title: Severe anemia in Papua New Guinean children from a malaria-endemic area: a case-control etiologic study.
abstract: BACKGROUND
  There are few detailed etiologic studies of severe anemia in children from malaria-endemic areas and none in those countries with holoendemic transmission of multiple Plasmodium species.
  
  
  RESULTS
  We examined associates of severe anemia in 143 well-characterized Papua New Guinean (PNG) children aged 0.5-10 years with hemoglobin concentration <50 g/L (median [inter-quartile range] 39 [33]-[44] g/L) and 120 matched healthy children (113 [107-119] g/L) in a case-control cross-sectional study. A range of socio-demographic, behavioural, anthropometric, clinical and laboratory (including genetic) variables were incorporated in multivariate models with severe anemia as dependent variable. Consistent with a likely trophic effect of chloroquine or amodiaquine on parvovirus B19 (B19V) replication, B19V PCR/IgM positivity had the highest odds ratio (95% confidence interval) of 75.8 (15.4-526), followed by P. falciparum infection (19.4 (6.7-62.6)), vitamin A deficiency (13.5 (5.4-37.7)), body mass index-for-age z-score <2.0 (8.4 (2.7-27.0)) and incomplete vaccination (2.94 (1.3-7.2)). P. vivax infection was inversely associated (0.12 (0.02-0.47), reflecting early acquisition of immunity and/or a lack of reticulocytes for parasite invasion. After imputation of missing data, iron deficiency was a weak positive predictor (6.4% of population attributable risk).
  
  
  CONCLUSIONS
  These data show that severe anemia is multifactorial in PNG children, strongly associated with under-nutrition and certain common infections, and potentially preventable through vitamin A supplementation and improved nutrition, completion of vaccination schedules, and intermittent preventive antimalarial treatment using non-chloroquine/amodiaquine-based regimens.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Laurens
authors.initials: L
authors.lastname: Manning
authors.forename: Moses
authors.initials: M
authors.lastname: Laman
authors.forename: Anna
authors.initials: A
authors.lastname: Rosanas-Urgell
authors.forename: Pascal
authors.initials: P
authors.lastname: Michon
authors.forename: Susan
authors.initials: S
authors.lastname: Aipit
authors.forename: Cathy
authors.initials: C
authors.lastname: Bona
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000740:Anemia / Q000453:epidemiology* / Q000209:etiology*; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D016780:Malaria, Vivax / Q000150:complications / Q000453:epidemiology; D008297:Male; D010219:Papua New Guinea / Q000453:epidemiology; D010322:Parvoviridae Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D016732:Parvovirus B19, Human; D010963:Plasmodium falciparum; D010966:Plasmodium vivax; D014611:Vaccination / Q000706:statistics & numerical data; D014802:Vitamin A Deficiency / Q000150:complications / Q000453:epidemiology
chemical_list: D006454:Hemoglobins