{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:12:32Z","timestamp":1791360752482,"version":"4.3.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"DOI":"10.1186\/s12936-026-05804-4","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T15:26:57Z","timestamp":1769614017000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Reevaluating malaria severity metrics: insights from PfHRP2-derived biomass estimates in Ghanaian children"],"prefix":"10.1186","volume":"25","author":[{"given":"Enoch Acheampong","family":"Konadu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrews Osei","family":"Obese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb Kobina","family":"Danso-Coffie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Addison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Kyei-Baafour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorotheah","family":"Obiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda Eva","family":"Amoah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwadwo Asamoah","family":"Kusi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Gyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Oduro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"5804_CR1","unstructured":"WHO. World malaria report 2024: addressing inequity in the global malaria response. 2024."},{"issue":"1","key":"5804_CR2","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1186\/s12887-024-05178-z","volume":"24","author":"B Mseza","year":"2024","unstructured":"Mseza B, Kumbowi PK, Nduwimana M, Banga D, Busha ET, Egesa WI, et al. Prevalence and factors associated with cerebral malaria among children aged 6 to 59\u00a0months with severe malaria in Western Uganda: a hospital-based cross-sectional study. BMC Pediatr. 2024;24(1):704.","journal-title":"BMC Pediatr"},{"key":"5804_CR3","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-41275-w","author":"P Winskill","year":"2023","unstructured":"Winskill P, Dhabangi A, Kwambai TK, Mori AT, Mousa A, Okell LC. Estimating the burden of severe malarial anaemia and access to hospital care in East Africa. Nat Commun. 2023. https:\/\/doi.org\/10.1038\/s41467-023-41275-w.","journal-title":"Nat Commun"},{"issue":"4","key":"5804_CR4","doi-asserted-by":"publisher","first-page":"262","DOI":"10.4314\/gmj.v58i4.3","volume":"58","author":"OR Ibrahim","year":"2025","unstructured":"Ibrahim OR, Issa A, Alao MA, Suleiman BM. Outcomes and factors associated with severe malaria-related anaemia in paediatric patients in northern Nigeria. Ghana Med J. 2025;58(4):262\u20138.","journal-title":"Ghana Med J"},{"issue":"1","key":"5804_CR5","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000036835","volume":"103","author":"B Genanew","year":"2024","unstructured":"Genanew B, Getu F, Walle M, Hailu A. Anemia among malaria patients with and without soil-transmitted helminths in Arba Minch town health facilities: a comparative cross-sectional study. Medicine (Baltimore). 2024;103(1):e36835.","journal-title":"Medicine (Baltimore)"},{"issue":"6","key":"5804_CR6","doi-asserted-by":"publisher","first-page":"e873","DOI":"10.1016\/S2214-109X(22)00125-5","volume":"10","author":"C Guinovart","year":"2022","unstructured":"Guinovart C, Siga\u00faque B, Bassat Q, Loscertales MP, Nhampossa T, Ac\u00e1cio S, et al. The epidemiology of severe malaria at Manhi\u00e7a District Hospital, Mozambique: a retrospective analysis of 20 years of malaria admissions surveillance data. Lancet Glob Health. 2022;10(6):e873\u201381.","journal-title":"Lancet Glob Health"},{"issue":"5","key":"5804_CR7","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1007\/s00436-003-0975-6","volume":"91","author":"C Lindenthal","year":"2003","unstructured":"Lindenthal C, Kremsner PG, Klinkert M-Q. Commonly recognised Plasmodium falciparum parasites cause cerebral malaria. Parasitol Res. 2003;91(5):363\u20138.","journal-title":"Parasitol Res"},{"issue":"6","key":"5804_CR8","doi-asserted-by":"publisher","first-page":"3271","DOI":"10.1128\/IAI.73.6.3271-3277.2005","volume":"73","author":"NK Viebig","year":"2005","unstructured":"Viebig NK, Wulbrand U, F\u00f6Rster R, Andrews KT, Lanzer M, Knolle PA. Direct activation of human endothelial cells by Plasmodium falciparum-infected erythrocytes. Infect Immun. 2005;73(6):3271\u20137.","journal-title":"Infect Immun"},{"issue":"6","key":"5804_CR9","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1007\/s10096-008-0665-5","volume":"28","author":"HA Giha","year":"2009","unstructured":"Giha HA, Elghazali G, A-Elgadir TME, A-Elbasit IE, Elbashir MI. Severe malaria in an unstable setting: clinical and laboratory correlates of cerebral malaria and severe malarial anemia and a paradigm for a simplified severity scoring. Eur J Clin Microbiol Infect Dis. 2009;28(6):661\u20135.