Plasmodium falciparum-associated anemia in children at a large urban hospital in Zaire

• Published in: The American journal of tropical medicine and hygiene Vol. 48; no. 3; p. 365
• Main Authors: Hedberg, K, Shaffer, N, Davachi, F, Hightower, A, Lyamba, B, Paluku, K M, Nguyen-Dinh, P, Breman, J G
• Format: Journal Article
• Language: English
• Published: United States 01-03-1993
• Subjects: Analysis of Variance; Anemia - complications; Anemia - epidemiology; Anemia - etiology; Child, Preschool; Democratic Republic of the Congo - epidemiology; Female; Hematocrit; Humans; Infant; Malaria, Falciparum - complications; Male; Multivariate Analysis; Nutrition Disorders - complications; Odds Ratio; Prevalence; Risk Factors; Urban Population; Democratic Republic of the Congo; Measurement; Hemic System; Prevalence; Age Factors; Hematocrit; Viral Diseases; Biology; Laboratory Procedures; Urban Population; Research Methodology; Child Mortality; Zaire; Population Characteristics; Population; Physiology; Parasitic Diseases; Malnutrition; Child; Demographic Factors; Middle Africa; Laboratory Examinations And Diagnoses; Malaria; Mortality; Nutrition Disorders; Risk Factors; Africa; Youth; French Speaking Africa; Hiv Infections; Examinations And Diagnoses; Diseases; Hematological Effects; Data Analysis; Developing Countries; Africa South Of The Sahara; Population Dynamics
• ISSN: 0002-9637
• DOI: 10.4269/ajtmh.1993.48.365

Chloroquine-resistant Plasmodium falciparum malaria and human virus (HIV) infection through blood transfusions used to treat malaria-associated anemia are causes of increasing morbidity and mortality among children in Africa. To evaluate the role of malaria and other risk factors for pediatric anemia, we conducted a study of children brought to the emergency ward of a large urban hospital in Kinshasa, Zaire. A total of 748 children ages six through 59 months were enrolled; 318 (43%) children were anemic (hematocrit < 33%), including 74 (10%) who were severely anemic (hematocrit < 20%). Plasmodium falciparum parasites were detected in 166 children (22%); hematocrits for these children (mean 25.8%) were significantly lower than for aparasitemic children (mean 33.7%; P < 10(-6)). Fever with splenomegaly (odds ratio [OR] = 6.5, P = 0.02), parasitemia (OR = 3.5, P < 0.001), lower socioeconomic status (OR = 2.0, P = 0.004), and malnutrition (OR = 1.8, P = 0.06) were independently associated with anemia in a multivariate model. Recent antimalarial therapy was also associated with a lower hematocrit, suggesting that chloroquine may have aggravated the anemia. A reassessment of the effectiveness of strategies to diagnose and treat malaria and malnutrition is necessary to decrease the high prevalence of anemia and the resultant high rate of blood transfusions in areas endemic for malaria and HIV.