Double Jeopardy in Malaria Infected Children with Common Haemoglobinopathies: A Cross-sectional Study in Malaria Mesoendemic Districts of Ghana

Abstract

Introduction: Malaria and conditions associated with common haemoglobinopathies constitute a health threat to young children in sub-Saharan Africa. Malaria is known to exert some influence on common haemoglobin variants while haemoglobinopathies also exacerbate malarial infection especially in children as a result of anaemia and other conditions. Aim: To assess the views of parents/guardians on malaria and haemoglobinopathies and to determine the extent to which common haemoglobin variants influence malaria parasitaemia among children in the acute stage of the infection. Materials and Methods: This cross-sectional study was conducted in seven districts in the forest zone of Ghana between June 2018 to July 2018 and involved 342 malaria-parasitaemic subjects aged 5 years and below. Questionnaires were administered to elicit responses on malaria prevention and sickle cell knowledge from the parents/guardians/caretakers accompanying the children to seek healthcare. Follow-up responses on medication and treatment outcome were collected during and after treatment. Venous blood samples were collected for malaria test, sickle cell investigations and identification of common haemoglobinopathies. After treatment, malaria tests were conducted using microscopy. The Chi-square test was used to compare categorical data between groups, and the Independent t-test used to compare means between groups. Results: Out of total 342 subjects, 220 respondents (64.3%) identified fever as the most classical symptom of malaria, whilst 167 (48.8%) consistently used Insecticide Treated Nets (ITNs). More so, 146 respondents (42.7%) strongly agreed that Sickle Cell Disease (SCD) is a curse, and 182 respondents (53.2%) strongly agreed that SCD is inherited with 225 (65.8%) strongly agreeing that SCD children die before their teen ages. Common haemoglobin variants identified were Haemoglobin A and C bands (HbAC) 17 (5%), Normal Foetal Haemoglobin (HbAF) 7 (2%), Haemoglobin A and S bands (HbAS) 86 (25.1%), Haemoglobin S and C bands (HbSC) 4 (1.2%) and Haemoglobin S (homozygous) band (HbSS) 9 (2.6%). One month post-treatment, 10 (58.8%) of HbAC subjects, all 9 (100%) of HbSS and all 4 (100%) of HbSC subjects were still parasitaemic but with significantly low mean parasite density (495±1744). Conclusion: Knowledge on malaria among the parents/guardians/caretakers was satisfactory, but usage of bed nets was poor, warranting the need for targeted health education of the rural folk. Though parasite densities had significant reductions, all subjects with HbSC and HbSS phenotypes remained parasitaemic after 4 weeks of treatment, suggesting a double jeopardy for individuals with SCD. Routine newborn screening in all healthcare facilities in Ghana could be a proactive step in malaria case management.

Keywords

• anaemia
• new born screening
• parasite density
• plasmodium
• sickle cell disease