title: Assessing the impact of differences in malaria transmission intensity on clinical and haematological indices in children with malaria.
abstract: Malaria control interventions have led to a decline in transmission intensity in many endemic areas, and resulted in elimination in some areas. This decline, however, will lead to delayed acquisition of protective immunity and thus impact disease manifestation and outcomes. Therefore, the variation in clinical and haematological parameters in children with malaria was assessed across three areas in Ghana with varying transmission intensities.
  
  
  
  A total of 568 children between the ages of 2 and 14 years with confirmed malaria were recruited in hospitals in three areas with varying transmission intensities (Kintampo > Navrongo > Accra) and a comprehensive analysis of parasitological, clinical, haematological and socio-economic parameters was performed.
  
  
  
  Areas of lower malaria transmission tended to have lower disease severity in children with malaria, characterized by lower parasitaemias and higher haemoglobin levels. In addition, total white cell counts and percent lymphocytes decreased with decreasing transmission intensity. The heterozygous sickle haemoglobin genotype was protective against disease severity in Kintampo (P = 0.016), although this was not significant in Accra and Navrongo. Parasitaemia levels were not a significant predictor of haemoglobin level after controlling for age and gender. However, higher haemoglobin levels in children were associated with certain socioeconomic factors, such as having fathers who had any type of employment (P < 0.05) and mothers who were teachers (P < 0.05).
  
  
  
  The findings demonstrate significant differences in the haematological presentation and severity of malaria among areas with different transmission intensity in Ghana, indicating that these factors need to be considered in planning the management of the disease as the endemicity is expected to decline after control interventions.
authors.affiliation: West African Centre for Cell Biology of Infectious Pathogens and Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Volta Road, Legon, P. O. Box LG 54, Accra, Ghana.
authors.forename: Henrietta E
authors.initials: HE
authors.lastname: Mensah-Brown
authors.affiliation: West African Centre for Cell Biology of Infectious Pathogens and Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Volta Road, Legon, P. O. Box LG 54, Accra, Ghana.|Department of Applied Chemistry and Biochemistry, Faculty of Applied Sciences, University for Development Studies, Navrongo Campus, Navrongo, Ghana.
authors.forename: James
authors.initials: J
authors.lastname: Abugri
authors.affiliation: Department of Biostatistics, Room A9, School of Public Health, University of Ghana, Legon, Akilagpa Sawyerr Rd, Legon, P.O. Box LG13, Accra, Ghana.
authors.forename: Kwaku P
authors.initials: KP
authors.lastname: Asante
authors.affiliation: Kintampo Health Research Centre, P. O. Box AH 200, Kintampo, Ghana.
authors.forename: Duah
authors.initials: D
authors.lastname: Dwomoh
authors.affiliation: Department of Biostatistics, Room A9, School of Public Health, University of Ghana, Legon, Akilagpa Sawyerr Rd, Legon, P.O. Box LG13, Accra, Ghana.
authors.forename: David
authors.initials: D
authors.lastname: Dosoo
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana.
authors.forename: Frank
authors.initials: F
authors.lastname: Atuguba
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Conway
authors.affiliation: West African Centre for Cell Biology of Infectious Pathogens and Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Volta Road, Legon, P. O. Box LG 54, Accra, Ghana. gawandare@ug.edu.gh.
authors.forename: Gordon A
authors.identifier: 0000-0002-8793-3641
authors.initials: GA
authors.lastname: Awandare
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005869:Ghana; D006801:Humans; D008288:Malaria / Q000097:blood / Q000469:parasitology / Q000503:physiopathology* / Q000635:transmission*; D008297:Male; D018512:Parasitemia / Q000097:blood / Q000469:parasitology / Q000503:physiopathology / Q000635:transmission
keywords: Malaria; Severe malarial anaemia; Sickle cell trait; Transmission intensity