemia and to identify its determinants in Sudanese women in reproductive age.MethodsA population-based cross-sectional study was conducted in Sudan in 2016. A multi-stage stratified cluster sampling design was executed with consideration of rural population, urban population, and internally displaced persons/refugees camps residents. All women in reproductive age (15–49 years), classified by pregnancy status, in the targeted households were surveyed and personal characteristic data were collected. Their haemoglobin level and malaria infection (using rapid diagnostic test, RDT) were assessed. The World Health Organization (WHO) haemoglobin level cut-off for defining anaemia and severe anaemia in pregnant and non-pregnant women was used. Logistic regression analyses were performed.ResultsA total of 4271 women (WRA) of which 421 (9.9%) pregnant women (PW) were included in the study. The overall anaemia prevalence in WRA was 35.6%. It was 36.0 and 35.5% in PW and non-pregnant women (NPW), respectively. The average haemoglobin level was found to be 113.9 g/L (SD 16.3) and 123.2 g/L (SD 15.7) for PW and NPW respectively. Severe anaemia prevalence was 1.2% in each group. In the logistic regression model, anaemia was associated with malaria infection in PW (aOR 4.100, 95%CI 1.523–11.039, p = 0.003), NPW (aOR 2.776, 95%CI 1.889–4.080, p < 0.001), and WRA (aOR 2.885, 95%CI 2.021–4.119, p < 0.001). Other identified determinants of anaemia in NPW was living in camps (aOR 1.499, 95%CI 1.115–2.017, p = 0.007) and in WRA was being in the poorest economic class (aOR 1.436, 95%CI 1.065–1.936, p = 0.018).ConclusionsAnaemia is a public health problem in Sudan. The study supported the association between malaria infection and anaemia, but not with low and moderate malaria transmission areas. Resources need to be allocated for all anaemic populations with special attention for the populations in most need and interventions need to be implemented based on local variations. Malaria control interventions, specifically case management, may have a major impact in reducing anaemia prevalence in low to moderate malaria transmission areas.

Influence of blood group, Glucose-6-phosphate dehydrogenase and Haemoglobin genotype on Falciparum malaria in children in Vihiga highland of Western Kenya

BackgroundGenetic diversity of ABO blood, glucose-6-phosphate dehydrogenase (G6PD) deficiency and haemoglobin type and their ability to protect against malaria vary geographically, ethnically and racially. No study has been carried out in populations resident in malaria regions in western Kenya.MethodA total of 574 malaria cases (severe malaria anaemia, SMA = 137 and non-SMA = 437) seeking treatment at Vihiga County and Referral Hospital in western Kenya, were enrolled and screened for ABO blood group, G6PD deficiency and haemoglobin genotyped in a hospital-based cross-sectional study.ResultWhen compared to blood group O, blood groups A, AB and B were not associated with SMA (P = 0.380, P = 0.183 and P = 0.464, respectively). Further regression analysis revealed that the carriage of the intermediate status of G6PD was associated with risk to SMA (OR = 1.52, 95%CI = 1.029–2.266, P = 0.035). There was, however, no association between AS and SS with severe malaria anaemia. Co-occurrence of both haemoglobin type and G6PD i.e. the AA/intermediate was associated with risk to SMA (OR = 1.536, 95%CI = 1.007–2.343, P = 0.046) while the carriage of the AS/normal G6PD was associated with protection against SMA (OR = 0.337, 95%CI = 0.156–0.915, P = 0.031).ConclusionResults demonstrate that blood group genotypes do not have influence on malaria disease outcome in this region. Children in Vihiga with blood group O have some protection against malaria. However, the intermediate status of G6PD is associated with risk of SMA. Further, co-inheritance of sickle cell and G6PD status are important predictors of malaria disease outcome. This implies combinatorial gene function in influencing disease outcome.

