Post-Malaria Anemia Is Rare in Malawian Children with Cerebral Malaria

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  • 1 Department of Pediatrics, Children’s National Medical Center, Washington, District of Columbia;
  • 2 Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi;
  • 3 Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington, District of Columbia;
  • 4 Division of Epidemiology, The George Washington University School of Public Health, Washington, District of Columbia;
  • 5 Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan;
  • 6 Division of Neurology, The George Washington University/Children’s National Medical Center, Washington, District of Columbia

Artesunate therapy for severe malaria syndromes has been associated with post-treatment hemolysis and anemia. We defined post-malaria anemia as any decrease in hematocrit between the index hospitalization for severe malaria and 1 month after. We determined the incidence and severity of post-malaria anemia in Malawian children surviving cerebral malaria (CM) by analyzing hospital and follow-up data from a long-standing study of CM pathogenesis. Children enrolled before 2014 and treated with quinine (N = 258) were compared with those admitted in 2014 and after, and treated with artesunate (N = 235). The last hematocrit value obtained during hospitalization was compared with the 1-month post-hospitalization hematocrit value. The overall rate of a post-hospitalization decrease in hematocrit in children surviving CM was 5.3% (11 of 235 or 4.7% for quinine, 15 of 258 or 5.8% for artesunate; odds ratio, 3.23 [0.88, 18.38]); no patients with a decrease in hematocrit were symptomatic, and none required transfusion after hospitalization. Of the 26 children who had a decrease in hematocrit 1 month after hospitalization, 23.1% had evidence of a new malaria infection. When children treated with quinine and artesunate were combined, a higher hematocrit level on admission, lower quantitative histidine-rich protein level, and splenomegaly were associated independently with post-malaria anemia. In African survivors of CM, post-malaria anemia is rare, mild, and unassociated with the anti-malarial treatment received.

Author Notes

Address correspondence to Douglas G. Postels, Division of Neurology, Children’s National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010. E-mail: dpostels@childrensnational.org

Financial support: G. G.’s work was supported by the Robert H. Parrott Research, Education, Advocacy, and Child Health Care Program at Children’s National as well as by the Children’s National Global Health Initiative. R. I.’s work in the Division of Biostatistics and Study Methodology was supported by award number UL1TR001876 from the NIH National Center for Advancing Translational Sciences. Financial support for statistical analysis was provided by intramural funds from the Division of Neurology at Children’s National Medical Center.

Authors’ addresses: Geoffrey Guenther, Department of Pediatrics, Children’s National Medical Center, Washington, DC, E-mail: gguenther2@childrensnational.org. Alexuse M. Saidi, Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi, E-mail: alexmsaidi@gmail.com. Rima Izem, Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington, DC, and Division of Epidemiology, The George Washington University School of Public Health, Washington, DC, E-mail: rizem@cnmc.org. Karl Seydel, Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi, and Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, E-mail: seydel@msu.edu. Douglas G. Postels, Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi, and Division of Neurology, The George Washington University/Children’s National Medical Center, Washington, DC, E-mail: dpostels@childrensnational.org.

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