Birhanu Zewdie, Yihdego Yemane Ye-Ebiyo, Emana Daniel, Feyissa Damtew, Kenate Silashi, Kebede Estifanos, Getahun Kefelegn, Yewhalaw Delenasaw
Department of Health Education and Behavioral Sciences, Institute of Health, Jimma University, P.O. Box 378, Ethiopia.
Abt Associates, Africa Indoor Residual Spraying, Accra, Ghana.
Acta Trop. 2017 Sep;173:1-10. doi: 10.1016/j.actatropica.2017.05.021. Epub 2017 May 15.
In the context of reduced transmission of malaria, it is essential to examine the association between exposure to malaria and haemoglobin level. This study measured the Haemoglobin level of children 2-9 years of age and examined its association with malariometric indices. A cross sectional study was conducted, during June 2016, on 763 children 2-9 years old, recruited from ten sites representing different malaria transmission settings in Ethiopia. Haemoglobin concentration was determined using HemoCue analyzer. Malariometric indices (splenomegaly rate, parasite rate and serological marker) were measured. The overall prevalence of anaemia was 17.3% (95% CI: 14.6-19.9) in the study population. Mild, moderate and severe anaemia accounted for 7.3%, 7.2% and 2.8% respectively. Of the children with anaemia (132), only 7 (5.3%) had malaria parasitaemia. The prevalence of malaria parasitaemia was 3.6% (2/56), 9.1% (5/55) and 0.0% (0/21) among children with mild, moderate and severe anaemia, respectively. Malaria reactive antibody and anaemia co-occurred in 3.13% (21/672) of the samples. Seroprevalence and parasitaemia did not have significant association with anaemia (p>0.05). However, splenomegaly was significantly associated with increased risk of anaemia (AOR=14.93; p=0.001). Anaemia was significantly higher among children 2-4 years old (22.2%), and children living in households without any insecticide treated bed net (34.0%). The prevalence of anaemia was lower by 55.0% among children living in households with at least one net (AOR=0.45, 95% CI: 0.21-0.96). Repeated exposure to malaria infections (seropositive) and parasitaemia was less likely to contribute to development of anaemia among children 2-9 years in this study setting. Thus, in low malaria endemic settings, anaemia prevention and control program required to reconsider the historical evidence that suggests malaria is one of the major risk factor for anaemia.
在疟疾传播减少的背景下，研究疟疾暴露与血红蛋白水平之间的关联至关重要。本研究测量了2至9岁儿童的血红蛋白水平，并考察了其与疟疾测量指标之间的关联。2016年6月，在埃塞俄比亚十个代表不同疟疾传播环境的地点招募了763名2至9岁儿童，进行了一项横断面研究。使用血红蛋白分析仪测定血红蛋白浓度。测量了疟疾测量指标（脾肿大率、寄生虫率和血清学标志物）。研究人群中贫血的总体患病率为17.3%（95%置信区间：14.6 - 19.9）。轻度、中度和重度贫血分别占7.3%、7.2%和2.8%。在贫血儿童（132名）中，只有7名（5.3%）患有疟疾寄生虫血症。轻度、中度和重度贫血儿童中疟疾寄生虫血症的患病率分别为3.6%（2/56）、9.1%（5/55）和0.0%（0/21）。3.13%（21/672）的样本中同时出现疟疾反应性抗体和贫血。血清阳性率和寄生虫血症与贫血无显著关联（p>0.05）。然而，脾肿大与贫血风险增加显著相关（比值比=14.93；p = 0.001）。2至4岁儿童（22.2%）以及居住在没有任何经杀虫剂处理蚊帐家庭的儿童中贫血患病率显著更高。居住在至少有一顶蚊帐家庭的儿童中贫血患病率降低了55.0%（比值比=0.45，95%置信区间：0.21 - 0.96）。在本研究环境中，2至9岁儿童反复暴露于疟疾感染（血清阳性）和寄生虫血症不太可能导致贫血的发生。因此，在低疟疾流行地区，贫血预防和控制计划需要重新审视认为疟疾是贫血主要危险因素之一的历史证据。
