Plasmodium Falciparum-Associated Anemia in Children at a Large Urban Hospital in Zaire

Katrina HedbergDivision of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital, Combatting Childhood Communicable Diseases Project (CCCD), Atlanta, Georgia

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Nathan ShafferDivision of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital, Combatting Childhood Communicable Diseases Project (CCCD), Atlanta, Georgia

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Farzin DavachiDivision of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital, Combatting Childhood Communicable Diseases Project (CCCD), Atlanta, Georgia

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Allen HightowerDivision of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital, Combatting Childhood Communicable Diseases Project (CCCD), Atlanta, Georgia

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Bongo LyambaDivision of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital, Combatting Childhood Communicable Diseases Project (CCCD), Atlanta, Georgia

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Kalenga Mbudi PalukuDivision of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital, Combatting Childhood Communicable Diseases Project (CCCD), Atlanta, Georgia

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Phuc Nguyen-DinhDivision of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital, Combatting Childhood Communicable Diseases Project (CCCD), Atlanta, Georgia

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Joel G. BremanDivision of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital, Combatting Childhood Communicable Diseases Project (CCCD), Atlanta, Georgia

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Chloroquine-resistant Plasmodium falciparum malaria and human immunodeficiency 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.

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