BMC Infectious Diseases (Dec 2017)

Factors contributing to anaemia after uncomplicated falciparum malaria in under five year-old Nigerian children ten years following adoption of artemisinin-based combination therapies as first-line antimalarials

  • Akintunde Sowunmi,
  • Bayo Fatunmbi,
  • Kazeem Akano,
  • Olubunmi A. Wewe,
  • Chimere Agomo,
  • Finomo Finomo,
  • Joy Ebenebe,
  • Nma Jiya,
  • Jose Ambe,
  • Robinson Wammanda,
  • Godwin Ntadom,
  • Olugbenga Mokuolu,
  • George Emechebe,
  • Nnenna Ezeigwe,
  • Adejumoke I. Ayede,
  • Elsie O. Adewoye,
  • Grace O. Gbotosho,
  • Onikepe A. Folarin,
  • Christian T. Happi,
  • Stephen Oguche,
  • Wellington A. Oyibo,
  • Francis Useh

DOI
https://doi.org/10.1186/s12879-017-2876-9
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 18

Abstract

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Abstract Background Artemisinin-based combination therapies (ACTs) have remained efficacious treatments of acute falciparum malaria in many endemic areas but there is little evaluation of factors contributing to the anaemia of acute falciparum malaria following long term adoption of ACTs as first-line antimalarials in African children. Methods Malarious 4% were evaluated by stepwise multiple logistic regression models. Survival analysis and kinetics of DAFH were evaluated by Kaplan-Meier estimator and non-compartment model, respectively. Results Pre-treatment, 355 of 959 children were anaemic. Duration of illness >2 days and parasitaemia ≤10,000 μL−1 were independent predictors of anaemia pre-treatment. EAA occurred in 301 of 604 children. Predictors of EAA were age ≤ 15 months, history of fever pre-treatment and enrolment haematocrit ≤35%. The probabilities of progression from normal haematocrit to EAA were similar for all treatments. MAFH >4% occurred in 446 of 694 children; its predictors were anaemia pre-treatment, enrolment parasitaemia ≤50,000 μL−1, parasitaemia one day post-treatment initiation and gametocytaemia. DAFH >4% occurred in 334 of 719 children; its predictors were history of fever pre-and fever 1 day post-treatment initiation, haematocrit ≥37%, and parasitaemia >100,000 μL−1. In 432 children, declines in DAFH deficits were monoexponential with overall estimated half-time of 2.2d (95% CI 1.9–2.6). Area under curve of deficits in DAFH versus time and estimated half-time were significantly higher in non-anaemic children indicating greater loss of haematocrit in these children. Conclusion After ten years of adoption of ACTs, anaemia is common pre-and early post-treatment, falls in haematocrit attributable to a single infection is high, and DAFH >4% is common and significantly lower in anaemic compared to non-anaemic Nigerian children. Trial registration Pan African Clinical Trial Registry (PACTR) [ PACTR201709002064150, 1 March 2017 ].

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