What causes malaria anemia?

In this issue of Blood, Mahamar et al(1) report on predictors of malariaassociated anemia in a prospective study conducted in Malian children living in an area of intense seasonal malaria transmission. Across the African Sahel (the transitional area between the Sahara and the Sudanian savanna), Plasmodium falciparum malaria transmission is intense during the 3- to 4-month rainy season. Anemia is the main manifestation of severe malaria in these areas,(2) seen mainly in young children. During the rains, severe malarial anemia frequently necessitates blood transfusion, and it is an important cause of death in children younger than 5 years of age. In 2020, there were an estimated 627 000 deaths from malaria globally, and a large proportion of those were in children with severe malaria anemia in West Africa.(3) Now, in this area, seasonal malaria chemoprevention (monthly treatment courses of amodiaquine-sulfadoxine-pyrimethamine) is given annually during the 3- to 4-month rainy season to more than 20 million children between 3 and 59 months of age to prevent malaria and its adverse consequences. During the rainy season, malaria is ubiquitous; in many areas, mosquitoes inoculate inhabitants of this area with P falciparum parasites several times per week. Many of these acquired infections are asymptomatic because disease-controlling immunity is acquired during childhood. But some infections cause illness, and a few are lethal. Even after hospital admission for severe malarial anemia, there is still high mortality following discharge, which may be prevented by malaria chemoprophylaxis.4 Severe malarial anemia is also associated with long-term neurocognitive impairment, especially in young children.(5)

Automated summary

This study investigated the predictors of malaria-associated anemia in Malian children. Anemia is a common manifestation of severe malaria, especially in young children. It is prevalent during the rainy season, and severe malarial anemia often requires blood transfusion. Additionally, severe malarial anemia is associated with high mortality and long-term neurocognitive impairment in children.