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      Uncomplicated falciparum malaria among schoolchildren in Bajil district of Hodeidah governorate, west of Yemen: association with anaemia and underweight

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          Abstract

          Background

          Malaria, malnutrition and anaemia are major public health problems in Yemen, with Hodeidah being the most malaria-afflicted governorate. To address the lack of relevant studies, this study was conducted to determine the prevalence of Plasmodium falciparum and its relation to nutritional status and haematological indices among schoolchildren in Bajil district of Hodeidah governorate, west of Yemen.

          Methods

          A cross-sectional study was conducted among 400 schoolchildren selected randomly from four schools in Bajil district. Data about demographic characteristics, risk factors and anthropometric measurements of age, height and weight were collected. Duplicate thick and thin blood films were prepared, stained with Giemsa and examined microscopically for malaria parasites. The density of P. falciparum asexual stages was estimated on thick films. EDTA-blood samples were examined for the haematological indices of haemoglobin (Hb) and blood cell counts.

          Results

          Plasmodium falciparum was prevalent among 8.0% (32/400) of schoolchildren with a mean parasite density of 244.3 ± 299.3/µL of blood and most infections showing low-level parasitaemia, whereas Plasmodium vivax was detected in one child (0.25%). Residing near water collections was a significant independent predictor of falciparum malaria [adjusted odds ratio (AOR) = 2.6, 95.0% CI 1.20–5.72; p = 0.016] in schoolchildren. Mild anaemia was prevalent among more than half of P. falciparum-infected schoolchildren and significantly associated with falciparum malaria (AOR = 5.8, 95.0% CI 2.39–14.17; p < 0.001), with a mean Hb concentration of 10.7 ± 1.0 g/dL. Although the mean values of the total white blood cells, monocytes and platelets were significantly lower in infected than non-infected schoolchildren, they were within normal ranges. More than half of the children were malnourished, with stunting (39.3%) and underweight (36.0%) being the most prevalent forms of malnutrition; 6.3% of children were wasted. Underweight (AOR = 5.3, 95.0% CI 2.09–13.62; p < 0.001) but not stunting or wasting, was a significant predictor of falciparum malaria among schoolchildren.

          Conclusion

          Asymptomatic falciparum malaria is prevalent among schoolchildren in Bajil district of Hodeidah Governorate, with predominance of low parasitaemic infections and significant association with mild anaemia and underweight. Residence near water collection is a significant predictor of infection with falciparum malaria among schoolchildren. Further studies among children with severe malaria and those with high parasite densities are recommended.

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          Most cited references 42

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          Development of normalized curves for the international growth reference: historical and technical considerations.

          The World Health Organization recommended in 1978 that the National Center for Health Statistics/Centers for Disease Control growth reference curves be used as an international growth reference. To permit the expression of growth in terms of standard deviations, CDC developed growth curves from the observed data that approximate normal distributions. Because of significant skewness, standard deviations for weight-for-age and weight-for-height were calculated separately for distributions below and above the median. Standard deviations below the median were calculated from the 5th, 10th, 25th, and 50th observed percentiles while those above the median were based on the 50th, 75th, 90th, and 95th observed percentiles. Height-for-age distributions did not show significant skewness, thus, the standard deviations were calculated based on all six of the above observed percentiles. The normalized reference curves provide a highly useful data base that permits the standardized comparison of anthropometric data from different populations.
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            Suppression of erythropoiesis in malarial anemia is associated with hemozoin in vitro and in vivo.

            Malarial anemia is a global public health problem and is characterized by a low reticulocyte response in the presence of life-threatening hemolysis. Although cytokines, in particular tumor necrosis factor-alpha (TNF-alpha), can suppress erythropoiesis, the grossly abnormal bone marrow morphology indicates that other factors may contribute to ineffective erythropoiesis. We hypothesized that the cytotoxic hemozoin (Hz) residues from digested hemoglobin (Hb) significantly contribute to abnormal erythropoiesis. Here, we show that not only isolated Hz, but also delipidated Hz, inhibits erythroid development in vitro in the absence of TNF-alpha. However, when added to cultures, TNF-alpha synergizes with Hz to inhibit erythropoiesis. Furthermore, we show that, in children with malarial anemia, the proportion of circulating monocytes containing Hz is associated with anemia (P < .001) and reticulocyte suppression (P = .009), and that this is independent of the level of circulating cytokines, including TNF-alpha. Plasma Hz is also associated with anemia (P < .001) and reticulocyte suppression (P = .02). Finally, histologic examination of the bone marrow of children who have died from malaria shows that pigmented erythroid and myeloid precursors are associated with the degree of abnormal erythroid development. Taken together, these observations provide compelling evidence for inhibition of erythropoiesis by Hz.
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              Impact of Plasmodium falciparum infection on haematological parameters in children living in Western Kenya

              Background Malaria is the commonest cause of childhood morbidity in Western Kenya with varied heamatological consequences. The t study sought to elucidate the haemotological changes in children infected with malaria and their impact on improved diagnosis and therapy of childhood malaria. Methods Haematological parameters in 961 children, including 523 malaria-infected and 438 non-malaria infected, living in Kisumu West District, an area of malaria holoendemic transmission in Western Kenya were evaluated. Results The following parameters were significantly lower in malaria-infected children; platelets, lymphocytes, eosinophils, red blood cell count and haemoglobin (Hb), while absolute monocyte and neutrophil counts, and mean platelet volume (MPV) were higher in comparison to non-malaria infected children. Children with platelet counts of <150,000/uL were 13.8 times (odds ratio) more likely to have malaria. Thrombocytopaenia was present in 49% of malaria-infected children and was associated with high parasitaemia levels, lower age, low Hb levels, increased MPV and platelet aggregate flag. Platelet aggregates were more frequent in malaria-infected children (25% vs. 4%, p<0.0001) and associated with thrombocytopaenia rather than malaria status. Conclusion Children infected with Plasmodium falciparum malaria exhibited important changes in some haematological parameters with low platelet count and haemoglobin concentration being the two most important predictors of malaria infection in children in our study area. When used in combination with other clinical and microscopy, these parameters could improve malaria diagnosis in sub-patent cases.
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                Author and article information

                Contributors
                rashadqb@yahoo.com , r.abdulghani@su.edu.ye
                Journal
                Malar J
                Malar J
                Malaria Journal
                BioMed Central (London )
                1475-2875
                7 October 2020
                7 October 2020
                2020
                : 19
                Affiliations
                [1 ]GRID grid.412413.1, ISNI 0000 0001 2299 4112, Laboratory Department, Kuwait University Hospital, , Sana’a University, ; Sana’a, Yemen
                [2 ]GRID grid.412413.1, ISNI 0000 0001 2299 4112, Department of Medical Parasitology, Faculty of Medicine and Health Sciences, , Sana’a University, ; Sana’a, Yemen
                [3 ]GRID grid.444917.b, ISNI 0000 0001 2182 316X, Tropical Disease Research Center, Faculty of Medicine and Health Sciences, , University of Science and Technology, ; Sana’a, Yemen
                [4 ]GRID grid.7155.6, ISNI 0000 0001 2260 6941, Department of Parasitology, Medical Research Institute, , Alexandria University, ; Alexandria, Egypt
                [5 ]GRID grid.448646.c, Laboratory Medicine Department, Faculty of Applied Medical Sciences, , Al Baha University, ; Al Baha, Saudi Arabia
                Article
                3431
                10.1186/s12936-020-03431-1
                7542704
                33028361
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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