IMPACT OF PREVENTIVE PRACTICES ON ANAEMIA DUE TO MALARIA AMONG CHILDREN ATTENDING OUT-PATIENT CLINIC IN SPECIALIST HOSPITAL YOLA, ADAMAWA STATE, NIGERIA

The study focused on the impact of preventive practices on anaemia due to malaria among children. The study considered Out-Patients children who came to laboratory for malaria diagnostic test. Blood sample was examined using Giemsa stain for parasite detection and speciation. Informed consent was obtained and structured questionnaire were administered. Pack Cell Volume was used to screened for anaemia. A total of 310 children were sampled. Malaria anaemia in relation to types of net used, children that were anaemic with malaria used damage insecticide nets recorded highest and least among those using untreated insecticide net with 57.1% and 38.0% respectively (p˃0.05). Malaria anaemia based on insecticide application, those used cover cloth (50.0%) against mosquito vector and are anaemic with malaria recorded highest while those applied house spray (25.0%) had the least. Malaria anaemia with regard to sleeping habit of the child at night, high proportion were seen in children that were anaemic with malaria sleeping outdoor (56.5%) while those sleeping indoor (36.9%) recorded least (p˃0.05). Subjects that were anaemic with malaria and previously used Sulphonamides (51.4%) had highest prevalence (p˃0.05). Children that were anaemic with malaria and period of last treatment of four months (58.2%) recorded highest while period of last treatment of one month (24.1%) had the least (p˃0.05). Therefore, insecticide application using house spray, stayed indoor at night using mosquito nets had an impact on reducing the risk of anaemia due to malaria.

Complex case of differential diagnosis of malaria and hemolytic anemia

Correct diagnosis is the basis of timely and complete treatment. Sometimes situations arise in clinical practice when it seems that the diagnosis does not cause any doubts. However, experience shows that an erroneous diagnosis, even when it seems certain, is not uncommon.

Delayed iron improves iron status without altering malaria risk in severe malarial anemia

WHO guidelines recommend concurrent iron and antimalarial treatment in children with malaria and iron deficiency, but iron may not be well absorbed or utilized during a malaria episode. We aimed to determine whether starting iron 28 d after antimalarial treatment in children with severe malaria and iron deficiency would improve iron status and lower malaria risk. We conducted a randomized clinical trial on the effect of immediate compared with delayed iron treatment in Ugandan children 18 mo-5 y of age with 2 forms of severe malaria: cerebral malaria (CM; n=79) or severe malarial anemia (SMA; n=77). Asymptomatic community children (CC; n=83) were enrolled as a comparison group. Children with iron deficiency, defined as zinc protoporphyrin (ZPP) ≥ 80 µmol/mol heme, were randomly assigned to receive a 3-mo course of daily oral ferrous sulfate (2 mg · kg-1 · d-1) either concurrently with antimalarial treatment (immediate arm) or 28 d after receiving antimalarial treatment (delayed arm). Children were followed for 12 mo. All children with CM or SMA, and 35 (42.2%) CC, were iron-deficient and were randomly assigned to immediate or delayed iron treatment. Immediate compared with delayed iron had no effect in any of the 3 study groups on the primary study outcomes (hemoglobin concentration and prevalence of ZPP≥80 µmol/mol heme at 6 mo, malaria incidence over 12 mo). However, after 12 mo, children with SMA in the delayed compared with the immediate arm had a lower prevalence of iron deficiency defined by ZPP (29.4% compared with 65.6%, P=0.006), a lower mean concentration of soluble transferrin receptor (6.1 compared with 7.8 mg/L, P=0.03), and showed a trend toward fewer episodes of severe malaria (incidence rate ratio: 0.39; 95% CI: 0.14, 1.12). In children with SMA, delayed iron treatment did not increase hemoglobin concentration, but did improve long-term iron status over 12 mo without affecting malaria incidence.This trial was registered at clinicaltrials.gov as NCT01093989.

Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania

BackgroundMalaria in pregnancy increases the risk of deleterious maternal and birth outcomes. The use of ≥ 3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (IPTp-SP) is recommended for preventing the consequences of malaria during pregnancy. This study assessed the effect of IPTp-SP for prevention of malaria during pregnancy in low transmission settings.MethodsA cross-sectional study that involved consecutively selected 1161 pregnant women was conducted at Mwananyamala regional referral hospital in Dar es Salaam. Assessment of the uptake of IPTp-SP was done by extracting information from antenatal clinic cards. Maternal venous blood, cord blood, placental blood and placental biopsy were collected for assessment of anaemia and malaria. High performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect and quantify sulfadoxine (SDX). Dried blood spots (DBS) of placental blood were collected for determination of sub-microscopic malaria using polymerase chain reaction (PCR).ResultsIn total, 397 (34.2%) pregnant women reported to have used sub-optimal doses (≤ 2) while 764 (65.8%) used optimal doses (≥ 3) of IPTp-SP at the time of delivery. The prevalence of placental malaria as determined by histology was 3.6%. Submicroscopic placental malaria was detected in 1.4% of the study participants. Women with peripheral malaria had six times risk of maternal anaemia than those who were malaria negative (aOR, 5.83; 95% CI 1.10–30.92; p = 0.04). The geometric mean plasma SDX concentration was 10.76 ± 2.51 μg/mL. Sub-optimal IPTp-SP dose was not associated with placental malaria, premature delivery and fetal anaemia. The use of ≤ 2 doses of IPTp-SP increased the risk of maternal anaemia by 1.36-fold compared to ≥ 3 doses (aOR, 1.36; 95% CI 1.04–1.79; p = 0.02).ConclusionThe use of < 2 doses of IPTp-SP increased the risk of maternal anaemia. However, sub-optimal doses (≤ 2 doses) were not associated with increased the risk of malaria parasitaemia, fetal anaemia and preterm delivery among pregnant women in low malaria transmission setting. The use of optimal doses (≥ 3 doses) of IPTp-SP and complementary interventions should continue even in areas with low malaria transmission.

Acute Plasmodium berghei Mouse Infection Elicits Perturbed Erythropoiesis With Features That Overlap With Anemia of Chronic Disease.

Severe malaria anemia is one of the most common causes of morbidity and mortality arising from infection with Plasmodium falciparum. The pathogenesis of malarial anemia is complex, involving both parasite and host factors. As mouse models of malaria also develop anemia, they can provide a useful resource to study the impact of Plasmodium infections and the resulting host innate immune response on erythropoiesis. In this study, we have characterized the bone marrow and splenic responses of the erythroid as well as other hematopoietic lineages after an acute infection of Balb/c mice with Plasmodium berghei. Such characterization of the hematopoietic changes is critical to underpin future studies, using knockout mice and transgenic parasites, to tease out the interplay between host genes and parasite modulators implicated in susceptibility to malaria anemia. P. berghei infection led to a clear perturbation of steady-state erythropoiesis, with the most profound defects in polychromatic and orthochromatic erythroblasts as well as erythroid colony- and burst-forming units (CFU-E and BFU-E), resulting in an inability to compensate for anemia. The perturbation in erythropoiesis was not attributable to parasites infecting erythroblasts and affecting differentiation, nor to insufficient erythropoietin (EPO) production or impaired activation of the Signal transducer and activator of transcription 5 (STAT5) downstream of the EPO receptor, indicating EPO-signaling remained functional in anemia. Instead, the results point to acute anemia in P. berghei-infected mice arising from increased myeloid cell production in order to clear the infection, and the concomitant release of pro-inflammatory cytokines and chemokines from myeloid cells that inhibit erythroid development, in a manner that resembles the pathophysiology of anemia of chronic disease.

