@article{Starck2021-mb,

title = {The effect of malaria on haemoglobin concentrations: a  nationally representative household fixed-effects study of  17,599 children under 5 years of age in Burkina Faso},

author = {Tim Starck and Caroline A Bulstra and Halidou Tinto and Toussaint Rouamba and Ali Sie and Thomas Jaenisch and Till B\"{a}rnighausen},

doi = {10.1186/s12936-021-03948-z},

issn = {1475-2875},

year  = {2021},

date = {2021-10-23},

urldate = {2021-10-23},

journal = {Malar. J.},

volume = {20},

number = {1},

pages = {416},

publisher = {Springer Science and Business Media LLC},

abstract = {BACKGROUND: Although the association between malaria and anaemia 

 is widely studied in patient cohorts, the 

 population-representative causal effects of malaria on anaemia 

 remain unknown. This study estimated the malaria-induced 

 decrease in haemoglobin levels among young children in 

 malaria-endemic Burkina Faso. METHODS: The study was based on 

 pooled individual-level nationally representative health survey 

 data (2010-2011, 2014, 2017-2018) from 17 599 children under 5 

 years of age. This data was used to estimate the effects of 

 malaria on haemoglobin concentration, controlling for household 

 fixed-effects, age, and sex in a series of regression analyses. 

 The fixed-effects controlled for observed and unobserved 

 confounding on the household level and allowed to determine the 

 impact of malaria infection status on haemoglobin levels and 

 anaemia prevalence. Furthermore, the diagnostic results from 

 microscopy and rapid diagnostic tests were leveraged to provide 

 a quasi-longitudinal perspective of acute and prolonged effects 

 after malaria infection. RESULTS: The prevalence of both malaria 

 (survey prevalence ranging from 17.4% to 65.2%) and anaemia 

 (survey prevalence ranging from 74% to 88.2%) was very high in 

 the included surveys. Malaria was estimated to significantly 

 reduce haemoglobin levels, with an overall effect of - 7.5 g/dL 

 (95% CI - 8.5, - 6.5). Acute malaria resulted in a - 7.7 g/dL 

 (95% CI - 8.8, - 6.6) decrease in haemoglobin levels. Recent 

 malaria without current parasitaemia decreased haemoglobin 

 concentration by - 7.1 g/dL (95% CI - 8.3, - 5.9). The 

 in-sample predicted prevalence of severe anaemia was 9.4% among 

 malaria positives, but only 2.2% among children without 

 malaria. CONCLUSION: Malaria infection has a strong detrimental 

 effect on haemoglobin levels among young children in Burkina 

 Faso. This effect seems to carry over even after acute 

 infection, indicating prolonged haemoglobin reductions even 

 after successful parasite-elimination. The quasi-experimental 

 fixed-effect approach adds a population level perspective to 

 existing clinical evidence.},

note = {© 2021. The Author(s).

PMID: 34688294 

PMCID: PMC8542337},

keywords = {Anaemia, Burkina Faso, Haemoglobin, Household fixed-effects, Malaria, Microscopy, Rapid diagnostic tests},

pubstate = {published},

tppubtype = {article}

}