{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:11:18Z","timestamp":1793293878154,"version":"4.5.0"},"reference-count":69,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,7,24]],"date-time":"2015-07-24T00:00:00Z","timestamp":1437696000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"University of Arkansas Department of Anthropology"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Phys Anthropol"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Recent studies in paleopathology have shown promise in associating some skeletal lesions with malarial infection. However, malaria's skeletal manifestation has never been confirmed using a large clinical reference sample from an endemic area for malaria with known individual causes of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>To pinpoint evidence of malaria infection on ancient skeletal remains, this study uses an epidemiological approach to compare skeletal lesions in a modern reference sample of 98 individuals from Uganda, where malaria is holoendemic, to a similar modern sample of 106 individuals from a malaria\u2010free area.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five porous skeletal lesions are identified that appear more frequently in the endemic area population, especially in anemic individuals. These appear on the cranium, vertebral column, and humeral and femoral necks. Periostitis also associates strongly with individuals in the endemic population; however, linear enamel hypoplasias show an inverse association. The identified lesions are tested for their association with each other, and then tested individually for their diagnostic power through measures of sensitivity and specificity. A diagnostic outcome algorithm is formed from the remaining skeletal lesions and their inter\u2010lesion associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Several etiological explanations for the characteristic malarial skeletal lesions are explored, including severe malarial anemia, an imbalance in bone remodeling, and extramedullary erythropoiesis. The importance of careful differential diagnoses between other infectious and noninfectious causes of these lesions is discussed, including the potential for coinfection of malaria with other infectious diseases. The findings of this study are pivotal in establishing diagnostic criteria by which we can identify the prevalence and impact of malaria on past populations. Am J Phys Anthropol 158:624\u2013635, 2015. \u00a9 2015 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajpa.22819","type":"journal-article","created":{"date-parts":[[2015,7,24]],"date-time":"2015-07-24T09:17:46Z","timestamp":1437729466000},"page":"624-635","source":"Crossref","is-referenced-by-count":72,"title":["The skeletal manifestation of malaria: An epidemiological approach using documented skeletal collections"],"prefix":"10.1002","volume":"158","author":[{"given":"Nicole E.","family":"Smith\u2010Guzm\u00e1n","sequence":"first","affiliation":[{"name":"Department of Anthropology University of Arkansas Fayetteville AR 72701"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,7,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000086936"},{"key":"e_1_2_8_3_1","first-page":"130","article-title":"The reaction area of the femoral neck","volume":"32","author":"Angel JL.","year":"1964","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.153.3737.760"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jas.2007.11.019"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-11-64"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1094"},{"key":"e_1_2_8_8_1","first-page":"1005","article-title":"An analysis of malaria in pregnancy in Africa","volume":"61","author":"Brabin BJ.","year":"1983","journal-title":"Bull World Health Organ"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781444392449"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511584220.015"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0047-2484(74)90203-6"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12291-011-0137-z"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/oa.955"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.2307\/2954410"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1330440311"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2014.00441"},{"key":"e_1_2_8_17_1","first-page":"23","article-title":"Non\u2010metric variation of the infracranial skeleton","volume":"125","author":"Finnegan M.","year":"1978","journal-title":"J Anat"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/00034983.1969.11686625"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.21648"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2009.1.87"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.121"},{"key":"e_1_2_8_22_1","first-page":"57","article-title":"Cribra orbitalia: pathogenesis and probable etiology","volume":"22","author":"Hengen OP.","year":"1971","journal-title":"Homo"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.2307\/282505"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/0043824032000111362"},{"key":"e_1_2_8_25_1","first-page":"69","article-title":"Low birth\u2010weight and malarial infection of the placenta","volume":"38","author":"Jelliffe EF.","year":"1968","journal-title":"Bull World