Background
Methods
Sample collection
Determination of clinical and haematological indices
Determination of haemoglobin types
Classification of disease severity
Statistical analysis
Results
Comparison of clinical and demographic parameters across transmission areas
Kintampo | Navrongo | Accra | Total | P value | |
---|---|---|---|---|---|
Number of enrolees | 275 | 144 | 149 | 568 | |
Female, % | 44.00 | 52.78 | 43.28 | 46.11 | 0.174* |
Age, years | 5.37 (0.20) | 5.40 (0.40) | 6.246 (0.280) | 5.60 (0.16) | <0.001** |
Haemoglobin levels, g/dL | 9.83 (0.10) | 9.95 (0.16) | 10.72 (0.14) | 10.10 (0.08) | <0.001** |
Parasitaemia, parasites/µL | 148.435 (12.714) | 46.429 (3.977) | 37.999 (3.274) | 101.210 (10.056) | <0.001** |
Comparison of haematological parameters in children with malaria across transmission areas
Haematological indices | Study sites | Kruskal–Wallis | ||
---|---|---|---|---|
Kintampo (N = 266) | Navrongo (N = 144) | Accra (N = 117) |
P value | |
Median (IQR) | Median (IQR) | Median (IQR) | ||
Erythrocyte indices | ||||
RBC (103/mm3) | 4.0 (3.5–4.4) | 4.1 (3.6–4.5) | 4.4 (4.0–4.8) | <0.001 |
MCV (µm3) | 78.0 (74.0–81.0) | 75.0 (70.0–78.0) | 73.7 (68.5–77.7) | <0.001 |
MCH (pg.) | 25.5 (23.6–26.7) | 25.8 (23.9–27.3) | 25.1 (23.1–26.9) | 0.131 |
MCHC (g/dL) | 32.4 (31.7–33.3) | 34.3 (33.5–35.2) | 34.1 (33.1–35.0) | <0.001 |
RDW (%) | 15.1 (14.1–16.5) | 16.4 (15.4–17.6) | 14.7 (13.6–16.2) | <0.001 |
Leucocyte indices | ||||
WBC (103/mm3) | 8.5 (6.6–13.0) | 8.2 (5.8–10.4) | 7.5 (5.5–10.3) | 0.016 |
LYM (%) | 30.1 (21.0–41.3) | 19.4 (13.2–28.9) | 18.5 (13.8–29.7) | <0.001 |
MON (%) | 6.8 (5.3–8.6) | 5.5 (3.8–7.5) | 7.1 (4.5–11.0) | <0.001 |
GRA (%) | 62.6 (49.5–72.6) | 75.2 (64.2–83.1) | 72.4 (61.6–79.7) | <0.001 |
Platelet indices | ||||
PLT (103/mm3) | 125.5 (87.8–182.0) | 141.0 (100.0–210.3) | 126.5 (78.3–210.3) | 0.048 |
MPV (µm3) | 7.3 (6.8–8.3) | 7.8 (7.3–8.3) | 9.3 (8.8–10.2) | <0.001 |
PDW (%) | 15.1 (13.2–17.3) | 14.7 (11.5–16.5) | 11.9 (10.8–14.0) | <0.001 |
Impact of haemoglobin S and C on clinical and haematological indices
Haematological indices | Haemoglobin type |
P value | ||
---|---|---|---|---|
AA (N = 346) | AS (N = 46) | AC (N = 37) | ||
Median (IQR) | Median (IQR) | Median (IQR) | ||
Erythrocyte indices | ||||
Haemoglobin (g/dL)a
| 10.3 (9.0–11.4) | 10.80 (9.4–11.65) | 10.30 (8.57–11.55) | 0.219#
|
RBC (103/mm3) | 4.1 (3.7–4.5) | 4.3 (3.9–4.6) | 4.2 (3.6–4.8) | 0.187 |
