The incidence of malaria after splenectomy in Papua New Guinea

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Abstract
Patients, methods, and results The study was performed in East New Britain in the Bismarck Archipelago. Nonga Base Hospital, Rabaul, is the islands' referral hospital, and the plantations employ people from all over Papua New Guinea. In 1982-92, 115 patients were treated for splenic trauma, 31 by splenectomy and 84 by splenic conservation. Despite considerable effort, only 56 patients were traceable in 1993, largely because the others had moved to remote parts of Papua New Guinea (35 had returned to the Highlands, a non-malarious area). Six of the 56 had died; the causes of death could not be verified in the two who had undergone splenectomy, while relatives stated old age, bomb blast, cancer, and sorcery as causes in the four with conserved spleens. This left 50 patients (17 who had undergone splenectomy and 33 splenic conservation) who were followed up to obtain a history of post-trauma illnesses (malaria, upper respiratory tract infection, sores, influenza, tuberculosis) and to take blood for a full blood count and malarial film. We also studied 50 controls, similar in age, sex, and place of origin to the patients and admitted to the surgical wards during the same period for a non-traumatic cause. Data were analysed using the χ2 test. All 17 patients who underwent splenectomy reported that they had had malaria compared with only 18 of 33 (55%) in the conservation group and 23 of 50 controls (P<0.05). Upper respiratory tract infections were also more common in the splenectomy group (table). Fifteen (88%) of the splenectomy group were positive for malaria at the time of interview compared with six (18%) of the conservation group and eight (16%) controls (P<0.001). The patients who had undergone splenectomy also tended to have a higher leucocyte count (P<0.01), but there was no difference in haemoglobin concentrations. Compliance with antimalarial prophylaxis declined from 100% in the first year to 29% after three years in the splenectomy group. View this table: In this window In a new window Illnesses and results of blood examination in patients with splenic trauma and hospital controls 1-10 years after injury. Values are numbers (percentages) unless stated otherwise