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Severe Anemia in Papua New Guinean Children from a Malaria-Endemic Area: A Case-Control Etiologic Study
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نویسنده
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manning l. ,laman m. ,rosanas-urgell a. ,michon p. ,aipit s. ,bona c. ,siba p. ,mueller i. ,davis t.m.e.
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منبع
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plos neglected tropical diseases - 2012 - دوره : 6 - شماره : 12
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چکیده
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Background: there are few detailed etiologic studies of severe anemia in children from malaria-endemic areas and none in those countries with holoendemic transmission of multiple plasmodium species. methodology/principal findings: we examined associates of severe anemia in 143 well-characterized papua new guinean (png) children aged 0.5-10 years with hemoglobin concentration <50 g/l (median [inter-quartile range] 39 [33-44] g/l) and 120 matched healthy children (113 [107-119] g/l) in a case-control cross-sectional study. a range of socio-demographic,behavioural,anthropometric,clinical and laboratory (including genetic) variables were incorporated in multivariate models with severe anemia as dependent variable. consistent with a likely trophic effect of chloroquine or amodiaquine on parvovirus b19 (b19v) replication,b19v pcr/igm positivity had the highest odds ratio (95% confidence interval) of 75.8 (15.4-526),followed by p. falciparum infection (19.4 (6.7-62.6)),vitamin a deficiency (13.5 (5.4-37.7)),body mass index-for-age z-score <2.0 (8.4 (2.7-27.0)) and incomplete vaccination (2.94 (1.3-7.2)). p. vivax infection was inversely associated (0.12 (0.02-0.47),reflecting early acquisition of immunity and/or a lack of reticulocytes for parasite invasion. after imputation of missing data,iron deficiency was a weak positive predictor (6.4% of population attributable risk). conclusions/significance: these data show that severe anemia is multifactorial in png children,strongly associated with under-nutrition and certain common infections,and potentially preventable through vitamin a supplementation and improved nutrition,completion of vaccination schedules,and intermittent preventive antimalarial treatment using non-chloroquine/amodiaquine-based regimens. © 2012 manning et al.
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آدرس
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school of medicine and pharmacology,university of western australia,fremantle hospital,fremantle,wa, Australia, school of medicine and pharmacology,university of western australia,fremantle hospital,fremantle,wa,australia,papua new guinea institute of medical research,madang, Papua New Guinea, papua new guinea institute of medical research,madang, Papua New Guinea, papua new guinea institute of medical research,madang,papua new guinea,faculty of health sciences,divine word university,madang,madang province, Papua New Guinea, papua new guinea institute of medical research,madang, Papua New Guinea, papua new guinea institute of medical research,madang, Papua New Guinea, papua new guinea institute of medical research,madang, Papua New Guinea, papua new guinea institute of medical research,madang,papua new guinea,infection and immunity division,walter and eliza hall institute,parkville,vic,australia,center de recerca en salut internacional de barcelona (cresib),barcelona, Spain, school of medicine and pharmacology,university of western australia,fremantle hospital,fremantle,wa, Australia
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Authors
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