Impact of Plasmodium falciparum infection on the frequency of moderate to severe anaemia in children below 10 years of age in Gabon

A prospective observational study over a two-year period to assess the burden of anaemia and its relationship to Plasmodium falciparum infection and age was conducted in 8,195 febrile Gabonese children.The proportion of children with anaemia was 83.6% (n = 6830), higher in children between the ages of six and 23 months. Those under three years old were more likely to develop moderate to severe anaemia (68%). The prevalence of malaria was 42.7% and P. falciparum infection was more frequent in children aged 36–47 months (54.5%). The proportion of anaemic children increased with parasite density (p < 0.01). Most of infected children were moderately to severely anaemic (69.5%, p < 0.01). Infants aged from one to 11 months had a higher risk of developing severe malarial anaemia. In children over six years of age, anaemia occurrence was high (>60%), but was unrelated to P. falciparum parasitaemia.Malaria is one of the main risk factors for childhood anaemia which represents a public health problem in Gabon. The risk of severe malarial anaemia increases up the age of three years. Efforts to improve strategies for controlling anaemia and malaria are needed.Anaemia is a common cause of paediatric morbidity and mortality in sub-Saharan Africa [1,2]. Its complex aetiology involves interactions between multiple factors, which include malaria, helminthiasis, and infection with Human Immunodeficiency Virus, bacterial infections, nutritional deficiencies and haemoglobinopathies. Severe anaemia is one of the major complications of malaria in children [3,4]. The age distribution of severe malarial anaemia suggests that the acquisition of immunity has a positive effect on haemoglobin levels. In highly endemic areas, susceptibility to severe malarial anaemia increases during the age periods when parasite density and the frequency of uncomplicated episodes of malaria are highest [5].Malaria, in turn, is a leading cause of anaemia in endemic regions. The use of insecticide-treated bed n