Health Organ"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300985811432344"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-06-508325"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.22574"},{"key":"e_1_2_8_29_1","first-page":"471","article-title":"The role of diet, disease, and physiology in the origin of porotic hyperostosis","volume":"49","author":"Lallo JW","year":"1977","journal-title":"Hum Biol"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0060307"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-3-26"},{"key":"e_1_2_8_32_1","volume-title":"Photographic regional atlas of bone disease: a guide to pathologic and normal variation in the human skeleton","author":"Mann RW","year":"2005"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/oa.2383"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1228892"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/01459740.1978.9986939"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1330070221"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(94)90484-7"},{"key":"e_1_2_8_38_1","first-page":"221","volume-title":"Sistematizaci\u00f3n metodol\u00f3gica en Paleopatolog\u00eda, Actas V Congreso Nacional AEP","author":"Miquel\u2010Feucht MJ","year":"1999"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1330930302"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0046101"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.36.187.305"},{"key":"e_1_2_8_42_1","unstructured":"N\u00e1jeraJA HempelJ.1996. The Burden of Malaria. Geneva: World Health Organization Div. of Control of Tropical Disease Malaria unit. Report No. CTD\/MAL\/96.10."},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1408.080235"},{"key":"e_1_2_8_44_1","volume-title":"Distribution of Plasmodium ovale in the eastern, western and northern regions of Uganda","author":"Onori E.","year":"1967"},{"key":"e_1_2_8_45_1","volume-title":"Identification of Pathological Conditions in Human Skeletal Remains","author":"Ortner DJ.","year":"2003"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1537\/ase.100302"},{"key":"e_1_2_8_47_1","unstructured":"PinelloC.2008. Attempted ancient DNA detection of Plasmodium vivax in medieval and post\u2010medieval Britain. Unpublished PhD Dissertation University of Manchester."},{"key":"e_1_2_8_48_1","volume-title":"Advances in human palaeopathology","author":"Pinhasi R","year":"2008"},{"key":"e_1_2_8_49_1","first-page":"45","volume-title":"Advances in Human Palaeopathology","author":"Pinhasi R","year":"2008"},{"key":"e_1_2_8_50_1","first-page":"7","article-title":"Malaria in ancient Egypt: paleoimmunological investigation on predynastic mummified remains","volume":"32","author":"Rabino Massa E","year":"2000","journal-title":"Chungar\u00e1"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.22354"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a112510"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.4236\/aa.2012.23018"},{"key":"e_1_2_8_54_1","first-page":"195","article-title":"Biomolecular archaeology of malaria","volume":"3","author":"Sallares R","year":"2001","journal-title":"Anc Biomol"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2014.08.010"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(08)70130-0"},{"key":"e_1_2_8_57_1","volume-title":"Malaria: parasite biology, pathogenesis, and protection","author":"Sherman IW","year":"1998"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpp.2015.03.001"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1080\/0043824032000111371"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1330660407"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1330740410"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-015-0677-4"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-8644(199609)101:1<11::AID-AJPA2>3.0.CO;2-G"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.21031"},{"key":"e_1_2_8_65_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.10321"},{"key":"e_1_2_8_66_1","volume-title":"Humanity's burden: a global history of malaria","author":"Webb JLA.","year":"2009"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9781107280625"},{"key":"e_1_2_8_68_1","unstructured":"World Health Organization.2007. Gender Health and Malaria. Geneva Switzerland."},{"key":"e_1_2_8_69_1","unstructured":"World Health Organization.2012. World Malaria Report: Uganda. Geneva Switzerland."},{"key":"e_1_2_8_70_1","unstructured":"World Health Organization.2014. World Malaria Report 2014. Geneva Switzerland."}],"container-title":["American Journal of Physical Anthropology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fajpa.22819","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajpa.22819","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T15:49:36Z","timestamp":1696607376000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajpa.22819"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,7,24]]},"references-count":69,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2015,12]]}},"alternative-id":["10.1002\/ajpa.22819"],"URL":"https:\/\/doi.org\/10.1002\/ajpa.22819","archive":["Portico"],"relation":{},"ISSN":["0002-9483","1096-8644"],"issn-type":[{"value":"0002-9483","type":"print"},{"value":"1096-8644","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,7,24]]}}}