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Blood Adv. 2018 Nov 13;2(21):3035-3044. doi: 10.1182/bloodadvances.2018023069.

Prevalence of inherited blood disorders and associations with malaria and anemia in Malawian children.

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Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Center for Global Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Pediatrics and.
Hubert Department of Global Health, Emory University, Atlanta, GA.
Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA.
Naval Medical Center San Diego, San Diego, CA.
University of North Carolina Project, Lilongwe, Malawi.
School of Bioscience, University of Nottingham, Sutton Bonington, United Kingdom.
British Geological Survey, Environmental Science Centre, Keyworth, Nottingham, United Kingdom.
Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA.
Department of Medicine, University of North Carolina, Chapel Hill, NC; and.
Emory Global Health Institute, Emory, GA.


In sub-Saharan Africa, inherited causes of anemia are common, but data are limited regarding the geographical prevalence and coinheritance of these conditions and their overall contributions to childhood anemia. To address these questions in Malawi, we performed a secondary analysis of the 2015-2016 Malawi Micronutrient Survey, a nationally and regionally representative survey that estimated the prevalence of micronutrient deficiencies and evaluated both inherited and noninherited determinants of anemia. Children age 6 to 59 months were sampled from 105 clusters within the 2015-2016 Malawi Demographic Health Survey. Hemoglobin, ferritin, retinol binding protein, malaria, and inflammatory biomarkers were measured from venous blood. Molecular studies were performed using dried blood spots to determine the presence of sickle cell disease or trait, α-thalassemia trait, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. Of 1279 eligible children, 1071 were included in the final analysis. Anemia, iron deficiency, and malaria were common, affecting 30.9%, 21.5%, and 27.8% of the participating children, respectively. α-Thalassemia trait was common (>40% of children demonstrating deletion of 1 [33.1%] or 2 [10.0%] α-globin genes) and associated with higher prevalence of anemia (P < .001). Approximately 20% of males had G6PD deficiency, which was associated with a 1.0 g/dL protection in hemoglobin decline during malaria infection (P = .02). These data document that inherited blood disorders are common and likely play an important role in the prevalence of anemia and malaria in Malawian children.

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