PLASMODIUM-FALCIPARUM-ASSOCIATED ANEMIA IN CHILDREN AT A LARGE URBAN HOSPITAL IN ZAIRE

Chloroquine-resistant Plasmodium falciparum malaria and human immunode ficiency virus (HIV) infection through blood transfusions used to trea t malaria-associated anemia are causes of increasing morbidity and mor tality among children in Africa. To evaluate the role of malaria and o ther risk factors for pediatric anemia, we conducted a study of childr en brought to the emergency ward of a large urban hospital in Kinshasa , Zaire. A total of 748 children ages six through 59 months were enrol led; 318 (43%) children were anemic (hematocrit < 33%), including 74 ( 10%) who were severely anemic (hematocrit < 20%). Plasmodium falciparu m parasites were detected in 166 children (22%); hematocrits for these children (mean 25.8%) were significantly lower than for aparasitemic children (mean 33.7%; P < 10(-6)). Fever with splenomegaly (odds ratio [OR] = 6.5, P = 0.02), parasitemia (OR = 3.5, P < 0.001), lower socio economic status (OR = 2.0, P = 0.004), and malnutrition (OR = 1.8, P = 0.06) were independently associated with anemia in a multivariate mod el. Recent antimalarial therapy was also associated with a lower hemat ocrit, suggesting that chloroquine may have aggravated the anemia. A r eassessment of the effectiveness of strategies to diagnose and treat m alaria and malnutrition is necessary to decrease the high prevalence o f anemia and the resultant high rate of blood transfusions in areas en demic for malaria and HIV.