title: Malaria and nutritional status in children living on the coast of Kenya.
abstract: BACKGROUND
  The relation between malnutrition and malaria is controversial. On the one hand, malaria may cause malnutrition, whereas on the other hand, malnutrition itself may modulate susceptibility to the disease.
  
  
  OBJECTIVE
  The objective was to investigate the association between Plasmodium falciparum malaria and malnutrition in a cohort of Kenyan children.
  
  
  METHODS
  The study involved the longitudinal follow-up of children aged 0-95 [corrected] mo for clinical malaria episodes and anthropometric measurements through 4 cross-sectional surveys. We used Poisson regression analysis to investigate the association between malaria and nutritional status.
  
  
  RESULTS
  The crude incidence rate ratios (IRRs) for malaria during the 6-mo period before assessment in children defined as malnourished on the basis of low height-for-age or low weight-for-age z scores (<-2) were 1.17 (95% CI: 0.91, 1.50; P=0.21) and 0.94 (0.71, 1.25; P=0.67), respectively, which suggests no association between malaria and the subsequent development of protein-energy malnutrition. However, we found that age acted as an effect modifier in the association between malaria episodes and malnutrition on prospective follow-up. The IRR for malaria in children aged 0-2 y, who were subsequently characterized as underweight, was 1.65 (1.10, 2.20; P=0.01), and a significant overall relation between malaria and stunting was found on regression analysis after adjustment for the interaction with age (IRR: 1.91; 1.01, 3.58; P=0.04).
  
  
  CONCLUSIONS
  Although children living on the coast of Kenya continue to experience clinical episodes of uncomplicated malaria throughout the first decade of life, the effect of malaria on nutritional status appears to be greatest during the first 2 y of life.
authors.affiliation: KEMRI/Wellcome Trust Program, Center for Geographic Medicine Research, Coast, Kilifi District Hospital, Kilifi, Kenya. nyakeriga@imun.su.se
authors.forename: Alice M
authors.initials: AM
authors.lastname: Nyakeriga
authors.forename: Marita
authors.initials: M
authors.lastname: Troye-Blomberg
authors.forename: Alex K
authors.initials: AK
authors.lastname: Chemtai
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Williams
mesh_terms: D000367:Age Factors; D000886:Anthropometry; D015362:Child Nutrition Disorders / Q000150:complications* / Q000453:epidemiology*; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008137:Longitudinal Studies; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D009017:Morbidity; D009752:Nutritional Status; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000150:complications* / Q000453:epidemiology*; D012044:Regression Analysis