Severity of malaria in children with HbS in Togo

The WHO definition of severe malaria has recently-been broadened to include manifestations of nonneurological organ failure (e.g., severe anemia, hemoglobinuria, hypoglycemia, renal failure). The risk of severe malaria meeting the new definition was studied in children with and without HbS managed at the Tokoin Teaching Hospital in Lome, Togo. Alkaline hemoglobin electrophoresis was performed in 278 children admitted during a period of high malarial endemicity. Forty (14.4%) were HbS-positive; 28 were SS and 12 AS. Of the remaining 238 patients, 219 (85.6%) were AA and 19 were AC. Patients with AS or SS were significantly less likely to develop neurological manifestations and hypoglycemia. They had lower parasitemia levels than HbS-negative patients, but were more likely to develop severe anemia due to destruction of parasitized erythrocytes.