The Correlation between Malaria and Anemia: a

Review
Nelini1, Ramadhan Tosepu2*
1
Program Studi Kesehatan Masyarakat, Pasca Sarjana Universitas
Halu Oleo, Kendari, Indonesia
2
Departments of Environmental Health, Faculty of Public Health,
University of Halu Oleo, Kendari, Indonesia

*Corespondence
Ramadhan Tosepu
Department of Environmental Health, Faculty of Public Health,
University of Halu Oleo, Kendari, Indonesia, email:
ramadhan.tosepu@uho.ac.id

Abstract
Malaria and anemia are the main underlying factors for illness in children.
The purpose of this study was to assess the association between malaria and
anemia in children. This study uses a literature review approach regarding
research on malaria and anemia, using Google scholar and Sciencedirect. The
articles taken are original research in the last ten years. It found that malaria
has excellent potential for sufferers of anemia because malaria attacks red
blood cells. So it was concluded malaria is an essential correlation of anemia
on children. A global health strategy to reduce the burden of anemia must
prioritize malaria prevention.
Keywords: Malaria, anemia, children

1. Introduction
Anemia and malaria are the most important health problems throughout the world,
especially in tropical countries with low resources. Most severe malaria infections are
caused by Plasmodium Falciparum infection, and are a leading cause of death and illness
in sub-Saharan African children. Malaria can cause anemia mainly through hemolysis,
destruction of red blood cells, although there are other factors that can be involved, such
as long-term subclinical malaria infection which induces inflammation in the anemia [1].
Malaria is a cause of death and illness, especially in children under 5 years of age. A total
of 214 million populations affected by clinical malaria were reported in 2015 and caused
438,000 deaths, most of them are children in Africa [2]. In malaria endemic areas,
pregnant women and children under the age of 5 are at increased risk of malaria due to
severe complications. It is also found that Plasmodium falciparum infection in pregnant
women is known to cause death and morbidity in the mother and fetus [3]. Malaria causes
iron deficiency in anemia (IDA) and affects the same geographical and demographic
groups and the pathophysiological relationship between the two is very complex. Acute
malaria can cause severe anemia due to the destruction of infected and uninfected red
blood cells, and subclinical chronic malaria can induce anemia in inflammation [4].
Meanwhile, molecular evidence has found 25% of malaria susceptibility due to genetic
factors. Among these factors, genes are related to pathogens and innate immune
responses [5]. On pregnant women, Plasmodium falciparum infection is associated with
absorption of infected red blood cells (iRBCs) in the placenta. The function of this
parasitic placenta is impaired by inflammation, coagulation, and tissue damage caused by
pathogenic infections [6]. This infectious mosquito infection results in most of the life
cycle in humans in red blood cells, which occurs approximately ten times every 2 days
until it is controlled by either immunity or medication [7].
This review aims to summarize previous research that outlines the relationship between
malaria and the incidence of anemia abroad. The purpose of this research study is to
develop ideas about strategies to reduce diseases caused by malaria infections that can
cause anemia in the future.

2. The Method
2.1 Searching Strategy
Google and Google Scholar are used as the main source of databases accessed on
September 22, 2019 to extract research published in English that addresses the foreign
context. With keywords combination: "Malaria", "anemia", "children", "Overseas" which
are used to search for articles. The writer observed several studies published during 2014-
2019. Titles, keywords and abstracts are filtered in the first step for relevant articles and
full research that meets the inclusion criteria, included in this analysis.

2.2 Inclusion Criteria

1. On humans, the nature and quality of the immune response determine the
outcome of the disease, whereas in mosquitoes the immune affects the ability of
vectors to transmit parasites. Human immune resistance to malaria develops with
age and exposure levels, so people who live in malaria endemic countries tend to
become resistant to malaria symptoms, but not to Plasmodium Flasciparum
infection.
 2. Research published Overseas in 2014-2019 that discusses malaria with anemia,
especially on children and pregnant women.

Potentially relevant studies These 10 articles were emitted because

are identified by searching in
of irrelevant titles and keywords
the Google Schoolar, Science
Direct Database (N = 18)

Studies are selected by title

and keywords (n = 8)

Studies are selected for more

detailed evaluations (full text
articles taken, and abstracts
read) (n = 7)

Potentially relevant studies (n

= 4)

Graphic Picture 1. Review of Article Flow

2.3 Literature Searching Results

Eighteen articles were collected from Google Scholar and Science Direct in the first step.
Among all articles, 10 articles were excluded because they did not meet the title and
keywords, while 8 articles were included. In the case of full research, 7 articles were
included, and in the final stage, 4 articles met the inclusion criteria. The methodology and
main findings of the 4 articles are summarized in Table 1. The research took place in
(Khartoum, Sudan), (Great Britain), (Mangaluru, India), and (London).
All articles study the relationship between malaria variables and the incidence of anemia.
Several methods are used to determine the relationship between malaria variables and the
incidence of anemia. Two of the research articles used research under the field study
method [1], [2]. Two other research articles used cross sectional studies with descriptive
analysis [3], [8], two research articles used the case control method [5], [7]. Only one
article used the observational cohort [4], in which the last one used Swiss Webster [6].

