title: Hemoglobin C Trait Provides Protection From Clinical Falciparum Malaria in Malian Children.
abstract: BACKGROUND
  Hemoglobin C trait, like hemoglobin S trait, protects against severe malaria in children, but it is unclear whether hemoglobin C trait also protects against uncomplicated malaria. We hypothesized that Malian children with hemoglobin C trait would have a lower risk of clinical malaria than children with hemoglobin AA.
  
  
  METHODS
  Three hundred children aged 0-6 years were enrolled in a cohort study of malaria incidence in Bandiagara, Mali, with continuous passive and monthly active follow-up from June 2009 to June 2010.
  
  
  RESULTS
  Compared to hemoglobin AA children (n = 242), hemoglobin AC children (n = 39) had a longer time to first clinical malaria episode (hazard ratio [HR], 0.19; P = .001; 364 median malaria-free days vs 181 days), fewer episodes of clinical malaria, and a lower cumulative parasite burden. Similarly, hemoglobin AS children (n = 14) had a longer time to first clinical malaria episode than hemoglobin AA children (HR, 0.15; P = .015; 364 median malaria-free days vs 181 days), but experienced the most asymptomatic malaria infections of any group.
  
  
  CONCLUSIONS
  Both hemoglobin C and S traits exerted a protective effect against clinical malaria episodes, but appeared to do so by mechanisms that differentially affect the response to infecting malaria parasites.
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine Howard Hughes Medical Institute, Baltimore, Maryland.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Travassos
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako.
authors.forename: Drissa
authors.initials: D
authors.lastname: Coulibaly
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine Howard Hughes Medical Institute, Baltimore, Maryland.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Laurens
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako.
authors.forename: Ahmadou
authors.initials: A
authors.lastname: Dembélé
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako.
authors.forename: Youssouf
authors.initials: Y
authors.lastname: Tolo
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako.
authors.forename: Abdoulaye K
authors.initials: AK
authors.lastname: Koné
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako.
authors.forename: Karim
authors.initials: K
authors.lastname: Traoré
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako.
authors.forename: Amadou
authors.initials: A
authors.lastname: Niangaly
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako Centre de Recherche et de Lutte contre la Drépanocytose, Bamako, Mali.
authors.forename: Aldiouma
authors.initials: A
authors.lastname: Guindo
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine.
authors.forename: Yukun
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine Howard Hughes Medical Institute, Baltimore, Maryland.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Berry
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine Howard Hughes Medical Institute, Baltimore, Maryland.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Jacob
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine Howard Hughes Medical Institute, Baltimore, Maryland.
authors.forename: Shannon
authors.initials: S
authors.lastname: Takala-Harrison
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine Howard Hughes Medical Institute, Baltimore, Maryland.
authors.forename: Matthew
authors.initials: M
authors.lastname: Adams
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine Howard Hughes Medical Institute, Baltimore, Maryland.
authors.forename: Biraj
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine Howard Hughes Medical Institute, Baltimore, Maryland.
authors.forename: Amy Z
authors.initials: AZ
authors.lastname: Mu
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako.
authors.forename: Bourema
authors.initials: B
authors.lastname: Kouriba
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine.
authors.forename: Kirsten E
authors.initials: KE
authors.lastname: Lyke
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako Centre de Recherche et de Lutte contre la Drépanocytose, Bamako, Mali.
authors.forename: Dapa A
authors.initials: DA
authors.lastname: Diallo
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako.
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
authors.affiliation: Center for Malaria Research, Institute for Global Health, University of Maryland School of Medicine Howard Hughes Medical Institute, Baltimore, Maryland.
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Plowe
authors.affiliation: Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako.
authors.forename: Mahamadou A
authors.initials: MA
authors.lastname: Thera
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology* / Q000235:genetics*; D006444:Hemoglobin C / Q000235:genetics*; D006451:Hemoglobin, Sickle / Q000235:genetics; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000235:genetics*; D008297:Male; D008302:Mali / Q000453:epidemiology
chemical_list: D006451:Hemoglobin, Sickle; D006444:Hemoglobin C
keywords: Mali; Plasmodium falciparum; cohort study; hemoglobin C; hemoglobin S; malaria