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"5804_CR10","doi-asserted-by":"publisher","first-page":"1469790","DOI":"10.3389\/fmala.2024.1469790","volume":"2","author":"EM Diallo","year":"2024","unstructured":"Diallo EM, Kourouma K, Diakite N, Diallo A, Blanquet M, Toure A, et al. Factors affecting treatment delays among malaria patients presenting at health facilities in Guinea, 2022\u20132023. Front Malaria. 2024;2:1469790.","journal-title":"Front Malaria."},{"issue":"1","key":"5804_CR11","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1084\/jem.20110762","volume":"209","author":"J Fonager","year":"2012","unstructured":"Fonager J, Pasini EM, Braks JAM, Klop O, Ramesar J, Remarque EJ, et al. Reduced CD36-dependent tissue sequestration of Plasmodium-infected erythrocytes is detrimental to malaria parasite growth in vivo. J Exp Med. 2012;209(1):93\u2013107.","journal-title":"J Exp Med"},{"issue":"3","key":"5804_CR12","doi-asserted-by":"publisher","first-page":"ofx11","DOI":"10.1093\/ofid\/ofx151","volume":"4","author":"GS Park","year":"2017","unstructured":"Park GS, Opoka RO, Shabani E, Wypyszynski A, Hanisch B, John CC. Plasmodium falciparum Histidine-Rich Protein-2 Plasma Concentrations are Higher in Retinopathy-Negative Cerebral Malaria Than in Severe Malarial Anemia. Open Forum Infect Dis. 2017;4(3):ofx11.","journal-title":"Open Forum Infect Dis"},{"key":"5804_CR13","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-022-30990-5","author":"S Uyoga","year":"2022","unstructured":"Uyoga S, Watson JA, Wanjiku P, Rop JC, Makale J, Macharia AW, et al. The impact of malaria-protective red blood cell polymorphisms on parasite biomass in children with severe Plasmodium falciparum malaria. Nat Commun. 2022. https:\/\/doi.org\/10.1038\/s41467-022-30990-5.","journal-title":"Nat Commun"},{"issue":"8","key":"5804_CR14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0020204","volume":"2","author":"AM Dondorp","year":"2005","unstructured":"Dondorp AM, Desakorn V, Pongtavornpinyo W, Sahassananda D, Silamut K, Chotivanich K, et al. Estimation of the total parasite biomass in acute falciparum malaria from plasma PfHRP2. PLoS Med. 2005;2(8):e204.","journal-title":"PLoS Med"},{"issue":"8","key":"5804_CR15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001297","volume":"9","author":"ICE Hendriksen","year":"2012","unstructured":"Hendriksen ICE, Mwanga-Amumpaire J, Von Seidlein L, Mtove G, White LJ, Olaosebikan R, et al. Diagnosing severe falciparum malaria in parasitaemic African children: a prospective evaluation of plasma PfHRP2 measurement. PLoS Med. 2012;9(8):e1001297.","journal-title":"PLoS Med"},{"key":"5804_CR16","doi-asserted-by":"crossref","unstructured":"WHO. Severe and complicated malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1990;84:1\u201365.","DOI":"10.1016\/0035-9203(90)90363-J"},{"key":"5804_CR17","unstructured":"Ministry of Health Ghana. Standard Treatment Guildlines. Sixth ed. 2010. p. 365\u201373."},{"issue":"3","key":"5804_CR18","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1093\/infdis\/jis371","volume":"206","author":"KB Seydel","year":"2012","unstructured":"Seydel KB, Fox LL, Glover SJ, Reeves MJ, Pensulo P, Muiruri A, et al. Plasma concentrations of parasite histidine-rich protein 2 distinguish between retinopathy-positive and retinopathy-negative cerebral malaria in Malawian children. J Infect Dis. 2012;206(3):309\u201318.","journal-title":"J Infect Dis"},{"issue":"1","key":"5804_CR19","doi-asserted-by":"publisher","first-page":"4098","DOI":"10.1038\/s41467-022-31640-6","volume":"13","author":"FK Musasia","year":"2022","unstructured":"Musasia FK, Nkumama IN, Frank R, Kipkemboi V, Schneider M, Mwai K, et al. Phagocytosis of Plasmodium falciparum ring-stage parasites predicts protection against malaria. Nature Commun. 2022;13(1):4098.","journal-title":"Nature Commun"},{"issue":"9918","key":"5804_CR20","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/S0140-6736(13)60024-0","volume":"383","author":"NJ White","year":"2014","unstructured":"White NJ, Pukrittayakamee S, Hien TT, Faiz MA, Mokuolu OA, Dondorp AM. Malaria. Lancet. 