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. 2012 Jun;86(6):925-30.
doi: 10.4269/ajtmh.2012.11-0164.

Contributions of polyclonal malaria, gametocytemia, and pneumonia to infant severe anemia incidence in malaria hyperendemic Pemba, Tanzania

Thomas Jaenisch  1 , Sunil Sazawal, Arup Dutta, Saikat Deb, Mahdi Ramsan, David J Sullivan
Affiliations

Contributions of polyclonal malaria, gametocytemia, and pneumonia to infant severe anemia incidence in malaria hyperendemic Pemba, Tanzania

Thomas Jaenisch et al. Am J Trop Med Hyg. 2012 Jun.

Abstract

The causative factors for severe anemia incidence in sub-Saharan Africa are multifactorial. In an observational, longitudinal study of two cohorts of about 300 infants followed-up for six months in a malaria hyperendemic area, the risk factors for severe anemia incidence were clinical malaria and pneumonia, which outweighed nutritional and sociodemographic factors. Severe anemia incidence was 1-2/year at age 2 months, peaked around 6-7/year at age 7-12 months, and decreased back to 1-2/year at age 16-22 months. The age-dependent increase of severe anemia incidence was shown to be parallel to the age-dependent increase of clinical malaria. Previous clinical malaria episodes increased the severe anemia risk by 80%, and gametocyte carriage and pneumonia at prior visit was associated with a six-fold increase and a > 10-fold increase, respectively. The role of pneumonia and malaria as risk factors, and areas for interventions for severe anemia, should not be underestimated.

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Figures

Figure 1.
Figure 1.
Anemia prevalence (< 7 mg/dL; < 10 mg/dL) and malaria parasite prevalence per two-week period in 537 children on Pemba Island, Zanzibar, Tanzania. Hb = hemoglobin.
Figure 2.
Figure 2.
Incidence of severe anemia (hemoglobim < 7 mg/dL) and incidence of malaria (as by any parasites plus fever/history of fever) per age in months in 537 children on Pemba Island, Zanzibar, Tanzania, December 2003–January 2005. rdt = rapid diagnostic test.
Figure 3.
Figure 3.
Multiplicity of infection (moi) by age in months, in 3,066 polymerase chain reaction–positive visits among 533 children on Pemba Island, Xanzibar, Tanzania. A, Absolute frequency (1–4+); B, Relative frequency of monoclonal infections (including 95% confidence interval [CI]).
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