Identification of Red Blood Cell Disorders in Malaria-Endemic and Non-Endemic Regions in Borneo

Abstract

Malaria remains a significant public health challenge despite advancements in treatment and prevention. The interaction between the malaria parasite and human red blood cells (RBCs) leads to the evolution of RBC disorders that offer protection against malaria. This study aimed to determine the prevalence of RBC disorders from archived DNA samples collected from malaria-endemic and non-endemic regions of Borneo using molecular genotyping to detect Southeast Asian ovalocytosis, HbE, and α-thalassemia. Statistical analysis revealed that malaria is significantly more prevalent in Central Borneo than in North Borneo (6.36% vs. 1.02%, p < 0.05). SAO and HbE were found to be significantly higher in the malaria-endemic area with 4.59% vs. 1.71%, (p < 0.05) and 19.79% vs. 10.24%, (p < 0.001), respectively. The study also examined the association between RBC disorders and malaria prevalence. Individuals with SAO have a 1.58 times higher chance of malaria infection (OR = 1.58, 95% CI = 0.201 - 12.485), whereas those with HbE have a 0.58 times lower chance (OR = 0.58, 95% CI = 0.133 - 2.545); however, these findings were not statistically significant due to wide confidence intervals. Difficulties in detecting α-thalassemia mutations underscored the need for optimized PCR methodologies and high-fidelity PCR kits. These results support the theory that malaria induces positive selective pressure on RBC disorders.