Malaria associated severe anemia in children is the most important complication of Plasmodium falciparum infection in
sub-Saharan Africa. To evaluate anemia and malaria in an area with recurrent malaria epidemics in the western highlands of Kenya,
we conducted cross-sectional surveys in four “lowland” (1440–1660 m) and two “highland” (1960 and 2040 m) villages in 2002.
Among 1314 subjects randomly selected from all age groups, the overall prevalence of anemia (hemoglobin, Hb < 11 g/dl)
was 14% and P. falciparum infection 17%. In children =5 years, anemia prevalence ranged from 57% at 1440 m to 11% at 2040 m
and correlated with altitude (r = -0.88, P < 0.05). Similarly, P. falciparum prevalence ranged from 31 to 0% and correlated
with altitude (r = -0.93, P < 0.01). Malnutrition defined by a body mass index <15th percentile characterized 39% of the
population and the hookworm prevalence was 3.9%. In the lowland villages, anemia was most common in children =5 years of
age (34%) followed by women of childbearing age (16%). A similar pattern was also observed in the highland villages. In these
vulnerable populations, hemoglobin concentration was significantly associated with malaria infection, but not with malnutrition
or hookworm infestation and comparisons of anemia prevalence between highland and lowland villages revealed that two-thirds
of anemia could be attributed to malaria infection. The prevalence of severe anemia (Hb < 8 g/dl) was 1.5%; of these, 90%
resided in lowland villages, 70% were under-fives, while 20% were women of childbearing age. In severely anemic subjects,
the Hb concentration decreased further with malnutrition (P < 0.05).
Anemia was more prevalent in the lowland villages characterized by high prevalence of P. falciparum infection. We conclude
that malaria may also be the main cause of anemia in the highland fringe areas of sub-Saharan Africa. Measures that reduce
the prevalence of malaria will consequently reduce anemia in both, young children and adult women and the need for blood
transfusions associated with the risk of HIV-transmission.