COMPARATIVE STUDY BETWEEN VISCERAL LEISHMANIASIS AND MALARIA FALCIPARUM IN CASES PRESENTED BY FEVER WITH ANEMIA IN THE REPUBLIC OF YEMEN

No doubt, both visceral leishmaniasis and malignant malaria are more or less common in many Eastern Mediterranean Countries. Both of these arthropod-borne infectious diseases have overlapping clinical presentations. This study aimed to clarify the main clinical features and laboratory diagnostic tests. A total of forty Plasmodium falciparum patients and thirty visceral leishmaniasis patients were studied. Sheets were filled on each subject included, full history taking, full clinical examination, CBC, liver and renal function tests, x-ray chest and abdominal ultrasound, bone marrow aspiration.. The results showed that jaundice and liver affection tests were more common in malaria (jaundice, 55%, high ALT & AST, 60%) than in visceral leishmaniasis (high bilirubin, 30% high ALT & AST, 40%). Besides, the malaria affected the central nervous system (coma and impaired sensorium, 30%) more than visceral leishmaniasis (coma and impaired sensorium, 5%). The effect of visceral leishmaniasis on the lymphatic system (splenomegaly, 95% & hepatomegaly, 70%) was more than malaria (70% & 60% respectively). The visceral leishmaniasis markedly affected the bone marrow (anemia, 95%, thrombocytopenia, 65% & leucopenia, 70%) more than malaria (anemia, 28%, thrombocytopenia, 50% & leucopenia, 34%). Diarrhea and cough were common in visceral leishmaniasis (80% & 55% respectively) than in malaria (20% & 5%respectively) but DIC was common in malignant malaria (20%).

Indications for blood and blood products transfusions among children in a semi-urban tertiary hospital in Nigeria

Background: Anaemia is prevalent among children in our environment, often necessitating blood transfusions. The knowledge of the common indications for blood transfusion and the required preventive measures is likely to reduce the transfusion rates. Objective: To determine the disease conditions requiring blood transfusion in post-neonatal age children at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Methods: The hospital records of all children aged 1 month to 18 years admitted into the post-neonatal ward who received blood transfusions over 18 months (1st July 2015to­31st December 2016) were reviewed. Results: There were 710 paediatric admissions out of which 82 (11.6%) received blood transfusions. Ninety transfusions were carried out amongst 82 children, at a ratio of 1.1 transfusions per child. Severe malaria (28.1%), sickle cell anaemia (19.5%) and septicaemia (18.3) were the most common disease conditions requiring blood transfusions. The leading blood products transfused included packed red cells (64.5%) and whole blood (30.0%). Conclusion: Blood transfusion is frequently indicated in the paediatric population in our setting, largely due to severe malaria and sickle cell anaemia problems. Intensifying efforts on the use of long-lasting insecticide-treated nets and environmental control may reduce the prevalence of severe malaria, while improved nutrition, adequate hydration, regular malaria prophylaxis, prompt treatment of infections and regular use of haematinics may minimize the need for blood transfusions among children with sickle cell anaemia.

Plasmodium Perforin-Like Protein Pores on the Host Cell Membrane Contribute in Its Multistage Growth and Erythrocyte Senescence

The pore forming Plasmodium Perforin Like Proteins (PPLP), expressed in all stages of the parasite life cycle are critical for completion of the parasite life cycle. The high sequence similarity in the central Membrane Attack Complex/ Perforin (MACPF) domain among PLPs and their distinct functional overlaps define them as lucrative target for developing multi-stage antimalarial therapeutics. Herein, we evaluated the mechanism of Pan-active MACPF Domain (PMD), a centrally located and highly conserved region of PPLPs, and deciphered the inhibitory potential of specifically designed PMD inhibitors. The E. coli expressed rPMD interacts with erythrocyte membrane and form pores of ~10.5 nm height and ~24.3 nm diameter leading to hemoglobin release and dextran uptake. The treatment with PMD induced erythrocytes senescence which can be hypothesized to account for the physiological effect of disseminated PLPs in loss of circulating erythrocytes inducing malaria anemia. The anti-PMD inhibitors effectively blocked intraerythrocytic growth by suppressing invasion and egress processes and protected erythrocytes against rPMD induced senescence. Moreover, these inhibitors also blocked the hepatic stage and transmission stage parasite development suggesting multi-stage, transmission-blocking potential of these inhibitors. Concievably, our study has introduced a novel set of anti-PMD inhibitors with pan-inhibitory activity against all the PPLPs members which can be developed into potent cross-stage antimalarial therapeutics along with erythrocyte senescence protective potential to occlude PPLPs mediated anemia in severe malaria.

