Malaria Alert Centre, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi.
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O. Box 30096, Mahatma Ghandhi Road, Chichiri, Blantyre, Malawi.
Malar J. 2022 Oct 1;21(1):278. doi: 10.1186/s12936-022-04297-1.
Iron status is considered as a continuum from an iron deficiency with anaemia, without anaemia, varying amounts of stored iron to iron overload. The burden of Plasmodium falciparum infections is typically high among school-aged children (SAC). Nonetheless, SAC are often less likely to be covered by malaria interventions, making them a group with an untreated reservoir of parasite transmission. This study aimed to assess the effects of asymptomatic and clinical malaria infections on biochemical markers of iron status among SAC in Malawi.
Data from the 2015-2016 Malawi Micronutrient Survey (MNS) was used and multivariable logistic regression models using a generalized estimating equation to account for the complex cluster survey design were constructed. Blood samples of 684 children aged 5 to 14 years old were evaluated for clinical and asymptomatic malaria infections. Furthermore, blood samples were used to estimate haemoglobin (Hb), serum ferritin (SF) and, soluble transferrin receptors (sTfR) concentrations.
Of the 684 SAC analysed, approximately 42% had asymptomatic malaria, while 41.0% had clinical malaria. Anaemia (low Hb levels), iron deficiency (low SF concentration), and functional iron deficiency (high sTfR levels) were found in 20%, 5%, and 30% of the children, respectively. School-aged children with asymptomatic malaria had increased odds of being anaemic (adjusted odds ratio [aOR]: 3.71, 95% confidence interval [CI]: 2.29-5.99) and increased levels of sTfR (aOR: 3.00, 95% CI 2.01-4.47). Similarly, SAC with clinical malaria had increased odds of being anaemic (aOR: 3.54, 95% CI 2.19-5.72) and increased levels of sTfR (aOR: 3.02, 95% CI 2.02-4.52).
Both asymptomatic and clinical malaria were independent risk factors for anaemia and functional iron deficiency (FID). The notion that asymptomatic and clinical malaria were associated with both anaemia and FID underscores the need for public health programmers to consider adding mass screening and treatment for malaria to existing school-based health programmes.
铁状态被认为是一个从缺铁伴贫血、不伴贫血、储存铁量不等到铁过载的连续体。在学龄儿童（SAC）中，疟原虫感染的负担通常很高。尽管如此，SAC 往往不太可能被疟疾干预措施覆盖，这使得他们成为一个未接受寄生虫传播治疗的人群。本研究旨在评估马拉维 SAC 中无症状和临床疟疾病例感染对铁状态生化标志物的影响。
本研究使用了 2015-2016 年马拉维微量营养素调查（MNS）的数据，并构建了多变量逻辑回归模型，使用广义估计方程来考虑复杂的聚类调查设计。对 684 名 5 至 14 岁儿童的血液样本进行了临床和无症状疟疾病例感染评估。此外，还使用血液样本估计了血红蛋白（Hb）、血清铁蛋白（SF）和可溶性转铁蛋白受体（sTfR）浓度。
在所分析的 684 名 SAC 中，约 42%患有无症状疟疾，而 41.0%患有临床疟疾。贫血（Hb 水平低）、缺铁（SF 浓度低）和功能性缺铁（sTfR 水平高）分别在 20%、5%和 30%的儿童中发现。患有无症状疟疾的 SAC 儿童患贫血的几率增加（调整后的优势比 [aOR]：3.71，95%置信区间 [CI]：2.29-5.99），sTfR 水平升高（aOR：3.00，95%CI 2.01-4.47）。同样，患有临床疟疾的 SAC 儿童患贫血的几率增加（aOR：3.54，95%CI 2.19-5.72），sTfR 水平升高（aOR：3.02，95%CI 2.02-4.52）。
无症状和临床疟疾都是贫血和功能性缺铁（FID）的独立危险因素。无症状和临床疟疾均与贫血和 FID 相关的这一概念，凸显了公共卫生规划者需要考虑在现有的学校为基础的卫生方案中增加疟疾大规模筛查和治疗。
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