Background: In Madagascar, the last study on sickle cell disease (SCD) was done in the early 1980s. The country is\nknown as endemic for malaria and respiratory infections. The main objective of this study was to estimate the\nprevalence of SCD; the secondary objective was to evaluate its association with malaria and respiratory infections.\nMethods: This is a cross-sectional study which was carried out in a rural village in the south east coast of\nMadagascar between May 2011 and November 2013. Participants were children aged between 2ââ?¬â??59 months\npresenting with fever measured by axillary temperature ââ?°Â¥37.5 Ã?°C at inclusion. Genotyping of haemoglobin S was\ndone by PCR and malaria was diagnosed by Rapid Diagnostic Test. Research for viral and atypical bacterial\nrespiratory pathogens was performed on nasopharyngeal swabs. Uni-and multivariate polytomous logistic\nregression was done to assess associations between microbiological results and SCD status, with HbAA phenotype\nas reference.\nResults: A total of 807 children were analysed. Prevalence of SCD among febrile children was 2.4% (95% CI, 1.5ââ?¬â??3.\n7%) and that of SCT was 23.8% (95% CI, 20.9ââ?¬â??26.9%). There was no difference in the prevalence of malaria infection\naccording to haemoglobin status (p = 0.3). Rhinovirus (22.5%), adenovirus (14.1%), and bocavirus (11.6%) were the\nmost common respiratory pathogens detected. After univariate analysis, patients with SCD were more frequently\ninfected by parechovirus (p = 0.01), while patients with SCT were more prone to RSV A or B infection (p = 0.01).\nAfter multivariate analysis, HbAS phenotype was associated with higher risk of RSV A and B infection compared to\nHbAA (adjusted OR = 1.9; 95% CI: 1.2ââ?¬â??3.1, p = 0.009), while HbSS phenotype was associated with higher risk of\nparechovirus infection (adjusted OR = 6.0; 95% CI: 1.1ââ?¬â??31.3, p = 0.03) compared to HbAA, independently of age,\ngender, period per quarter, and the other viruses.\nConclusion: The prevalence of SCD among under-five children presenting with fever was high in the study\npopulation. No association was found between SCT and malaria but few viruses, especially parechovirus, seem to\nplay an important role in the occurrence of pneumoniae among SCD patients.
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