MCV (µm3) | 77.0 (73.0–80.0) | 74.5 (71.8–77.9) | 73.5 (68.7–79.0) | 0.007 |
MCH (pg.) | 25.6 (23.8–26.9) | 24.5 (23.7–26.6) | 24.7 (22.7–25.7) | 0.008 |
MCHC (g/dL) | 33.3 (32.2–34.4) | 33.4 (32.2–34.4) | 32.8 (32.1–34.3) | 0.743 |
RDW (%) | 15.4 (14.3–16.7) | 16.2 (15.0–17.4) | 15.6 (14.8–17.4) | 0.002 |
Leucocyte indices | ||||
WBC (103/mm3) | 8.2 (6.2–10.5) | 8.9 (6.1–11.0) | 9.0 (6.9–13.0) | 0.058 |
LYM (%) | 27.3 (17.1–40.5) | 26.3 (17.4–41.3) | 27.0 (15.9–44.0) | 0.373 |
MON (%) | 6.3 (4.8–8.6) | 6.4 (5.1–8.5) | 6.4 (5.1–8.3) | 0.253 |
GRA (%) | 64.5 (49.5–76.4) | 63.7 (51.7–76.9) | 62.7 (44.6–74.8) | 0.226 |
Platelet indices | ||||
PLT (103/mm3) | 141 (92.0–211.0) | 166.5 (106.0–231.3) | 137.0 (79.0–234.0) | 0.044 |
MPV (µm3) | 7.8 (7.3–8.5) | 7.6 (6.9–8.1) | 7.5 (7.1–8.5) | 0.043 |
PDW (%) | 14.6 (12.4–16.7) | 14.4 (11.5–16.3) | 14.4 (11.9–18.7) | 0.555 |
Determinants of malaria severity
Relationship between haematological factors and anaemia severity
Haematological indices | Severity of malarial anaemia | Kruskal–Wallis | ||
---|---|---|---|---|
UM (N = 194) | MMA (N = 279) | MSMA (N = 65) | ||
Median (IQR) | Median (IQR) | Median (IQR) |
P value | |
Erythrocyte indices | ||||
RBC (103/mm3) | 4.5 (4.3–4.8) | 3.9 (3.5–4.2) | 2.5 (2.3–2.8) | <0.001 |
MCV (µm3) | 77.6 (73.0–81.0) | 75.0 (68.7–79.0) | 72.0 (65.3–79.8) | 0.003 |
MCH (pg.) | 26.2 (24.8–27.4) | 24.8 (22.8–26.6) | 24.9 (22.1–26.3) | <0.001 |
MCHC (g/dL) | 33.7 (32.5–34.6) | 33.1 (32.1–34.3) | 33.3 (31.4–34.9) | 0.005 |
RDW (%) | 14.8 (13.8–15.7) | 15.8 (14.6–17.1) | 17.3 (15.4–19.5) | <0.001 |
Leucocyte indices | ||||
WBC (103/mm3) | 8.5 (6.6–11.2) | 8.3 (6.1–10.6) | 7.6 (4.2–9.8) | 0.113 |
LYM (%) | 18.1 (12.0–27.0) | 26.7 (18.0–37.2) | 39.9 (32.4–48.4) | <0.001 |
MON (%) | 5.7 (3.9–7.7) | 6.3 (5.0–8.8) | 8.3 (6.6–10.1) | <0.001 |
GRA (%) | 75.6 (65.2–83.6) | 66.6 (54.7–76.0) | 51.0 (45.1–60.1) | <0.001 |
Platelet indices | ||||
PLT (103/mm3) | 168.0 (112.3–229.0) | 119.0 (78.0–180.0) | 117.0 (69.3–177.8) | <0.001 |
MPV (µm3) | 7.9 (7.2–9.0) | 7.6 (7.0–8.3) | 7.7 (7.2–8.3) | 0.005 |
PDW (%) | 14.7 (12.6–17.0) | 14.4 (11.6–16.6) | 13.5 (10.1–15.5) | 0.012 |
Socio-demographic predictors of anaemia severity and parasitaemia
Haemoglobin level in g/dL | Log parasite density | |||||||
---|---|---|---|---|---|---|---|---|
β* (95% CI β*) |
P value |
β** (95% CI β**) |
P value |
β* (95% CI β*) |
