Malaria and nutritional status among pre-school children: results from cross-sectional surveys in western Kenya.
Protein-energy malnutrition (PEM) affects millions of children in the developing world. The relationship between malaria and PEM is controversial. The goal of this study was to evaluate whether undernutrition is associated with increased or decreased malaria attributable morbidity. Three cross-sectional surveys were conducted using insecticide-treated bed nets (ITNs) among children aged 0-36 months living in an area with intense malaria transmission. Data were collected on nutritional status, recent history of clinical illness, socioeconomic status, current malaria infection status, and hemoglobin. In multivariate models, stunted children had more malaria parasitemia (odds ratio [OR] 1.98, P < 0.0001), high-density parasitemia (OR 1.84; P < 0.0001), clinical malaria (OR 1.77; P < 0.06), and severe malarial anemia (OR 2.65; P < 0.0001) than nonstunted children. The association was evident in children with mild-to-moderate (-3 < height-for-age Z-score [HAZ] < -2) and severe stunting (HAZ < -3). The cross-sectional nature of the study limits the interpretation of causality, but the data provide further observational support that the presence of undernutrition, in particular chronic undernutrition, places children at higher, not lower risk of malaria-related morbidity.
Friedman
Jennifer F
JF
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. Jennifer_Friedman@Brown.edu
Kwena
Arthur M
AM
Mirel
Lisa B
LB
Kariuki
Simon K
SK
Terlouw
Dianne J
DJ
Phillips-Howard
Penelope A
PA
Hawley
William A
WA
Nahlen
Bernard L
BL
Shi
Ya Ping
YP
ter Kuile
Feiko O
FO
D001512:Bedding and Linens; D015362:Child Nutrition Disorders / Q000150:complications* / Q000453:epidemiology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008288:Malaria / Q000150:complications* / Q000453:epidemiology; D008297:Male; D009017:Morbidity; D009752:Nutritional Status; D026023:Permethrin / Q000494:pharmacology; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors
D026023:Permethrin