title: Familial aggregation of cerebral malaria and severe malarial anemia.
abstract: BACKGROUND
  The predominant manifestations of severe malaria in African children are cerebral malaria (CM) and severe malarial anemia (SMA). As a first step toward a family-based approach to identify the environmental and genetic pathways that contribute to severe malaria, we tested whether it aggregates within families.
  
  
  METHODS
  Family history of severe malaria was explored during face-to-face interviews with parents. Logistic regression was used to determine whether CM and SMA aggregate within individuals and within families. The pattern of familial aggregation was then expressed as familial odds ratios that were adjusted for relevant risk factors.
  
  
  RESULTS
  This study was of 2811 inhabitants of Bamako, Mali, clustered in 407 nuclear families. The probands were 136 children with severe malaria and 271 healthy children from the community. Within-person association of CM and SMA was significant (odds ratio, 6.15 [95% confidence interval (CI), 2.62-14.41]). Over a lifetime, with each additional affected relative, the odds of a person contracting CM increased by 1.98 times (95% CI, 1.59-2.45), and the odds of having SMA increased by 1.91 times (95% CI, 1.05-3.47). Over a lifetime, for a child whose sibling had a history of CM, the odds of having CM were 2.49 times greater (95% CI, 1.51-4.10) than the odds for a child whose sibling had no such history; for a child whose sibling had a history of SMA, the odds of having SMA were 4.92 times greater (95% CI, 1.21-19.9) than the odds for a child whose sibling had no such history.
  
  
  CONCLUSIONS
  Our data suggest strong familial aggregation of CM and SMA.
authors.affiliation: Immunology and Genetics of Parasitic Diseases, Institut National de la Santé et de la Recherche Médicale U.399, Faculty of Medicine, Université de la Méditerranée, Marseilles, France. stephane.ranque@medecine.univ-mrs.fr
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ranque
authors.forename: Innocent
authors.initials: I
authors.lastname: Safeukui
authors.forename: Belco
authors.initials: B
authors.lastname: Poudiougou
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Traoré
authors.forename: Modibo
authors.initials: M
authors.lastname: Keita
authors.forename: Diamori
authors.initials: D
authors.lastname: Traoré
authors.forename: Mahamadou
authors.initials: M
authors.lastname: Diakité
authors.forename: Mahamadou B
authors.initials: MB
authors.lastname: Cissé
authors.forename: Marouf M
authors.initials: MM
authors.lastname: Keita
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
authors.forename: Alain J
authors.initials: AJ
authors.lastname: Dessein
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000235:genetics* / Q000469:parasitology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000235:genetics*; D016778:Malaria, Falciparum / Q000097:blood / Q000235:genetics* / Q000503:physiopathology; D008297:Male