P value |
β** (95% CI β**) |
P value | |
Age | 0.21 (0.16, 0.25) | <0.0001 | 0.19 (0.14, 0.24) | <0.001 | −0.07 (−0.09, −0.03) | <0.0001 | −0.07 (−0.10, −0.05) | 0.002 |
Sex | ||||||||
Male | Ref | Ref | Ref | Ref | ||||
Female | −0.29 (−0.61,0.03) | 0.079 | −0.30 (−0.61, −0.01) | 0.055 | −0.09 (−0.25, 0.07) | 0.267 | −0.01 (−0.17, 0.15) | 0.896 |
Ecological zones | ||||||||
Accra | Ref | Ref | Ref | Ref | ||||
Navrongo | −0.69 (−1.11, −0.34) | <0.001 | 0.10 (−0.54, 0.73) | 0.769 | 0.29 (0.11, 0.51) | 0.003 | 0.30 (−0.03, 0.63) | 0.070 |
Kintampo | −0.90 (−1.26, −0.52) | <0.001 | −0.27 (−0.92, 0.38) | 0.418 | 0.31 (0.11, 0.46) | 0.002 | 0.41(0.08, 0.75) | 0.014 |
Mother’s education | ||||||||
None | Ref | Ref | Ref | Ref | ||||
Primary | −0.13 (−0.36, 0.62) | 0.603 | −0.49 (−1.00, 0.03) | 0.064 | −0.28 (−0.50, −0.02) | <0.050 | −0.10 (−0.34, 0.20) | 0.447 |
Middle | 0.30 (−0.43, 1.03) | 0.425 | −0.60 (−1.31, 0.12) | 0.104 | −0.11 (−0.47, 0.26) | 0.563 | 0.05 (−0.32, 0.43) | 0.776 |
JHS | 0.39 (−0.02, 0.79) | 0.062 | −0.32 (−0.79, 0.15) | 0.184 | −0.10 (−0.29, 0.10) | 0.348 | 0.03 (−0.20, 0.29) | 0.799 |
Vocation | 0.80 (−0.33, 1.94) | 0.165 | −0.56 (−1.70, 0.59) | 0.339 | −0.23 (−0.81, 0.35) | 0.432 | 0.16 (−0.43, 0.75) | 0.603 |
Secondary | 0.70 (−0.15, 1.24) | 0.012 | −0.40 (−1.05, 0.25) | 0.223 | −0.08 (−0.35, 0.19) | 0.571 | 0.01 (−0.32, 0.35) | 0.999 |
Tertiary | 1.00 (−0.13, 2.14) | 0.083 | −0.57 (−1.95, 0.81) | 0.416 | −0.06 (−0.62, 0.50) | 0.830 | −0.22 (−0.91, 0.51) | 0.551 |
Father’s education | ||||||||
None | Ref | Ref | Ref | Ref | ||||
Primary | 0.24 (−0.32, 0.79) | 0.400 | 0.27 (−0.27, 0.81) | 0.326 | 0.02 (−0.26, 0.29) | 0.991 | 0.04 (−0.24, 0.32) | 0.790 |
Middle | 1.01 (0.51, 1.64) | <0.0001 | 0.77 (0.18, 1.36) | 0.010 | 0.12 (−0.19, 0.43) | 0.666 | 0.12 (−0.19, 0.43) | 0.436 |
JHS | 0.64 (0.17, 1.12) | <0.0001 | 0.35 (−0.20, 0.91) | 0.212 | −0.10 (−0.39, 0.19) | 0.034 | −0.11 (−0.39, 0.17) | 0.442 |
Vocation | 0.21 (−1.27, 1.69) | 0.780 | 0.74 (−0.67, 2.16) | 0.304 | −0.79 (−1.52, 0.06) | 0.299 | −0.78 (−1.51, −0.05) | 0.036 |
Secondary | 1.05 (0.60, 1.51) | <0.0001 | 0.64 (0.10, 1.18) | 0.021 | 0.03 (−0.26, 0.31) | 0.397 | 0.04 (−0.24, 0.32) | 0.770 |
Tertiary | 1.12 (0.56, 1.68) | <0.0001 | 0.43 (−0.41, 1.27) | 0.318 | 0.17 (−0.26, 0.61) | 0.456 | 0.18 (−0.25, 0.62) | 0.406 |
Mother’s occupation | ||||||||
Unemployed | Ref | Ref | Ref | Ref | ||||