The Gain in Antimalarial Vaccine

With reference my article ‘How Malaria is Practically Eradicated in Malaysia – A Reminiscence’ (AJRID, Jan 6, 2020), me seem to have left out writing on the present availability, role and impact of vaccines against malaria.&#x0D; The only approved vaccine RTS,S, known by the trade name Mosquirix is launched in 2019 in a WHO-led implementation program piloting the vaccine, among children aged not more than 2 years, in three high-malaria countries in Africa. The vaccine has a relatively low efficacy at 26 – 50% - thus, the WHO do not recommend the vaccine in infants aged 6 to 12 weeks. It is given in 3 doses between 5 and 9 months of age and the fourth-dose at around 2 years old.&#x0D; Said the WHO Director-General, ‘The malaria vaccine could save tens of thousands of children’s lives’.&#x0D; In spite of the low-efficacy, the vaccine is safe and prevents 30% of severe malaria causing death and prevents 60% of cases of severe malaria anaemia, the most common reason children die from malaria.&#x0D; The pilot-programme aim to reach around 360,000 children annually in the three country, focusing on areas with moderate-to-high malaria-transmission.&#x0D; The programme is designed to provide evidence and experience toward WHO policy-recommendations on the wider use of the vaccine. The programme aim to monitor reductions in child deaths, vaccine-uptake, including whether parents are compliant.&#x0D; The author find a need to write on the result of the Phase III Trial of the vaccine to be used, the RTS,S, beside outlining the basic on malaria-vaccine development.&#x0D; Finally, the remaining vaccine(s) in development are talked on.

Estimating hospital catchments from in-patient admission records: a spatial statistical approach applied to malaria

Admission records are seldom used in sub-Saharan Africa to delineate hospital catchments for the spatial description of hospitalised disease events. We set out to investigate spatial hospital accessibility for severe malarial anaemia (SMA) and cerebral malaria (CM). Malaria admissions for children between 1 month and 14 years old were identified from prospective clinical surveillance data recorded routinely at four referral hospitals covering two complete years between December 2015 to November 2016 and November 2017 to October 2018. These were linked to census enumeration areas (EAs) with an age-structured population. A novel mathematical-statistical framework that included EAs with zero observations was used to predict hospital catchment for malaria admissions adjusting for spatial distance. From 5766 malaria admissions, 5486 (95.14%) were linked to specific EA address, of which 272 (5%) were classified as cerebral malaria while 1001 (10%) were severe malaria anaemia. Further, results suggest a marked geographic catchment of malaria admission around the four sentinel hospitals although the extent varied. The relative rate-ratio of hospitalisation was highest at <1-hour travel time for SMA and CM although this was lower outside the predicted hospital catchments. Delineation of catchments is important for planning emergency care delivery and in the use of hospital data to define epidemiological disease burdens. Further hospital and community-based studies on treatment-seeking pathways to hospitals for severe disease would improve our understanding of catchments.

Malaria Parasitaemia and Anaemia among Patients Attending a Palm Oil Plantation Hospital, Southwest Region, Cameroon

Endowed with extensive biological and cultural diversities, unique eco-climatic conditions and diverse topography implementing of the same malaria control measures throughout Cameroon, difficult. This study aimed to determine the prevalence of malaria in patients attending Pamol Hospital Lobe (PHL) in Lobe Estate, South West Region, Cameroon. This was a hospital-based cross-sectional study conducted at the PHL, between March and November 2014. The prevalence of malaria and anaemia were investigated in 581 patients using thick blood film and a Urit-1 systems respectively. All data obtained were analysed using SPSS 17.0. The chi-square test was used to establish the association between the prevalence of malaria and age, sex and place of residence of patients, while P<0.05 was considered statistically significant. The overall prevalence rate of malaria parasitaemia was 78.8% (458). The age group 10- 15 years had the highest prevalence of 80% and while 5-9 years had the least 77.6% (52). The prevalence of malaria was found not to be significantly associated with age group and gender (χ 2=0.200, P=0.978; χ2=1.425, P=0.233). However, the Mean Trophozoites±SD significantly differed between males and females (P<0.05). Our findings indicate no significant difference between the place of residence and malaria parasitaemia. (P˃0.731). Nearly half (49.2%) of the participants were anaemic (Hb level < 11 g/dL) while only 2.1% were severely anaemic (Hb level < 4 g/dL). The Mean Trophozoites±SD were higher in patients that were moderately anaemic (814.18±787.569), contrastingly lower in those that were severely anaemic (589.09±675.299). Malaria prevalence in the PHL remains high. The distribution of Long Lasting Insecticide Treated Nets (LLINs) should further be intensified in the communities, especially during peak malaria transmission season.

