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. 2017 Aug 15;17(1):568.
doi: 10.1186/s12879-017-2644-x.

Relationships between sickle cell trait, malaria, and educational outcomes in Tanzania

Kevin Croke  1 , Deus S Ishengoma  2 , Filbert Francis  2 , Julie Makani  3 , Mathias L Kamugisha  2 , John Lusingu  2 , Martha Lemnge  2 , Horacio Larreguy  4 , Günther Fink  5 , Bruno P Mmbando  2
Affiliations

Relationships between sickle cell trait, malaria, and educational outcomes in Tanzania

Kevin Croke et al. BMC Infect Dis. .

Abstract

Background: Sickle Cell Trait (SCT) has been shown to be protective against malaria. A growing literature suggests that malaria exposure can reduce educational attainment. This study assessed the relationship and interactions between malaria, SCT and educational attainment in north-eastern Tanzania.

Methods: Seven hundred sixty seven children were selected from a list of individuals screened for SCT. Febrile illness and malaria incidence were monitored from January 2006 to December 2013 by community health workers. Education outcomes were extracted from the Korogwe Health and Demographic Surveillance system in 2015. The primary independent variables were malaria and SCT. The association between SCT and the number of fever and malaria episodes from 2006 to 2013 was analyzed. Main outcomes of interest were school enrolment and educational attainment in 2015.

Results: SCT was not associated with school enrolment (adjusted OR 1.42, 95% CI [0.593,3.412]) or highest grade attained (adjusted grade difference 0.0597, 95% CI [-0.567, 0.686]). SCT was associated with a 29% reduction in malaria incidence (adjusted IRR 0.71, 95% CI [0.526, 0.959]) but not with fever incidence (adjusted IRR 0.905, 95% CI [0.709-1.154]). In subgroup analysis of individuals with SCT, malaria exposure was associated with reduced school enrollment (adjusted OR 0.431, 95% CI [0.212, 0.877]).

Conclusions: SCT appears to reduce incidence of malaria. Overall, children with SCT do not appear to attend more years of school; however children who get malaria despite SCT appear to have lower levels of enrolment in education than their peers.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Medical Research Coordinating Committee of the National Institute for Medical Research, Tanzania. Informed consent both orally and in writing (in Kiswahili) was obtained from all individual participants or parents/guardians in case of children and adolescents (below 18 years).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Number of malaria cases and percent of febrile illnesses confirmed as malaria by year
See this image and copyright information in PMC

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