Post-Malaria Anemia Is Rare in Malawian Children with Cerebral Malaria

Am J Trop Med Hyg. 2021 Apr 26;104(6):2146-2151. doi: 10.4269/ajtmh.20-1668.

Abstract

Artesunate therapy for severe malaria syndromes has been associated with post-treatment hemolysis and anemia. We defined post-malaria anemia as any decrease in hematocrit between the index hospitalization for severe malaria and 1 month after. We determined the incidence and severity of post-malaria anemia in Malawian children surviving cerebral malaria (CM) by analyzing hospital and follow-up data from a long-standing study of CM pathogenesis. Children enrolled before 2014 and treated with quinine (N = 258) were compared with those admitted in 2014 and after, and treated with artesunate (N = 235). The last hematocrit value obtained during hospitalization was compared with the 1-month post-hospitalization hematocrit value. The overall rate of a post-hospitalization decrease in hematocrit in children surviving CM was 5.3% (11 of 235 or 4.7% for quinine, 15 of 258 or 5.8% for artesunate; odds ratio, 3.23 [0.88, 18.38]); no patients with a decrease in hematocrit were symptomatic, and none required transfusion after hospitalization. Of the 26 children who had a decrease in hematocrit 1 month after hospitalization, 23.1% had evidence of a new malaria infection. When children treated with quinine and artesunate were combined, a higher hematocrit level on admission, lower quantitative histidine-rich protein level, and splenomegaly were associated independently with post-malaria anemia. In African survivors of CM, post-malaria anemia is rare, mild, and unassociated with the anti-malarial treatment received.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anemia / epidemiology*
  • Anemia / etiology*
  • Anemia / parasitology
  • Antimalarials / therapeutic use
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Malaria, Cerebral / complications
  • Malaria, Cerebral / drug therapy
  • Malaria, Cerebral / epidemiology*
  • Malaria, Cerebral / mortality
  • Malaria, Falciparum / complications
  • Malaria, Falciparum / drug therapy
  • Malaria, Falciparum / epidemiology*
  • Malaria, Falciparum / mortality
  • Malawi / epidemiology
  • Male

Substances

  • Antimalarials