Farmer | −0.60 (−1.17, −0.03) | 0.041 | −0.18 (−0.79, 0.43) | 0.558 | 0.26 (−0.02, 0.55) | 0.070 | 0.14 (−0.18, 0.45) | 0.390 |
Teacher | 0.82 (0.20, 1.41) | 0.114 | 1.27 (0.23, 2.31) | 0.017 | 0.38 (−0.12, 0.89) | 0.138 | 0.49 (−0.05, 1.03) | 0.074 |
Trader | 0.47 (−0.07, 1.0) | 0.088 | 0.41 (−0.12, 0.94) | 0.127 | 0.12 (−0.14, 0,39) | 0.368 | 0.17 (−0.10, 0.45) | 0.208 |
Other | 0.14 (−0.47, 0.75) | 0.654 | 0.18 (−0.45, 0.81) | 0.567 | 0.17 (−0.14, 0.48) | 0.276 | 0.18 (−0.11, 0.53) | 0.204 |
Father’s occupation | ||||||||
Unemployed | Ref | Ref | Ref | |||||
Farmer | 0.28 (−0.815, 1.38) | 0.613 | 1.32 (0.08, 2.56) | 0.037 | 0.15 (−0.41, 0.71) | 0.602 | 0.08 (−0.56, 0.72) | 0.807 |
Teacher | 1.41 (0.22, 2.60 | 0.020 | 1.84 (0.48, 3.20) | 0.008 | −0.01 (−0.61, 0.63) | 0.983 | −0.08 (−0.79, 0.62) | 0.818 |
Trader | 0.67 (−0.46, 1.80) | 0.247 | 1.33 (0.09, 2.57) | 0.036 | −0.01 (−0.59, 0.58) | 0.990 | 0.01 (−0.64, 0.65) | 0.909 |
Other | 1.00 (−0.11, 2.10) | 0.077 | 1.24 (0.01, 2.46) | 0.048 | 0.02 (−0.55, 0.58) | 0.959 | 0.13 (−0.51, 0.76) | 0.456 |
Professional | 0.91 (−0.31, 2.14) | 0.143 | 1.24 (−0.16, 2.65) | 0.082 | −0.06 (−0.70, 0.58) | 0.863 | −0.07 (−0.79, 0.66) | 0.955 |
Cement block house | ||||||||
Yes | Ref | Ref | Ref | |||||
No | −0.40 (−0.72, −0.0) | 0.015 | −0.07 (−0.44, 0.30) | 0.707 | −0.11 (−0.05, 0.26) | 0.190 | 0.20 (−0.01, 0.39) | 0.045 |
Thatched house | ||||||||
Yes | Ref | Ref | Ref | |||||
No | 0.64 (0.33, 0.96) | <0.0001 | 0.17 (−0.24, 0.57) | 0.420 | −0.03 (−0.19, 0.12) | 0.696 | 0.10(−0.11, 0.31) | 0.356 |
Mosquito control measures | ||||||||
Bed net use | Ref | Ref | Ref | Ref | ||||
No bed net use | 0.69 (0.36, 1.02) | <0.0001 | 0.30 (−0.09, 0.69) | 0.131 | −0.40 (−0.56, −0.24) | <0.001 | −0.32 (−0.52, −0.12) | 0.002 |
Own farm | ||||||||
Yes | Ref | Ref | Ref | Ref | ||||
No | 0.83 (0.502, 1.16) | <0.0001 | 0.03 (−0.44, 0.49) | 0.917 | −0.14 (−0.30, 0.03) | 0.113 | 0.21 (−0.03, 0.44) | 0.092 |
Clinical factors | ||||||||
Parasite density (parasites/µL) | −1 × 10−6 (−2 × 10−6, −1 × 10−7) | 0.003 | 1 × 10−7 (−1.6 × 10−6, 1 × 10−7) | 0.593 | N/A | N/A | ||
Haemoglobin type | ||||||||
AA | Ref | Ref | Ref | Ref | ||||
AS | 0.48 (−0.06, 1.02) | 0.084 | 0.61 (0.053, 1.16) | 0.032 | −0.157 (−0.43, 0.11) | 0.254 | −0.20 (−0.48, 0.09) | 0.177 |
AC | −0.01 (−0.55, 0.53) | 0.972 | 0.06 (−0.46, 0.59) | 0.813 | 0.192 (−0.08, 0.46) | 0.158 | 0.24 (−0.03, 0.51) | 0.085 |