Plasmodium vivax infection: a major determinant of severe anaemia in infancy.
Most malarious countries outside of Africa are co-endemic for Plasmodium falciparum and Plasmodium vivax. The comparative burden of anaemia in the community caused by these two species is incompletely characterized.



A three-stage, cross-sectional, community survey was used to determine the proportion of moderate or severe anaemia (haemoglobin <7 g/dL) attributable to patent P. vivax, P. falciparum and mixed parasitaemia in Papua, Indonesia. Adjusted population-attributable fractions were calculated from multivariable logistic regression models. Eight hundred and twenty-five households were surveyed with a total of 5255 occupants, 3890 (74 %) of whom were present and provided a blood sample. Plasmodium falciparum parasitaemia was present in 8.1 % (n = 315) of participants, P. vivax in 6.4 % (n = 250) and mixed infections in 1.9 % (n = 72). Overall, P. falciparum was associated with a mean reduction in haemoglobin of 1.16 g/dL compared to those without patent parasitaemia [95 % confidence interval (95 % CI) 0.91, 1.41 g/dL]. The corresponding values for P. vivax and mixed infections were 0.66 g/dL (95 % CI 0.35, 0.96) and 1.25 g/dL (0.71, 1.80), respectively. Overall, 16.7 % (95 % CI 8.52, 24.2 %) of haemoglobin concentrations <7 g/dL in the community were estimated to be attributable to patent parasitaemia. The fractions for infants and 1-5 years old were 34.4 % (95 % CI -3.30, 58.3 %) and 23.2 % (95 % CI 3.34, 39.0 %), respectively. Plasmodium vivax was associated with a greater than threefold higher attributable fraction of anaemia in infants compared with P. falciparum [27.6 % (95 % CI -3.20, 49.2 %) versus 7.94 % (-5.87, 20.0 %)].



Despite comparatively low-level endemicity, malaria is associated with a significant proportion of all cases of community anaemia in southern Papua. Contrary to its benign reputation, P. vivax is an important and preventable risk factor for anaemia during infancy-a probable consequence of relapsing disease prior to the development of immunity.
Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.|Mimika District Health Authority, Timika, Papua, Indonesia.
Enny
E
Kenangalem
National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.
Muhammad
M
Karyana
Mimika District Health Authority, Timika, Papua, Indonesia.
Lenny
L
Burdarm
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Shunmay
S
Yeung
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Julie A
JA
Simpson
National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.
Emiliana
E
Tjitra
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811, Australia.|Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
Nicholas M
NM
Anstey
Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.|Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811, Australia.|Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia.
Jeanne Rini
JR
Poespoprodjo
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811, Australia. rprice@menzies.edu.au.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. rprice@menzies.edu.au.
Ric N
0000-0003-2000-2874
RN
Price
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811, Australia.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.|Division of Medicine, Christchurch Hospital, Christchurch, New Zealand.
Nicholas M
NM
Douglas
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications; D016780:Malaria, Vivax / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D055815:Young Adult
Anaemia; Indonesia; Malaria; Plasmodium falciparum; Plasmodium malariae; Plasmodium vivax