Disparities in the Susceptibilities of ABO and Rh Blood Antigens to Severe Plasmodium falciparum in Children Under Five Years; A Cross-Sectional Study among Rural Dwellers, North East Region, Ghana

Aim: To determine the association between ABO and Rh blood antigens, and severe Plasmodium falciparum malaria among children under five years.

Study Design: Hospital-based cross-sectional study

Place and Duration of Study: Janga District Hospital, North East Ghana from April to August, 2022.

Methodology: The study recruited 410 children below five years of age. Three millilitres of venous blood were collected from each participant for haemoglobin (Hb) estimation, thick and thin blood films for malaria parasites, and blood antigen determination. The data were analyzed with STATA version 16.0 and P<.05 was considered statistically significant.

Results: About one-third (32.68%) of the participants had severe Plasmodium falciparum malaria, and 264 (64.39%) had uncomplicated malaria. Blood group O Rh ‘D’ Positive (O+) was the most predominant blood antigen. Severe malaria commonly occurred in A Rh ‘D’ Positive (A+), 54/134 (40.30%) subjects compared to the other blood groups, while uncomplicated malaria was highest in the O+ group, 150/264 (56.82%). Complicated malaria patients were about seven times, and thrice likely to be of blood groups A+ and B Rh ‘D’ Positive (B+), respectively compared to blood group O+ (A+ vs O+: OR=7.60, 95% CI:4.27-13.51, p<.001; B+ vs O+: OR=3.11, 95% CI: 1.80-5.37, p<.001).

Conclusion: The study identified a relatively higher prevalence of P. falciparum malaria in children below five years in the Janga district. About one-third of the participants had severe malaria. Individuals with blood groups A+ and B+ are more susceptible to severe P. falciparum infection than those with blood type O+. Incorporation of blood antigen determination into the routine management of malaria is recommended.