3. Discussion
3.1 Relationship between Malaria Variables and Anemia
Until now malaria is still said to be a very dangerous infectious disease among billions of
people throughout the world, especially in the tropics and endemics area [3]. Malaria and
anemia are the main factors underlying the cause of the disease due to Plasmodium
Falciparum infection in African children. Knowledge of the clinical and epidemiological
risk factors for this disease has not been expressed with in-depth knowledge of the
immunology of the disease [2]. Malaria has had a major influence on the human genome
through selection of polymorphisms related to survival. Some of these events include
classic red blood cell variants of sickle cell trait and α + -thalassemia [7]. Effective
diagnosis and treatment in this case is malarian with cacious drugs which are the most
important strategy in the management and control of malaria in populations in endemic
areas [8]. Several studies have led to the peculiarity that iron supplementation in malaria-
endemic areas cause people to increase the risk of contracting malaria infection [4].
 Table 1. Characteristics Study which Discusses the Relationship between Malaria Variables and Anemia

Study & Research Area & Data Collection Statistical

Main Findings Comments
Language Point Risk Factors Diseases / Vectors Methods
Low resources,
iron deficiency, Provides iron
Long term
Ishag Adam Khartoum, Sudan parasitic supplements for
All cases Field study subclinical study
(2016) English (1) 2008-2016 infections, children who live
period
nutritional in endemic areas.
inefficiency.
Offers vaccines of
Environment, artemisinin-based
vulnerability, combination
immunity, young Number of cases therapy (ACT),
Tonney S.
United Kingdom age, malaria and infected with indoor residual Clinical study
Nyirenda et. Al Field study
(2017-2018) anemia living in Salmonella spraying (IRS), period
(2018) English (2)
the same bacteria long-lasting
individual / same insecticides
endemic area Mosquito nets
(LLINS) and
 intermittent
treatment therapy
for pregnant
women (IPTp).
Cross sectional
approach,
descriptive
method, using
Microsoft Excel Strengthen
Malaria infection and statistical malaria control
Valleesha N.
with Plasmodium analysis, using and antenatal care
Chandrashekar et. Mangaluru, India The climate is
vivax and GraphPad Prism, services, and build Long-term studies
al (2019) English (2014-2017) warm and humid
Plasmodium quantitative malaria outreach
(3)
Falciparum viruses variables, community
Kruskal-Wallis programs.
Test, and Mann-
Whitney U Test,
Spearman rank
correlation.
MM Goheen et.al London (2016) The impact of Number of malaria Growth rates, Estimating the Observational
(2016) English (4) similar cases invasion tests, and influence of studies, relatively
geographical and hematological hematological short study
demographical data tests, one- characteristics on periods
groups way ANOVA test in-vitro parasitic
/ 95% CI values growth rates.
using GraphPad
Prism
Mangaluru is the administrative capital of the Dakshina, Kannada district, located on the
coast of South Arab India. The city and its surroundings have a warm and humid climate,
save a high vector density and cause a high level of risk transmission in the incidence of
malaria [3]. The relationship between the growths of malaria parasites in red blood cells
can change the hematological parameters which can increase susceptibility [4]. Human
genetic factors are an important determinant of the risk of malaria. Most infectious
mosquito infections spend most of their life cycles in humans in red blood cells, which
are expressed about ten times every 2 days until they are controlled by either immunity or
medication [7]. Rapid diagnosis and treatment and management of malaria that remain
effective are key components in malaria control and the elimination agenda. The prompt
treatment of this malaria case is by vector control through the use of insecticides, and
spraying residues in the room which has contributed to a substantial reduction in the and
mortality of global morbidity associated with malaria [8].

4. Conclusion
Providing iron supplements for children who live in endemic areas, Offering vaccines
with artemisinin-based combination therapy (ACT), indoor residual spraying (IRS), long-
lasting mosquito nets insecticides (LLINS) and intermittent treatment therapy for
pregnant women (IPTp).
Strengthening malaria control and antenatal care services, and building malaria outreach
community programs, Estimating the effect of hematological characteristics on invitro
parasitic growth rates.
Anemia control is very important to support the growth and development of healthy
children, decrease mortality and reduce the prevalence of events in other countries. The
government hopes to reduce cases of anemia in children and must make resource
allocation decisions based on available scientific evidence that the importance of known
risk factors for anemia.
This review adds to the literature on anemia control by emphasizing the consistency of
malaria as a correlation of anemia in children in various circles. It also underlines the
complexity of the role of nutrition in anemia by showing that macro nutritional status,
although generally associated with anemia such as malaria.
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