Multiple Concurrent Illnesses Associated with Anemia in HIV-Infected and HIV-Exposed Uninfected Children Aged 6-59 Months, Hospitalized in Mozambique.

.Anemia is an increasingly recognized problem in sub-Saharan Africa. To determine the magnitude, severity, and associated factors of anemia among hospitalized children aged 6–59 months, HIV-infected and HIV-exposed uninfected children (a child born to a known HIV-infected mother) with a documented fever or history of fever within the prior 24 hours of hospital admission (N = 413) were included in this analysis. Of 413 children enrolled, 364 (88%) were anemic, with 53% classified as mild anemia (hemoglobin [Hb] 7–9.9 g/dL). The most common diagnoses associated with hospital admission included acute respiratory illness (51%), malnutrition (47%), gastroenteritis/diarrhea (25%), malaria (17%), and bacteremia (13%). A diagnosis of malaria was associated with a decrease in Hb by 1.54 g/dL (P < 0.001). In HIV-infected patients, malaria was associated with a similar decrease in Hb (1.47 g/dL), whereas a dual diagnosis of bacteremia and malaria was associated with a decrease in Hb of 4.12 g/dL (P < 0.001). No difference was seen in Hb for patients on antiretroviral therapy versus those who were not. A diagnosis of bacteremia had a roughly 4-fold increased relative odds of death during hospitalization (adjusted odds ratio = 3.97; 95% CI: 1.61, 9.78; P = 0.003). The etiology of anemia in high-burden malaria, HIV, tuberculosis, and poor nutrition countries is multifactorial, and multiple etiologies may be contributing to one’s anemia at any given time. Algorithms used by physician and nonphysician clinicians in Mozambique should incorporate integrated and non–disease specific approaches to pediatric anemia management and should include improved access to blood culture.

Status of Anaemia and Malaria Co-infection With HIV From HAART Clinics in Federal Capital Territory, Nigeria: A Cross-Sectional Study.

Background:Malaria and HIV are 2 significant infections of critical public health concern globally. Malaria infection is one of the preceding causes of morbidity and mortality in endemic developing countries, and its co-infections in HIV patients worsen prognosis; with anaemia being the most common haematologic outcome of the infections.Context and Purpose of Study:This study was aimed at determining the prevalence of anaemia and malaria co-infection among HIV-infected patients attending selected hospitals in Abuja between February and July 2019.Methods:A cross-sectional study was carried out to detect malaria in 420 HIV-positive patients who were 12 to 67 years old, using enzyme immunoassay and microscopy. A structured questionnaire was used to capture socio-demographic and risk factors ([Frequency of] Use of Malaria preventive Measures, History of anaemia, Blood type, malaria antecedents, and CD4+ Count) while packed cell volume was checked using micro haematocrit reader to determine anaemia status. Data were analysed using IBM SPSS v25.Results:The mean age of the study participants was 37.5 (±12.48). A total of 142 (33.8%) samples were positive for malaria, and 68 of the HIV-infected patients (16.2%) were anaemic; 4.8% of the 420 patients had malaria co-infection and anaemia simultaneously. More male participants had malaria co-infection (36.0%, P = .617) while more female participants had anaemia (22.7%, P = .058). Patients aged 61 to 70 years had the highest rates of malaria and those aged 51 to 60 years were most anaemic. Except for patients with normal CD4+ count, those who were more exposed to the evaluated risk factors were more co-infected and anaemic. Malaria co-infection did not significantly affect the onset of anaemia. Test for the validity of Microscopy against Enzyme Immunoassay (EIA) showed 83.1% sensitivity and 98.6% specificity. No association was observed between the variables and the parasitaemia density of the patients.Conclusions:This study highlighted higher rates of malaria co-infection and anaemia among HIV patients when compared with previous reports in the region although co-infection did not significantly affect anaemia status. Given this trend, strategies must be put in place to checkmate these ailments. Population studies are also advocated.

Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems.

Acute kidney injury (AKI) is a risk factor for neurocognitive impairment in severe malaria (SM), but the impact of AKI on long-term behavioral outcomes following SM is unknown. We conducted a prospective study on behavioral outcomes of Ugandan children 1.5 to 12 years of age with two forms of severe malaria, cerebral malaria (CM, n = 226) or severe malarial anemia (SMA, n = 214), and healthy community children (CC, n = 173). AKI was defined as a 50% increase in creatinine from estimated baseline. Behavior and executive function were assessed at baseline and 6, 12, and 24 months later using the Child Behavior Checklist and Behavior Rating Inventory of Executive Function, respectively. Age-adjusted z-scores were computed for each domain based on CC scores. The association between AKI and behavioral outcomes was evaluated across all time points using linear mixed effect models, adjusting for sociodemographic variables and disease severity. AKI was present in 33.2% of children with CM or SMA at baseline. Children ≥6 years of age with CM or SMA who had AKI on admission had worse scores in socio-emotional function in externalizing behaviors (Beta (95% CI), 0.52 (0.20, 0.85), p = 0.001), global executive function (0.48 (0.15, 0.82), p = 0.005) and behavioral regulation (0.66 (0.32, 1.01), p = 0.0002) than children without AKI. There were no behavioral differences associated with AKI in children <6 years of age. AKI is associated with long-term behavioral problems in children ≥6 years of age with CM or SMA, irrespective of age at study enrollment.

Prevalence and risk of malaria, anemia and malnutrition among children in IDPs camp in Edo State, Nigeria

BackgroundMalaria, anemia and malnutrition are global health challenges with significant morbidity and mortality, with higher rates among children particularly in Africa. Recently there has been displacement of over a million people due to different crisis in Nigeria. However, there is limited study on the public health issues facing these vulnerable populations. This study evaluated the prevalence and risk factors for malaria infection, anemia and malnutrition among children living in internally displaced persons (IDP) camp in Edo state, Nigeria. MethodA total of 250 children up to 10 years old were included in the study in the year 2018. Malaria infection was confirmed by rapid diagnostic tests. The hematocrit level was obtained using a centrifuge microhaematocrit and converted to haemoglobin using standard conversion while nutritional status was determined from anthropometric measurements collected, and demographic characteristics were obtained by the use of questionnaire. Anemia and malnutrition were defined according to World Health Organization standards. The logistic regression analysis was used to determine associations between predictor variables and primary outcomes. ResultMalaria infection and anemia were recorded for 55.2% and 54.0% of the children, respectively while malnutrition prevalence was 41.2% with wasting, underweight and stunting occurring in 0.04%, 11.2% and 39.2% respectively. Age was a significant risk factor for malaria with higher odds of having malaria infection in children 6–10 years of age [odds ratio (OR) = 2.032, P = 0.021] than in younger children. Being 6–10 years (OR = 2.307, P = 0.015) and having malaria infection (OR = 1.693, P = 0.048) were identified as significant risk factors of anemia while being in the age group of up to 5 years was the only significant risk factor (OR for the older age group = 0.251, P ≤ 0.001) associated with malnutrition. Specific attention needs to be paid to children in IDP camps. ConclusionAnemia and malnutrition control should be integrated with existing malaria control and should include children above five years of age.