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

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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.

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Association of G6PD deficiency with protection from uncomplicated falciparum malaria.(a) The forest plot of meta-analysis assessing the association between G6PD deficiency and prevalence of P. falciparum malaria. The comparators were malaria negative individuals. The observed results revealed absence of negative association between G6PD deficiency and P. falciparum malaria prevalence. (b) Funnel plot revealed the presence of publication bias towards negative association. (c) Trim and fill analysis led to further tilting away from the negative association, confirming the presence of publication bias among the included studies.
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f2: Association of G6PD deficiency with protection from uncomplicated falciparum malaria.(a) The forest plot of meta-analysis assessing the association between G6PD deficiency and prevalence of P. falciparum malaria. The comparators were malaria negative individuals. The observed results revealed absence of negative association between G6PD deficiency and P. falciparum malaria prevalence. (b) Funnel plot revealed the presence of publication bias towards negative association. (c) Trim and fill analysis led to further tilting away from the negative association, confirming the presence of publication bias among the included studies.

Mentions: A meta-analysis was performed to assess the frequencies of G6PD deficiency between uncomplicated P. falciparum malaria and malaria negative individuals. The odds ratios (OR) from 19 datasets obtained from 14 studies3571014151820222429313236 were pooled for this meta-analysis. There was significant heterogeneity among the studies; thus, random effect model was applied for the meta-analysis. The combined OR revealed absence of negative association between G6PD deficiency and uncomplicated malaria (OR, 0.77; 95% confidence interval (CI), 0.59–1.02; n, 19; p = 0.07) (Fig. 2a). There was publication bias in favor of studies with negative association (Fig. 2b). When the cut and fill method as proposed by Duval et al.41 was applied, the condition negative association was further lost (OR, 0.88; 95% CI, 0.66–1.17; n, 22; p = 0.435).


Association of glucose-6-phosphate dehydrogenase deficiency and malaria: a systematic review and meta-analysis
Association of G6PD deficiency with protection from uncomplicated falciparum malaria.(a) The forest plot of meta-analysis assessing the association between G6PD deficiency and prevalence of P. falciparum malaria. The comparators were malaria negative individuals. The observed results revealed absence of negative association between G6PD deficiency and P. falciparum malaria prevalence. (b) Funnel plot revealed the presence of publication bias towards negative association. (c) Trim and fill analysis led to further tilting away from the negative association, confirming the presence of publication bias among the included studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2: Association of G6PD deficiency with protection from uncomplicated falciparum malaria.(a) The forest plot of meta-analysis assessing the association between G6PD deficiency and prevalence of P. falciparum malaria. The comparators were malaria negative individuals. The observed results revealed absence of negative association between G6PD deficiency and P. falciparum malaria prevalence. (b) Funnel plot revealed the presence of publication bias towards negative association. (c) Trim and fill analysis led to further tilting away from the negative association, confirming the presence of publication bias among the included studies.
Mentions: A meta-analysis was performed to assess the frequencies of G6PD deficiency between uncomplicated P. falciparum malaria and malaria negative individuals. The odds ratios (OR) from 19 datasets obtained from 14 studies3571014151820222429313236 were pooled for this meta-analysis. There was significant heterogeneity among the studies; thus, random effect model was applied for the meta-analysis. The combined OR revealed absence of negative association between G6PD deficiency and uncomplicated malaria (OR, 0.77; 95% confidence interval (CI), 0.59–1.02; n, 19; p = 0.07) (Fig. 2a). There was publication bias in favor of studies with negative association (Fig. 2b). When the cut and fill method as proposed by Duval et al.41 was applied, the condition negative association was further lost (OR, 0.88; 95% CI, 0.66–1.17; n, 22; p = 0.435).

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