Malaria parasite density relationship with spleen size and fetal hemoglobin in Nigerian children with homozygous sickle cell disease

Objectives: This study aimed to determine the malaria parasite density in children with homozygous sickle cell disease and compare it with the splenic size and fetal Hb (HbF). Material and Methods: In this cross-sectional study, we determined the malaria parasite density of children with sickle cell anemia (SCA) in a steady state aged 2–15 years and compared it with aged-matched HbAA controls. The HbF levels of children with SCA in a steady state were also determined by the Betke alkali denaturation method. The spleen size was determined both clinically and sonographically. The relationship between malaria parasite density, spleen size, and HbF was also determined. Results: Subjects with HbSS 440 (360–600) had a higher parasite density than HbAA controls 200 (200–360). This was statistically significant (U-stat = 1728, P = 0.001). Malaria parasite density progressively reduced with increasing age in HbSS subjects with normal spleen status, while the reverse is true in those with abnormal spleen status. The difference was statistically significant, especially among the 6–10 year age group (U-stat = 4.50, P = 0.001). Malaria parasite density appears to be lower in the age group 2–5 years with high HbF; however, the statistical test was not significant (H-test = 0.602, P = 0.740). The scatter plot shows a negative and positive correlation between the 2–5-year age group and the 6–10-year age group with malaria parasite density, respectively. Conclusion: Children with HbSS had a higher malaria parasite density than matched HbAA controls. Furthermore, a significant relationship exists between malaria parasite density and spleen size in children with SCA. HbF level was not significantly related to asymptomatic malaria parasitemia. It is recommended that the early introduction of hydroxyurea to the care of SCA children is necessary in their routine care to reduce morbidity and mortality from confounding infectious diseases, including malaria.