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Background  Haemoglobin (Hb) recovers slowly in malaria and may be influenced by naturally acquired immunity. Hb recovery was compared in malaria immune, indigenous Papuan and non-Papuan adults with limited malaria exposure.    Methods  Hb concentrations were measured on Days (D) 0, 3, 7, and 28 in 57 Papuans and 105 non-Papuans treated with chloroquine, doxycycline or both drugs for acute, uncomplicated  Plasmodium vivax  (n?=?64) or  Plasmodium falciparum  (n?=?98).    Results  Mean (SD, range) D0 Hb was 12.7 (2.2, 7–21.3) g/dL and was similar in  P .  falciparum  infected Papuans and non-Papuans: 12.2  vs . 12.8 g/dL ( P ?=?0.15) but significantly lower in: (i)  P .  vivax -infected Papuans  vs .  P .  vivax -infected non-Papuans: 11.4  vs . 13.47 g/dL [∆?=?−2.07 (95% CI: –3.3 – –0.8),  P ?=?0.0018], (ii) all patients with splenomegaly ( vs . those without splenomegaly): 12.16  vs . 13.01 g/dL [∆?=?−0.85 (−1.6– –0.085),  P ?=?0.029], and (iii) all females  vs . all males: 10.18  vs . 13.01 g/dL [∆?=?−2.82 (−3.97 – –1.67),  P ?<?0.0001].Multiple regression identified female sex ( P ?=?0.000), longer illness duration ( P ?=?0.015) ( P .  falciparum  patients) and Papuan ethnicity ( P ?=?0.017) ( P .  vivax  patients) as significant factors for a lower D0 Hb.  Mean D28 Hb increased to 13.6 g/dL [∆?=?1.01 (0.5-1.5)  vs . D0 Hb,  P ?=?0.0001]. It was: (i) positively correlated with the D0 Hb (adjusted R 2 ?=?0.24,  P ?=?0.000), and was significantly lower in  P .  vivax  infected Papuans  vs . non-Papuans: 12.71  vs . 14.46 g/dL [∆?=?−1.7 (−2.95– –0.5,  P ?=?0.006).    Conclusions  Haemoglobin recovery was related to baseline Hb. Vivax-infected malaria immune Papuans had persistently lower Hb concentrations compared to non-Papuans with limited malaria exposure. This haematological disadvantage remains unexplained.

Haemoglobin dynamics in Papuan and non-Papuan adults in northeast Papua, Indonesia, with acute, uncomplicated vivax or falciparum malaria