Comparative analysis of malaria parasitaemia, reticulocytes, serum ferritin and malaria severity in sickle cell and non- sickle cell patients at Mbale Hospital, Eastern Uganda

Abstract

Malaria and sickle cell disease (SCD) remain major public health challenges in sub-Saharan Africa, with Uganda bearing a high burden. Plasmodium falciparum, the most virulent malaria parasite species, causes severe illness, especially in individuals with homozygous SCD. While heterozygous SCD offers some malaria protection, the homozygous form complicates disease progression. Serum ferritin, an iron-storage protein and acute phase reactant, is difficult to interpret during co-infections. This study aimed at assessing P. falciparum parasitemia, serum ferritin levels and malaria severity in patients with and without SCD in Eastern Uganda. A total of 100 P. falciparum-positive participants; 50 SCD and 50 NSCD controls, both male and female with mean age of 12.3 and 14.4 years respectively, mean weight 34kgs across all the participants was considered. Malaria parasitemia were lower in SCD patients under 5yrs of age mean parasite count 691 (IQR: 583- 2239) compared to the counterparts 1,287(IQR: 646-10,143) p value 0.125. While in patients slightly aged over 5years SCD had median count 153(IQR: 99-199) and NSCD 345(IQR: 214 -431), p value 0.001. Reticulocyte counts were higher in both patient category under and above 5yers of age; SCD patients had median count of 15.7(IQR: 2.003-21.05) and NSCD 2(IQR: 1.65-3.27) p value 0.0253, 14.8(IQR: 9.6 - 25.5); 1, 99(1, 62-3.1), p value <0.0001 respectively. correlation analysis revealed a weak negative relationship between P.faliciparum parasitemia and reticulocyte count in SCD, and a weak positive in NSCD, Pearson coefficient (r) -0.183 and 0.138, p value 0.21 and 0.34 respectively at 95% CI. SCD patients under 5years had low median Serum ferritin levels (605 IQR: 256-1,307) compared to NSCD patients (682 IQR: 315-2336) p value 0.382, while among cases over 5 years, SCD had high median ferritin levels (2,211 IQR: 556.7-8,540) compared to NSCD (646.2 IQR: 246.3-3223) p value 0.342. Correlation analysis between serum ferritin levels and Plasmodium falciparum parasite counts for both patient groups revealed no statistical significant relationship, negative correlation (r = –0.057; p = 0.618) for SCD and positive correlation (r = 0.115; p = 0.427) for NSCD. Assessment for malaria severity, There was no malaria severity following insignificant statistical difference of heamatological parameters (heamoglobin, WBCs, Platelets) coupled with Clinical manifestations (Aneamia, heamaturia and cerebral malaria) in SCD patients to warrant severity of malaria.

Keywords: Malaria parasitaemia, Reticulocytes, Serum ferritin, Sickle cell