Correction: Profiles of Plasmodium falciparum infections detected by microscopy through the first year of life in Kintampo a high transmission area of Ghana.

[This corrects the article DOI: 10.1371/journal.pone.0240814.]

Profiles of Plasmodium falciparum infections detected by microscopy through the first year of life in Kintampo a high transmission area of Ghana.

Although malaria mortality among children under five years of age is high, the characteristics of their infection patterns are not well described. The aim of this study was to examine the longitudinal sequence pattern of Plasmodium falciparum infections in the first year of life within a birth cohort in Kintampo, Ghana (N = 1855). Infants were monitored at home with monthly sampling and also at the clinic for any febrile illness between 2008 and 2011. Light microscopy was performed on monthly scheduled visits and febrile ill visits over twelve months of follow-ups (n = 19231). Microscopy-positive visits accompanied with or without symptoms were rare during the first five months of life but were common from six to twelve months of age. Among 1264 infants with microscopy data over a minimum of eight monthly visits and also throughout in sick visits, some were microscopy negative (36%), and others positive: only-symptomatic (35%), alternating (22%) and only-asymptomatic (7%). The median age of microscopic infection was seven months for the alternating group and eight months for both the only-symptomatic and only-asymptomatic groups. The alternating group had the highest cumulative incidence of microscopic infections, the lowest age at first infection and 87 different infection patterns. Parasite densities detected by microscopy were significantly higher for symptomatic versus asymptomatic infection. We conclude that infants in malaria endemic areas experience diverse infection profiles throughout their first year of life. Further investigations should include submicroscopic reservoir and may shed more light on the factors that determine susceptibility to malaria during infancy

Glucose-6-Phosphate Dehydrogenase Deficiency and Haemoglobin Drop after Sulphadoxine-Pyrimethamine Use for Intermittent Preventive Treatment of Malaria during Pregnancy in Ghana - A Cohort Study.

BACKGROUND: Sulphadoxine-Pyrimethamine (SP) is still the only recommended antimalarial for use in intermittent preventive treatment of malaria during pregnancy (IPTp) in some malaria endemic countries including Ghana. SP has the potential to cause acute haemolysis in G6PD deficient people resulting in significant haemoglobin (Hb) drop but there is limited data on post SP-IPTp Hb drop. This study determined the difference, if any in proportions of women with significant acute haemoglobin drop between G6PD normal, partial deficient and full deficient women after SP-IPTp. METHODS AND FINDINGS: Prospectively, 1518 pregnant women who received SP for IPTp as part of their normal antenatal care were enrolled. Their G6PD status were determined at enrollment followed by assessments on days 3, 7,14 and 28 to document any adverse effects and changes in post-IPTp haemoglobin (Hb) levels. The three groups were comparable at baseline except for their mean Hb (10.3 g/dL for G6PD normal, 10.8 g/dL for G6PD partial deficient and 10.8 g/dL for G6PD full defect women).The prevalence of G6PD full defect was 2.3% and 17.0% for G6PD partial defect. There was no difference in the proportions with fractional Hb drop ≥ 20% as compared to their baseline value post SP-IPTp among the 3 groups on days 3, 7, 14. The G6PD full defect group had the highest median fractional drop at day 7. There was a weak negative correlation between G6PD activity and fractional Hb drop. There was no statistical difference between the three groups in the proportions of those who started the study with Hb ≥ 8g/dl whose Hb level subsequently fell below 8g/dl post-SP IPTp. No study participant required transfusion or hospitalization for severe anaemia. CONCLUSIONS: There was no significant difference between G6PD normal and deficient women in proportions with significant acute haemoglobin drop post SP-IPTp and lower G6PD enzyme activity was not strongly associated with significant acute drug-induced haemoglobin drop post SP-IPTp but a larger study is required to confirm consistency of findings

Proportion of study participants with Hb ≥ 8g/dl on day 0 whose Hb fell below the safety level of 8g/dl in subsequent follow-up days.

<p>Proportion of study participants with Hb ≥ 8g/dl on day 0 whose Hb fell below the safety level of 8g/dl in subsequent follow-up days.</p

Correlation between G6PD activity (U/gHb) and fractional Hb drops in study participants with a decline in Hb from baseline post SP-IPTp.

<p>Correlation between G6PD activity (U/gHb) and fractional Hb drops in study participants with a decline in Hb from baseline post SP-IPTp.</p

Proportion of G6PD Normal, partial deficient and full deficient study participants with fractional Hb drop ≥ 20% (0.20) of baseline value.

<p>Proportion of G6PD Normal, partial deficient and full deficient study participants with fractional Hb drop ≥ 20% (0.20) of baseline value.</p

Box-plots for fractional Hb drops by G6PD status.

<p>Box-plots for fractional Hb drops by G6PD status.</p

Baseline demographic characteristics of study participants by G6PD status^*.

<p>*G6PD status was available for 1507 study women.</p><p>Baseline demographic characteristics of study participants by G6PD status^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136828#t001fn001" target="_blank">*</a>}.</p

Correlation between G6PD activity (U/gHb) and fractional Hb drop in study participants with fractional Hb drops >20% (-0.20) post SP-IPTp as compared to baseline Hb.

<p>Correlation between G6PD activity (U/gHb) and fractional Hb drop in study participants with fractional Hb drops >20% (-0.20) post SP-IPTp as compared to baseline Hb.</p

Mean Haemoglobin levels according to G6PD status and day of follow-up.

<p>Mean Haemoglobin levels according to G6PD status and day of follow-up.</p