Severe Anemia in Papua New Guinean Children from a Malaria-Endemic Area: A Case-Control Etiologic Study

Manning, L; Laman, M; Rosanas-Urgell, A; Michon, P; Aipit, S; Bona, C; Siba, P; Mueller, I; Davis, TME

Author(s): Manning, L; Laman, M; Rosanas-Urgell, A; Michon, P; Aipit, S; Bona, C; Siba, P; Mueller, I; Davis, TME;
Details: Publication Year 2012-12,Volume 6,Issue #12,Page e1972
Journal Title: PLOS NEGLECTED TROPICAL DISEASES
Publication Type: Journal Article
Abstract: Background: There are few detailed etiologic studies of severe anemia in children from malaria-endemic areas and none in those countries with holoendemic transmission of multiple Plasmodium species. Methodology/Principal Findings: We examined associates of severe anemia in 143 well-characterized Papua New Guinean (PNG) children aged 0.5-10 years with hemoglobin concentration <50 g/L (median [inter-quartile range] 39 [33-44] g/L) and 120 matched healthy children (113 [107-119] g/L) in a case-control cross-sectional study. A range of socio-demographic, behavioural, anthropometric, clinical and laboratory (including genetic) variables were incorporated in multivariate models with severe anemia as dependent variable. Consistent with a likely trophic effect of chloroquine or amodiaquine on parvovirus B19 (B19V) replication, B19V PCR/IgM positivity had the highest odds ratio (95% confidence interval) of 75.8 (15.4-526), followed by P. falciparum infection (19.4 (6.7-62.6)), vitamin A deficiency (13.5 (5.4-37.7)), body mass index-for-age z-score,2.0 (8.4 (2.7-27.0)) and incomplete vaccination (2.94 (1.3-7.2)). P. vivax infection was inversely associated (0.12 (0.02-0.47), reflecting early acquisition of immunity and/or a lack of reticulocytes for parasite invasion. After imputation of missing data, iron deficiency was a weak positive predictor (6.4% of population attributable risk). Conclusions/Significance: These data show that severe anemia is multifactorial in PNG children, strongly associated with under-nutrition and certain common infections, and potentially preventable through vitamin A supplementation and improved nutrition, completion of vaccination schedules, and intermittent preventive antimalarial treatment using non-chloroquine/amodiaquine-based regimens.
Publisher: PUBLIC LIBRARY SCIENCE
Keywords: PARVOVIRUS B19 INFECTION; VITAMIN-A SUPPLEMENTATION; PLACEBO-CONTROLLED TRIAL; PLASMODIUM-FALCIPARUM; YOUNG-CHILDREN; TANZANIAN INFANTS; MALAWIAN CHILDREN; AFRICAN CHILDREN; CRITICALLY-ILL; VIVAX
Research Division(s): Infection And Immunity
Publisher's Version: https://doi.org/10.1371/journal.pntd.0001972
Open Access at Publisher's Site: http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0001972
Terms of Use/Rights Notice: Copyright: © 2012 Manning et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Documents: journal.pntd.0001972.pdf - (0.31MB, application/pdf)

Creation Date: 2012-12-01 12:00:00