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Hemoglobin E and Glucose-6-Phosphate Dehydrogenase Deficiency and Plasmodium falciparum Malaria in the Chittagong Hill Districts of Bangladesh

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  • Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Johns Hopkins Malaria Research Institute, Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Hemoglobin E is largely confined to south and southeast Asia. The association between hemoglobin E (HbE) and malaria is less clear than that of hemoglobin S and C. As part of a malaria study in the Chittagong Hill Districts of Bangladesh, an initial random sample of 202 individuals showed that 39% and 49% of Marma and Khyang ethnic groups, respectively, were positive for either heterozygous or homozygous hemoglobin E. In this group, 6.4% were also found to be severely deficient and 35% mildly deficient for glucose-6-phosphate dehydrogenase (G6PD). In a separate Plasmodium falciparum malaria case–uninfected control study, the odds of having homozygous hemoglobin E (HbEE) compared with normal hemoglobin (HbAA) were higher among malaria cases detected by passive surveillance than age and location matched uninfected controls (odds ratio [OR] = 5.0, 95% confidence interval [CI] = 1.07–46.93). The odds of heterozygous hemoglobin E (HbAE) compared with HbAA were similar between malaria cases and uninfected controls (OR = 0.71, 95% CI = 0.42–1.19). No association by hemoglobin type was found in the initial parasite density or the proportion parasite negative after 2 days of artemether/lumefantrine treatment. HbEE, but not HbAE status was associated with increased passive case detection of malaria.

Author Notes

* Address correspondence to David J. Sullivan Jr., Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205. E-mail: dsulliv7@jhmi.edu

Financial support: This study was funded by Johns Hopkins Malaria Research Institute at the Johns Hopkins Bloomberg School of Public Health (grant no. 00679) and the Johns Hopkins MSTP program and Johns Hopkins Department of International Health for providing funding to Kerry L. Shannon. The icddr,b also gratefully acknowledges the following donors, which provide unrestricted support to the Center's research efforts: the Australian Agency for International Development (AusAID), the Government of the People's Republic of Bangladesh, the Canadian International Development Agency (CIDA), the Swedish International Development Cooperation Agency (SIDA), and the Department for International Development, United Kingdom (DFID). We are also indebted to the Johns Hopkins Center for Global Health and John Snow, Inc., who provided travel funding for a student investigator.

Authors' addresses: Kerry L. Shannon, Malathi Ram, and David A. Sack, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: shannonk7@gmail.com, mram1@jhu.edu, and dsack1@jhu.edu. Sabeena Ahmed, Hafizur Rahman, Ashish Chowdhury, Chai Shwai Prue, Jacob Khyang, M. Zahirul Haq, Jasmin Akter, and Wasif A. Khan, Centre for Population, Urbanization and Climate Change, icddr,b, Dhaka, Bangladesh, E-mails: sabeena@icddrb.org, hafizur@icddrb.org, dr_prue@icddrb.org, jacob@icddrb.org, mzhaq@icddrb.org, jakter@icddrb.org, and wakhan@icddrb.org. Gregory E. Glass, Department of Geography, Emerging Pathogens Institute, University of Florida, Gainesville, FL, E-mail: gglass@ufl.edu. Timothy Shields and David J. Sullivan Jr., Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: tshield2@jhu.edu and dsulliv7@jhmi.edu. Myaing M. Nyunt, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, E-mail: mnyunt@medicine.umaryland.edu.

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