2014;383(9918):723\u201335.","journal-title":"Lancet"},{"issue":"1","key":"5804_CR21","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-13-91","volume":"13","author":"K Plewes","year":"2014","unstructured":"Plewes K, Royakkers AA, Hanson J, Hasan MMU, Alam S, Ghose A, et al. Correlation of biomarkers for parasite burden and immune activation with acute kidney injury in severe falciparum malaria. Malar J. 2014;13(1):91.","journal-title":"Malar J"},{"issue":"7","key":"5804_CR22","doi-asserted-by":"publisher","first-page":"e2415","DOI":"10.1093\/cid\/ciaa1141","volume":"73","author":"S Uyoga","year":"2021","unstructured":"Uyoga S, Wanjiku P, Rop JC, Makale J, Macharia AW, Nyutu GM, et al. Plasma Plasmodium falciparum Histidine-rich Protein 2 Concentrations in Children With Malaria Infections of Differing Severity in Kilifi, Kenya. Clin Infect Dis. 2021;73(7):e2415\u201323.","journal-title":"Clin Infect Dis"},{"issue":"8","key":"5804_CR23","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1093\/infdis\/jiv205","volume":"212","author":"DA Milner","year":"2015","unstructured":"Milner DA, Lee JJ, Frantzreb C, Whitten RO, Kamiza S, Carr RA, et al. Quantitative assessment of multiorgan sequestration of parasites in fatal pediatric cerebral malaria. J Infect Dis. 2015;212(8):1317\u201321.","journal-title":"J Infect Dis"},{"issue":"4","key":"5804_CR24","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1093\/infdis\/jit419","volume":"209","author":"CA Moxon","year":"2014","unstructured":"Moxon CA, Chisala NV, Wassmer SC, Taylor TE, Seydel KB, Molyneux ME, et al. Persistent endothelial activation and inflammation after plasmodium falciparum infection in Malawian children. J Infect Dis. 2014;209(4):610\u20135.","journal-title":"J Infect Dis"},{"issue":"2","key":"5804_CR25","doi-asserted-by":"publisher","DOI":"10.15252\/emmm.201809164","volume":"11","author":"J Storm","year":"2019","unstructured":"Storm J, Jespersen JS, Seydel KB, Szestak T, Mbewe M, Chisala NV, et al. Cerebral malaria is associated with differential cytoadherence to brain endothelial cells. EMBO Mol Med. 2019;11(2):e9164.","journal-title":"EMBO Mol Med"},{"issue":"9","key":"5804_CR26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1001032","volume":"6","author":"B Franke-Fayard","year":"2010","unstructured":"Franke-Fayard B, Fonager J, Braks A, Khan SM, Janse CJ. Sequestration and tissue accumulation of human malaria parasites: Can we learn anything from rodent models of malaria? PLoS Pathog. 2010;6(9):e1001032.","journal-title":"PLoS Pathog"},{"issue":"9","key":"5804_CR27","doi-asserted-by":"publisher","first-page":"e809","DOI":"10.1097\/CCM.0000000000001739","volume":"44","author":"CG Hughes","year":"2016","unstructured":"Hughes CG, Pandharipande PP, Thompson JL, Chandrasekhar R, Ware LB, Ely EW, et al. Endothelial activation and blood-brain barrier injury as risk factors for delirium in critically ill patients. Crit Care Med. 2016;44(9):e809\u201317.","journal-title":"Crit Care Med"},{"issue":"2","key":"5804_CR28","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1086\/505078","volume":"194","author":"KD Seydel","year":"2006","unstructured":"Seydel KD, Milner D, Kamiza SB, Molyneux ME, Taylor TE. The distribution and intensity of parasite sequestration in comatose Malawian children. J Infect Dis. 2006;194(2):208\u201315.","journal-title":"J Infect Dis"},{"issue":"2","key":"5804_CR29","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1038\/nm986","volume":"10","author":"TE Taylor","year":"2004","unstructured":"Taylor TE, Fu WJ, Carr RA, Whitten RO, Mueller JG, Fosiko NG, et al. Differentiating the pathologies of cerebral malaria by postmortem parasite counts. Nat Med. 2004;10(2):143\u20135.","journal-title":"Nat Med"},{"issue":"5","key":"5804_CR30","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1093\/infdis\/jix622","volume":"217","author":"MM Plucinski","year":"2018","unstructured":"Plucinski MM, Dimbu PR, Fortes F, Abdulla S, Ahmed S, Gutman J, et al. Posttreatment HRP2 Clearance in Patients with Uncomplicated Plasmodium falciparum Malaria. J Infect Dis. 2018;217(5):685\u201392.","journal-title":"J Infect Dis"}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-026-05804-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-026-05804-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-026-05804-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T14:01:04Z","timestamp":1771596064000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12936-026-05804-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5804"],"URL":"https:\/\/doi.org\/10.1186\/s12936-026-05804-4","relation":{},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]},"assertion":[{"value":"28 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Institutional Review Board of the Noguchi Memorial Institute for Medical Research (CPN\/030\/08-09) and the Ghana Health Service Ethical Committee (GHS-ERC: 11\/11\/11). Informed written consent was obtained from parents or legal guardians after detailed explanations of the study\u2019s purpose, procedures, risks, and benefits. Participation was voluntary, with the option to withdraw at any time without affecting the standard of care.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"119"}}