Correlation between vivax malaria infection and iron deficiency in children

Main Article Content

Desmansyah Desmansyah
Rini Purnamasari
Theodorus Theodorus
Sulaiman Waiman


Background Iron deficiency is considered to be a major public health problem around the world due to its high prevalence as well as its effect on growth, development, and infection-resistance in children. In malaria-endemic areas, malaria infection is thought to contribute to the occurrence of iron deficiency, by means of hepcidin and hemolysis mechanisms. Objective To assess the prevalence of asymptomatic vivax malaria, compare hemoglobin levels and iron status parameters between vivax malaria-infected and uninfected children, assess the prevalence of iron deficiency, and evaluate a possible correlation between vivax malaria infection and iron deficiency. Methods This cross-sectional study was conducted from February to April 2013 at Sanana City of Sula Islands District, North Maluku. Six parameters were evaluated in 5-11-year-old children: malaria parasite infection, hemoglobin level, serum iron concentration, total iron-binding capacity (TIBC), serum transferrin saturation, and serum ferritin concentration. Results Among 296 children aged 5-11 years, 75 (25.3%) were infected with Plasmodium vivax. In infected children, hemoglobin, serum iron, transferrin saturation, TIBC and serum ferritin were significantly lower than in non-infected children (P<0.01). Using a serum ferritin cut-off of <15 μg/dL, 142 (48.0%) of the children were found to be iron deficient. There was a strong correlation between vivax malaria infection and iron deficiency (OR 3.573; 95%CI 2.03-6.29). ConclusionThe prevalence of asymptomatic vivax malaria infection was 25.3%. The hemoglobin level and iron status parameters in vivax malaria-infected subjects were significantly lower than in uninfected children. The prevalence of iron deficiency was 48.0% for all study subjects. Malaria vivax infection was correlated with iron deficiency in 5-11-year-old children at Sanana City.

Article Details

How to Cite
Desmansyah D, Purnamasari R, Theodorus T, Waiman S. Correlation between vivax malaria infection and iron deficiency in children. PI [Internet]. 1Mar.2015 [cited 21Sep.2019];55(1):44-. Available from:
Received 2016-07-12
Accepted 2016-07-12
Published 2015-03-01


1. WHO. Iron deficiency anaemia assessment, prevention and control: a guide for programme managers. 2nd ed. Geneva: WHO; 2004. p. 36-48.
2. WHO. Preventing iron deficiency in women and children: technical consensus on key issues. Geneva: WHO; 1999. p. 6-18.
3. Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA. 1997;277:973-6.
4. Raiten DJ, Namaste S, Brabia B. Considerations for the safe and effective use of iron interventions in areas of malaria burden: full technical report. New York: NICHD; 2009. p. 81-7.
5. Nyakeriga AM, Troye-Blomberg M, Dorfman JR, Alexander ND, Back R, Kortok M, et al. Iron deficiency and malaria among children living on the coast of Kenya. J Infect Dis. 2004;190:439-47.
6. Onyemaobi GA, Onimawo IA. Risk factors for iron deficiency anaemia in under-five children in Imo State, Nigeria. J Appl Sci Res. 2011;7:63-6.
7. Jeremiah ZA, Uko EK, Buseri FI, Jeremiah TA. Malarial iron deficiency anaemia among asymptomatic Nigerian children. J Nutr Environ Med. 2007;16:232-41.
8. Depkes RI. Riset kesehatan dasar Indonesia tahun 2007. Jakarta: Depkes RI; 2007. p. 28-48.
9. de Mast Q, Syafruddin D, Keijmel S, Riekerink TO, Deky O, Asih PB, et al. Increased serum hepcidin and alterations in blood iron parameters associated with asymptomatic P. falciparum and P. vivax malaria. Haematologica. 2010;95: 1068-74.
10. Desmansyah, Purnamasari R, Sari DP. Serum iron level and hemoglobin concentration in children in Sanana District Hospital, Sula Islands of North Maluku. Paediatr Indones. 2012;52:115.
11. Kemenkes RI. Epidemiologi malaria di Indonesia. Buletin Malaria. 2011;3:7-8.
12. Rampengan TH. Malaria pada anak. In: Harijanto PN, Nugroho A, Gunawan CA, editors. Malaria: dari molekuler ke klinis, 2nd ed. Jakarta: EGC; 2008. p. 156-9.
13. De Mast Q, van Dongen-Lases EC, Swinkels DW, Nieman AE, Roestenberg M, Druilhe P, et al. Mild increases in serum hepcidin and interleukin-6 concentrations impair iron incorporation in haemoglobin during an experimental human malaria infection. Br J Haematol. 2009 Jun;145(5):657-64.
14. Douglas NM, Anstey NM, Buffet PA, Poespoprodjo JR, Yeo TW, White NJ, et al. The anaemia of Plasmodium vivax malaria. Malar J. 2012;135:4.
15. Prentice AM. Iron metabolism, malaria, and other infections: what is all the fuss about? J Nutr. 2008;138:2537-41.
16. WHO. Iron deficiency anaemia assessment, prevention and control: a guide for programme managers. Geneva: WHO; 2001. p. 32-49.
17. Wu AC, Lesperance L, Bernstein H. Screening for iron deficiency. Pediatr Rev 2002;23:171-8.
18. Will AM. Disorders of iron metabolism: iron deficiency, iron overload and the sideroblastic anemia. In: Arceci RJ, Hann IM, Smith OP, editors. Pediatric hematology 3rd ed. Massachusetts: Blackwell Publishing; 2006. p. 79-84.