However, in a malaria endemic region such as Nigeria, the real effect of such interventions may be masked due to the confounding effect of malaria on serum Hb: Malaria infection initiates hemolysis of both parasitized and nonparasitized RBCs, which leads to a depletion of Hb concentrations, thus leading to anemia (53). This evidence concerns the gene GSTM1 and anemia.