Prevalence of inherited blood disorders and associations with malaria and anemia in Malawian children.

• Type of Material: Article
• Authors: Patrick T. McGann, Cincinnati Children's Hospital; Anne Williams, Emory University; Graham Ellis, Naval Medical Center San Diego, San Diego, CA.; Kathryn E. McElhinney, Cincinnati Children's Hospital; Laurel Romano, Cincinnati Children's Hospital; Julia Woodall, Cincinnati Children's Hospital; Thad A. Howard, Cincinnati Children's Hospital; Gerald Tegha, University of North Carolina Project, Lilongwe, Malawi.; Robert Krysiak, University of North Carolina Project, Lilongwe, Malawi.; R. Murray Lark, University of Nottingham; E. Louise Ander, Environmental Science Centre; Carine Mapango, Centers for Disease Control and Prevention; Kenneth I. Ataga, University of Nottingham; Satish Gopal, University of Nottingham; Nigel S. Key, University of Nottingham; Russell E. Ware, Cincinnati Children's Hospital; Parminder Suchdev, Emory University
• Language: English
• Date: 2018-11-13
• Publisher: American Society of Hematology: Blood Advances
• Publication Version: Final Published Version
• Copyright Statement: © 2018 AMERICAN SOCIETY OF HEMATOLOGY (ASH)
• Final Published Version (URL): http://dx.doi.org/10.1182/bloodadvances.2018023069
• Title of Journal or Parent Work: Blood Advances
• ISSN: 2473-9529
• Volume: 2
• Issue: 21
• Start Page: 3035
• End Page: 3044
• Grant/Funding Information: P.T.M. receives funding from the National Institutes of Health, National Heart, Lung, and Blood Institute (1K23HL128885).; The study was supported by the Emory Global Health Institute (Combating Childhood Illness Seed Grant; principal investigator: P.S.S.).; The overall Malawi Demographic Health Survey was funded by Irish Aid, World Bank, and UNICEF with technical assistance from the Centers for Disease Control and Prevention and Emory University.
• Keywords: Malawi; children; G6PD; malaria; sickle cell disease; inherited blood disorders; anemia
• Research Categories: Health Sciences, Public Health

Abstract

In sub-Saharan Africa, inherited causes of anemia are common, but data are limited regarding the geographical prevalence and coinheritance of these conditions and their overall contributions to childhood anemia. To address these questions in Malawi, we performed a secondary analysis of the 2015-2016 Malawi Micronutrient Survey, a nationally and regionally representative survey that estimated the prevalence of micronutrient deficiencies and evaluated both inherited and noninherited determinants of anemia. Children age 6 to 59 months were sampled from 105 clusters within the 2015-2016 Malawi Demographic Health Survey. Hemoglobin, ferritin, retinol binding protein, malaria, and inflammatory biomarkers were measured from venous blood. Molecular studies were performed using dried blood spots to determine the presence of sickle cell disease or trait, α-thalassemia trait, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. Of 1279 eligible children, 1071 were included in the final analysis. Anemia, iron deficiency, and malaria were common, affecting 30.9%, 21.5%, and 27.8% of the participating children, respectively. α-Thalassemia trait was common (>40% of children demonstrating deletion of 1 [33.1%] or 2 [10.0%] α-globin genes) and associated with higher prevalence of anemia (P < .001). Approximately 20% of males had G6PD deficiency, which was associated with a 1.0 g/dL protection in hemoglobin decline during malaria infection (P = .02). These data document that inherited blood disorders are common and likely play an important role in the prevalence of anemia and malaria in Malawian children.