title: Comparative effects of vivax malaria, fever and diarrhoea on child growth.
abstract: BACKGROUND
  The adverse impact of Plasmodium vivax on child health beyond acute febrile illness is poorly studied. The effect of vivax malaria on child growth was evaluated and compared with diarrhoeal disease and non-specific fever.
  
  
  METHODS
  Using data from a 43-month longitudinal cohort of children 0-72 months of age (n = 442) in the Peruvian Amazon, ponderal and linear growth velocities over 2-, 4- and 6-month periods were examined using longitudinal models and related to the incidence of disease during the same period.
  
  
  RESULTS
  An episode of vivax malaria led to 138.6 g (95% confidence interval (CI) 81.9-195.4), 108.6 g (62.8-153.2) and 61 g (20.9-101.1) less weight gain over 2-, 4- and 6-month intervals, respectively. These deficits were larger than both diarrhoea (21.9, 17.2 and 13.8 g less weight gain, respectively) and fever (39.0, 30.3 and 25.6 g less weight gain, respectively). An incident episode of vivax also led to 0.070 cm (0.004-0.137) and 0.083 cm (0.015-0.151) less linear growth over 4 and 6 months, respectively, which were also larger than deficits from diarrhoea (0.029 and 0.028 cm, respectively) and fever (not associated with linear growth deficits). Despite the larger effect of P. vivax incident episodes on growth of a particular child, diarrhoeal disease had a larger cumulative impact on growth deficits as diarrhoeal incidence rates in this community are >10-fold higher than vivax malaria.
  
  
  CONCLUSIONS
  Disease control measures for vivax malaria and diarrhoeal disease have the potential to improve the growth of children in endemic areas.
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
authors.forename: Gwenyth
authors.initials: G
authors.lastname: Lee
authors.forename: Pablo
authors.initials: P
authors.lastname: Yori
authors.forename: Maribel Paredes
authors.initials: MP
authors.lastname: Olortegui
authors.forename: William
authors.initials: W
authors.lastname: Pan
authors.forename: Laura
authors.initials: L
authors.lastname: Caulfield
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: John W
authors.initials: JW
authors.lastname: Sanders
authors.forename: Hermann Silva
authors.initials: HS
authors.lastname: Delgado
authors.forename: Margaret
authors.initials: M
authors.lastname: Kosek
mesh_terms: D002648:Child; D016001:Confidence Intervals; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D005334:Fever / Q000453:epidemiology*; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016014:Linear Models; D008137:Longitudinal Studies; D016780:Malaria, Vivax / Q000453:epidemiology*; D008297:Male; D010568:Peru / Q000453:epidemiology; D016012:Poisson Distribution; D011446:Prospective Studies; D015430:Weight Gain