Prevalence of malaria in an area with high prevalence of hemoglobin constant spring in Vietnam

Dear Sir,

Hemoglobin disorder is an important problem in Southeast Asia, where malaria is still an important tropical infection. ^[1] An interesting hypothesis is on the background of high prevalence of malaria in this area that leads to the natural selection process and the abnormal hemoglobin seems to be a resistant phenotype to the malaria infection in this region. ^[2] However, this concept still needs an approval. Here, we would like to discuss on the finding of a very high prevalence of hemoglobin Constant Spring in a rural area in Central Vietnam. ^[3] Among the minority in this area, the frequency of 0.143 could be observed. ^[3] Of interest, the local data in this area reveals that the prevalence of malaria in this area shows that malaria is detected in one to two case(s) per year during 10-year duration. It is very interesting that the prevalence of malaria in this area, where high prevalence of hemoglobin disorder can be seen, seems not high. There are many reasons for these observations. First, there might be underdiagnosis of malaria. Some minorities might not have access to healthcare service and the malaria cases were left into the community without proper record. Nevertheless, due to the good communication system in Vietnam at present, communal healthcare (CHC) is the first level of service accessible to the population in the state health network. It provides services in primary health care, early detection and control of epidemics, provision of primary healthcare and normal deliveries, provision of essential drugs, and education on family planning methods and health promotion. At the village level, village health workers (VHW) are assigned to do surveillance in the villages and provide education and consultancies during house visits. They report directly to the CHC. So the problem of malaria underdiagnosis might be completely managed. Second, the malaria might not be the present problem in this area. The malaria is an infectious disease that might be controllable, while the hemoglobinopathy is a genetic disease that can be inherited and is more difficult to get rid of. As Flint et al., noted, “we would expect the mutations that protect and do not compromise the health of their carriers to become widely disseminated, but it is likely that human intervention will alter this process of natural selection”. ^[4] Third, the hemoglobin Constant Spring might not be the phenotype that is resistant to malaria and naturally selected according to the already mentioned concept. ^[2]

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.146413