title: Malaria in patients with sickle cell anemia: burden, risk factors, and outcome at the outpatient clinic and during hospitalization.
abstract: Approximately 280,000 children are born with sickle cell anemia (SCA) in Africa annually, yet few survive beyond childhood. Falciparum malaria is considered a significant cause of this mortality. We conducted a 5-year prospective surveillance study for malaria parasitemia, clinical malaria, and severe malarial anemia (SMA) in Dar-es-Salaam, Tanzania, between 2004 and 2009. We recorded 10,491 visits to the outpatient clinic among 1808 patients with SCA and 773 visits among 679 patients without SCA. Similarly, we recorded 691 hospital admissions among 497 patients with SCA and 2017 in patients without SCA. Overall, the prevalence of parasitemia was lower in patients with SCA than in patients without SCA both at clinic (0.7% vs 1.6%; OR, 0.53; 95% CI, 0.32-0.86; P = .008) and during hospitalization (3.0% vs 5.6%; OR, 0.46; 95% CI, 0.25-0.94; P = .01). Furthermore, patients with SCA had higher rates of malaria during hospitalization than at clinic, the ORs being 4.29 (95% CI, 2.63-7.01; P < .001) for parasitemia, 17.66 (95% CI, 5.92-52.71; P < .001) for clinical malaria, and 21.11 (95% CI, 8.46-52.67; P < .001) for SMA. Although malaria was rare among patients with SCA, parasitemia during hospitalization was associated with both severe anemia and death. Effective treatment for malaria during severe illness episodes and further studies to determine the role chemoprophylaxis are required.
authors.affiliation: Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania. jmakani@muhas.ac.tz
authors.forename: Julie
authors.initials: J
authors.lastname: Makani
authors.forename: Albert N
authors.initials: AN
authors.lastname: Komba
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Cox
authors.forename: Julie
authors.initials: J
authors.lastname: Oruo
authors.forename: Khadija
authors.initials: K
authors.lastname: Mwamtemi
authors.forename: Jesse
authors.initials: J
authors.lastname: Kitundu
authors.forename: Pius
authors.initials: P
authors.lastname: Magesa
authors.forename: Stella
authors.initials: S
authors.lastname: Rwezaula
authors.forename: Elineema
authors.initials: E
authors.lastname: Meda
authors.forename: Josephine
authors.initials: J
authors.lastname: Mgaya
authors.forename: Kisali
authors.initials: K
authors.lastname: Pallangyo
authors.forename: Emelda
authors.initials: E
authors.lastname: Okiro
authors.forename: David
authors.initials: D
authors.lastname: Muturi
authors.forename: Charles R
authors.initials: CR
authors.lastname: Newton
authors.forename: Gregory
authors.initials: G
authors.lastname: Fegan
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Williams
mesh_terms: D000349:Africa / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D000755:Anemia, Sickle Cell / Q000401:mortality* / Q000469:parasitology; D005260:Female; D006760:Hospitalization; D006801:Humans; D016778:Malaria, Falciparum / Q000401:mortality* / Q000469:parasitology / Q000517:prevention & control; D008297:Male; D018512:Parasitemia / Q000401:mortality* / Q000469:parasitology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors