Alpha+ -thalassemia protects against anemia associated with asymptomatic malaria: evidence from community-based surveys in Tanzania and Kenya.


Veenemans, J; Andang'o, PE; Mbugi, EV; Kraaijenhagen, RJ; Mwaniki, DL; Mockenhaupt, FP; Roewer, S; Olomi, RM; Shao, JF; van der Meer, JW; Savelkoul, HF; Verhoef, H; (2008) Alpha+ -thalassemia protects against anemia associated with asymptomatic malaria: evidence from community-based surveys in Tanzania and Kenya. The Journal of infectious diseases, 198 (3). pp. 401-8. ISSN 0022-1899 DOI: https://doi.org/10.1086/589884

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Abstract

BACKGROUND: In hospital-based studies, alpha(+)-thalassemia has been found to protect against severe, life-threatening falciparum malaria. alpha(+)-Thalassemia does not seem to prevent infection or high parasite densities but rather limits progression to severe disease--in particular, severe malarial anemia. We assessed to what extent alpha(+)-thalassemia influences the association between mild, asymptomatic Plasmodium falciparum infection and hemoglobin concentration. METHODS: The study was based on 2 community-based surveys conducted among afebrile children (0.5-8 years old; n=801) in Kenya and Tanzania. RESULTS: Among children without inflammation (whole-blood C-reactive protein concentration <or=10 mg/L), P. falciparum infection was associated with only small reductions in hemoglobin concentration, and effects were similar across alpha-globin genotypes. By contrast, the reduction in hemoglobin concentration associated with P. falciparum infection accompanied by inflammation was larger and strongly depended on genotype (normal, -21.8 g/L; heterozygous, -16.7 g/L; and homozygous, -4.6 g/L). Relative to children with a normal genotype, this difference in effect was 5.1 g/L (95% confidence interval [CI], -1.0 to 11.1 g/L) for heterozygotes and 17.2 g/L (95% CI, 8.3 to 26.2 g/L) for homozygotes (estimates are adjusted for study site, age, height-for-age z score, and iron deficiency). CONCLUSIONS: alpha(+)-Thalassemia limits the decline in hemoglobin concentration that is associated with afebrile infections, particularly those that are accompanied by inflammation.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Research Centre: Malaria Centre
PubMed ID: 18582194
Web of Science ID: 257658500016
URI: http://researchonline.lshtm.ac.uk/id/eprint/2053

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