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Association of glucose-6-phosphate dehydrogenase deficiency and malaria: a systematic review and meta-analysis

View Article: PubMed Central - PubMed

ABSTRACT

Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency overlaps with malaria endemicity although it predisposes carriers to hemolysis. This fact supports the protection hypothesis against malaria. The aim of this systematic review is to assess the presence and the extent of protective association between G6PD deficiency and malaria. Thirteen databases were searched for papers reporting any G6PD alteration in malaria patients. Twenty-eight of the included 30 studies were eligible for the meta-analysis. Results showed absence of negative association between G6PD deficiency and uncomplicated falciparum malaria (odds ratio (OR), 0.77; 95% confidence interval (CI), 0.59–1.02; p = 0.07). However, this negative association happened in Africa (OR, 0.59; 95% CI, 0.40–0.86; p = 0.007) but not in Asia (OR, 1.24; 95% CI, 0.96–1.61; p = 0.10), and in the heterozygotes (OR, 0.70; 95% CI, 0.57–0.87; p = 0.001) but not the homo/hemizygous (OR, 0.70; 95% CI, 0.46–1.07; p = 0.10). There was no association between G6PD deficiency and total severe malaria (OR, 0.82; 95% CI, 0.61–1.11; p = 0.20). Similarly, there was no association with other malaria species. G6PD deficiency can potentially protect against uncomplicated malaria in African countries, but not severe malaria. Interestingly, this protection was mainly in heterozygous, being x-linked thus related to gender.

No MeSH data available.


Related in: MedlinePlus

Flow diagram showing the method for the search, abstract screening, systematic review, and meta-analysis.The database search using the search strategy was cleaned up to exclude duplicates. Titles and abstracts were initially screened to include all studies (published before January 2014) describing any association between G6PD deficiency and malaria. In addition to not meeting the inclusion criteria, reviews, case studies, editor correspondences, and studies whose data could not be retrieved were excluded during the full-text review.
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f1: Flow diagram showing the method for the search, abstract screening, systematic review, and meta-analysis.The database search using the search strategy was cleaned up to exclude duplicates. Titles and abstracts were initially screened to include all studies (published before January 2014) describing any association between G6PD deficiency and malaria. In addition to not meeting the inclusion criteria, reviews, case studies, editor correspondences, and studies whose data could not be retrieved were excluded during the full-text review.

Mentions: The initial search on public databases yielded 1600 study reports after excluding duplicates. Titles and abstracts screening resulted in exclusion of 1364 studies based on the exclusion criteria. Only 236 studies were considered eligible for inclusion for full-text review. Further 197 studies were excluded after full-text reading. A total of 39 studies were included, which comprises 49 data sets due to multi-center study reports. However, nine studies whose data either cannot be extracted, overlapped, or combined with the rest of the data, and thus were excluded. Among the 30 included studies, the species of Plasmodium are only Plasmodium falciparum in 17 studies3571011181920212223242526272829, only Plasmodium vivax in one study30, and combined species (P. falciparum with P. vivax, P. falciparum with P. malariae, P. vivax with P. malariae, and P. falciparum with P. vivax and P. malariae) in eight studies1415313233343536. Jalloh 200432, Tantular 199936, and Kruatrachue 196215 reported separate data for P. vivax which meta-analyzed with that of Leslie 201030. The species cannot be determined in four studies37383940. Finally, a total of 28 studies containing 34 datasets were included in the quantitative data synthesis and meta-analysis (Fig. 1).


Association of glucose-6-phosphate dehydrogenase deficiency and malaria: a systematic review and meta-analysis
Flow diagram showing the method for the search, abstract screening, systematic review, and meta-analysis.The database search using the search strategy was cleaned up to exclude duplicates. Titles and abstracts were initially screened to include all studies (published before January 2014) describing any association between G6PD deficiency and malaria. In addition to not meeting the inclusion criteria, reviews, case studies, editor correspondences, and studies whose data could not be retrieved were excluded during the full-text review.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382680&req=5

f1: Flow diagram showing the method for the search, abstract screening, systematic review, and meta-analysis.The database search using the search strategy was cleaned up to exclude duplicates. Titles and abstracts were initially screened to include all studies (published before January 2014) describing any association between G6PD deficiency and malaria. In addition to not meeting the inclusion criteria, reviews, case studies, editor correspondences, and studies whose data could not be retrieved were excluded during the full-text review.
Mentions: The initial search on public databases yielded 1600 study reports after excluding duplicates. Titles and abstracts screening resulted in exclusion of 1364 studies based on the exclusion criteria. Only 236 studies were considered eligible for inclusion for full-text review. Further 197 studies were excluded after full-text reading. A total of 39 studies were included, which comprises 49 data sets due to multi-center study reports. However, nine studies whose data either cannot be extracted, overlapped, or combined with the rest of the data, and thus were excluded. Among the 30 included studies, the species of Plasmodium are only Plasmodium falciparum in 17 studies3571011181920212223242526272829, only Plasmodium vivax in one study30, and combined species (P. falciparum with P. vivax, P. falciparum with P. malariae, P. vivax with P. malariae, and P. falciparum with P. vivax and P. malariae) in eight studies1415313233343536. Jalloh 200432, Tantular 199936, and Kruatrachue 196215 reported separate data for P. vivax which meta-analyzed with that of Leslie 201030. The species cannot be determined in four studies37383940. Finally, a total of 28 studies containing 34 datasets were included in the quantitative data synthesis and meta-analysis (Fig. 1).

View Article: PubMed Central - PubMed

ABSTRACT

Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency overlaps with malaria endemicity although it predisposes carriers to hemolysis. This fact supports the protection hypothesis against malaria. The aim of this systematic review is to assess the presence and the extent of protective association between G6PD deficiency and malaria. Thirteen databases were searched for papers reporting any G6PD alteration in malaria patients. Twenty-eight of the included 30 studies were eligible for the meta-analysis. Results showed absence of negative association between G6PD deficiency and uncomplicated falciparum malaria (odds ratio (OR), 0.77; 95% confidence interval (CI), 0.59–1.02; p = 0.07). However, this negative association happened in Africa (OR, 0.59; 95% CI, 0.40–0.86; p = 0.007) but not in Asia (OR, 1.24; 95% CI, 0.96–1.61; p = 0.10), and in the heterozygotes (OR, 0.70; 95% CI, 0.57–0.87; p = 0.001) but not the homo/hemizygous (OR, 0.70; 95% CI, 0.46–1.07; p = 0.10). There was no association between G6PD deficiency and total severe malaria (OR, 0.82; 95% CI, 0.61–1.11; p = 0.20). Similarly, there was no association with other malaria species. G6PD deficiency can potentially protect against uncomplicated malaria in African countries, but not severe malaria. Interestingly, this protection was mainly in heterozygous, being x-linked thus related to gender.

No MeSH data available.


Related in: MedlinePlus