Malaria is more dangerous when you have sickle cell
The two conditions collide badly, and in Uganda they collide often. This is the single most important thing for a Ugandan family with sickle cell to get right.
Why the combination is so serious
Malaria destroys red blood cells. Someone with sickle cell disease is already short of red blood cells, because their cells break down faster than normal. Add malaria and the anaemia can become severe very quickly, sometimes within a day. Malaria also sets off pain crises, and a child can end up with a crisis and severe anaemia at the same time.
This is why a fever that would be routine in another child is not routine here. In sickle cell, fever is an emergency until proven otherwise.
The confusing part: trait is not the same as disease
Sickle cell trait, where you carry one sickle gene, actually gives partial protection against severe malaria. That protection is the reason the gene is so common across Uganda in the first place.
Sickle cell disease, where you carry two, gives no such protection. It does the opposite. Families sometimes hear the malaria protection story and assume it applies to everyone with sickle cell in the family. It does not, and the mistake is dangerous.
Prevention is most of the work
- An insecticide-treated net, every single night, for the person with sickle cell and ideally everyone in the household. Not most nights. Every night, including when travelling and when staying with relatives.
- Take preventive medicine exactly as prescribed if your clinician has put you on it. Many sickle cell clinics prescribe ongoing malaria prophylaxis. Finish the course, and do not stop because the person feels well.
- Clear standing water around the house where mosquitoes breed.
- Be extra careful when travelling to a higher transmission area, and tell your clinician before you go.
When there is a fever
Get to a health facility the same day. Ask for a malaria test rather than assuming, because a fever in sickle cell can also be a bacterial infection, which is equally urgent and needs different treatment. Tell whoever sees you that the patient has sickle cell disease, at the start, before anything else. It changes how urgently they should treat and what they should look for.
Go immediately, do not wait for morning, if there is fever with difficulty breathing or chest pain, a suddenly swollen or tender belly, unusual paleness, floppiness or extreme tiredness in a child, or confusion.
What families get wrong most often
Treating repeated fevers at home with leftover medicine. Buying antimalarials from a drug shop without a test. Assuming that because the last three fevers were malaria, this one is too. And waiting until the morning, which is where a great deal of avoidable harm happens.
This article is general information, not medical advice. Your clinician knows your case and this page does not.