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Malar J. 2016 Jun 16;15:321. doi: 10.1186/s12936-016-1373-8.

Plasmodium vivax infection: a major determinant of severe anaemia in infancy.

Author information

1
Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.
2
Mimika District Health Authority, Timika, Papua, Indonesia.
3
National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.
4
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
5
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
6
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811, Australia.
7
Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
8
Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia.
9
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811, Australia. rprice@menzies.edu.au.
10
Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. rprice@menzies.edu.au.
11
Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
12
Division of Medicine, Christchurch Hospital, Christchurch, New Zealand.

Abstract

BACKGROUND:

Most 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.

METHODS:

A 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 %)].

CONCLUSION:

Despite 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.

KEYWORDS:

Anaemia; Indonesia; Malaria; Plasmodium falciparum; Plasmodium malariae; Plasmodium vivax

PMID:
27306221
PMCID:
PMC4910236
DOI:
10.1186/s12936-016-1373-8
[Indexed for MEDLINE]
Free PMC Article

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