The association between malaria parasitaemia, erythrocyte polymorphisms, malnutrition and anaemia in children less than 10 years in Senegal: a case control study.
BACKGROUND
Malaria and anaemia (Haemoglobin <11 g/dl) remain frequent in tropical regions and are closely associated. Although anaemia aetiologies are known to be multi-factorial, most studies in malaria endemic areas have been confined to analysis of possible associations between anaemia and individual factors such as malaria. A case control study involving children aged from 1 to 10 years was conducted to assess some assumed contributors to anaemia in the area of Bonconto Health post in Senegal.


METHODS
Study participants were randomly selected from a list of children who participated in a survey in December 2010. Children aged from 1 to 10 years with haemoglobin level below 11 g/dl represented cases (anaemic children). Control participants were eligible if of same age group and their haemoglobin level was >= 11 g/dl. For each participant, a physical examination was done and anthropometric data collected prior to a biological assessment which included: malaria parasitaemia infection, intestinal worm carriage, G6PD deficiency, sickle cell disorders, and alpha-talassaemia.


RESULTS
Three hundred and fifty two children < 10 years of age were enrolled (176 case and 176 controls). In a logistic regression analysis, anaemia was significantly associated with malaria parasitaemia (aOR=5.23, 95%CI[1.1-28.48]), sickle cell disorders (aOR=2.89, 95%CI[1,32-6.34]), alpha-thalassemia (aOR=1.82, 95%CI[1.2-3.35]), stunting (aOR=3.37, 95%CI[1.93-5.88], age ranged from 2 to 4 years (aOR=0.13, 95%CI[0.05-0.31]) and age > 5 years (aOR=0.03, 95%CI[0.01-0.08]). Stratified by age group, anaemia was significantly associated with stunting in children less than 5 years (aOR=3.1 95%CI[1.4 - 6.8]), with, sickle cell disorders (aOR=3.5 95%CI [1.4 - 9.0]), alpha-thalassemia (or=2.4 95%CI[1.1-5.3]) and stunting (aOR=3.6 95%CI [1.6-8.2]) for children above 5 years. No association was found between G6PD deficiency, intestinal worm carriage and children's gender.


CONCLUSIONS
Malaria parasitaemia, stunting and haemoglobin genetic disorders represented the major causes of anaemia among study participants. Anaemia control in this area could be achieved by developing integrated interventions targeting both malaria and malnutrition.
Service de Parasitologie, Faculté de Médecine et Pharmacie, Dakar, Sénégal. rogertine@hotmail.com
Roger C K
RC
Tine
Magatte
M
Ndiaye
Helle Holm
HH
Hansson
Cheikh T
CT
Ndour
Babacar
B
Faye
Michael
M
Alifrangis
K
K
Sylla
Jean L
JL
Ndiaye
Pascal
P
Magnussen
Ib C
IC
Bygbjerg
Oumar
O
Gaye
D000740:Anemia / Q000097:blood / Q000150:complications*; D000755:Anemia, Sickle Cell / Q000097:blood / Q000150:complications; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004747:Entamoeba / Q000302:isolation & purification; D004912:Erythrocytes / Q000378:metabolism*; D005260:Female; D016829:Giardia lamblia / Q000302:isolation & purification; D005954:Glucosephosphate Dehydrogenase / Q000235:genetics / Q000378:metabolism; D006454:Hemoglobins / Q000235:genetics / Q000378:metabolism; D006801:Humans; D007223:Infant; D008288:Malaria / Q000097:blood / Q000150:complications*; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000150:complications*; D018512:Parasitemia / Q000097:blood / Q000150:complications* / Q000469:parasitology; D011110:Polymorphism, Genetic; D012307:Risk Factors; D012548:Schistosoma haematobium / Q000302:isolation & purification; D012550:Schistosoma mansoni / Q000302:isolation & purification; D012675:Senegal; D017171:Strongyloides stercoralis / Q000302:isolation & purification; D017085:alpha-Thalassemia / Q000097:blood / Q000150:complications
D006454:Hemoglobins; D005954:Glucosephosphate Dehydrogenase