Mensah-Brown Henrietta E, Abugri James, Asante Kwaku P, Dwomoh Duah, Dosoo David, Atuguba Frank, Conway David J, Awandare Gordon A
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.
Malar J. 2017 Mar 1;16(1):96. doi: 10.1186/s12936-017-1745-8.
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.
疟疾控制干预措施已使许多流行地区的传播强度下降，并在一些地区实现了消除疟疾。然而，这种下降将导致保护性免疫力的获得延迟，从而影响疾病表现和结局。因此，在加纳三个传播强度不同的地区评估了疟疾患儿临床和血液学参数的差异。
在三个传播强度不同的地区（金坦波>纳夫龙戈>阿克拉）的医院招募了568名年龄在2至14岁之间确诊为疟疾的儿童，并对寄生虫学、临床、血液学和社会经济参数进行了综合分析。
疟疾传播率较低的地区，疟疾患儿的疾病严重程度往往较低，其特征是疟原虫血症较低和血红蛋白水平较高。此外，随着传播强度的降低，白细胞总数和淋巴细胞百分比也随之下降。杂合子镰状血红蛋白基因型对金坦波地区的疾病严重程度具有保护作用（P = 0.016），尽管在阿克拉和纳夫龙戈并不显著。在控制年龄和性别后，疟原虫血症水平不是血红蛋白水平的显著预测指标。然而，儿童血红蛋白水平较高与某些社会经济因素有关，例如父亲有任何类型的工作（P < 0.05）和母亲是教师（P < 0.05）。
研究结果表明，加纳不同传播强度地区疟疾的血液学表现和严重程度存在显著差异，这表明在规划疾病管理时需要考虑这些因素，因为预计控制干预措施后疟疾流行率将下降。
