Changes in Haemoglobin Values and Hepatosplenomegaly Produced by Control of Holoendemic Malaria

Abstract

Estimations of mean haemoglobin values, clinical examinations, and examinations for malarial parasitaemia were made in 1959 on two groups of villagers living in similar environments in the Sepik District, New Guinea. Malaria was holo-endemic in both areas; some light hookworm infections were found, but they were not significant haematologically. Immediately after the first series of examinations malaria control was extended over one group but not the other. No changes affecting health, apart from the malaria control, were observed in either area for the next three years. The examinations were repeated on the same individuals each year. The changes which were observed in the group under malaria control have been compared statistically with those in the other group. For purposes of comparison, the haemoglobin values of a group of healthy Europeans were determined by the method used in the villages. Mean haemoglobin values showed statistically significant improvements in the malaria-control area and were inversely correlatable with parasitaemia only among children under 15 years of age and women in the child-bearing period of life. Children up to 10 years of age had steady improvements in haemoglobin levels, but the values among older children and women showed limited rises confined to the second year. Men and adolescents of both sexes had subnormal mean haemoglobin levels which were not significantly improved by reductions in parasitaemia and clinical hepatosplenomegaly. After three years of malaria control the presence of parasitaemia was correlatable with haemoglobin levels lower than average among children and pregnant and lactating women but not among the other groups. Although palpable enlargement of both liver and spleen was found to be reversible and directly correlatable with malarial parasitaemia in the younger age-groups of both sexes, there was much persistent combined hepatosplenomegaly among women which had not been altered by malaria control. This condition was significantly associated with mean haemoglobin levels even lower than those of the rest of the women. The findings are discussed in relation to malarial pathology and premunition. They suggest that other factors besides overt parasitaemia and hepatosplenomegaly contribute materially to the low haemoglobin values of adults. © 1964, British Medical Journal Publishing Group. All rights reserved.