title: Plasmodium falciparum, anaemia and cognitive and educational performance among school children in an area of moderate malaria transmission: baseline results of a cluster randomized trial on the coast of Kenya.
abstract: OBJECTIVE
  Studies have typically investigated health and educational consequences of malaria among school-aged children in areas of high malaria transmission, but few have investigated these issues in moderate transmission settings. This study investigates the patterns of and risks for Plasmodium falciparum and anaemia and their association with cognitive and education outcomes on the Kenyan coast, an area of moderate malaria transmission.
  
  
  METHODS
  As part of a cluster randomised trial, a baseline cross-sectional survey assessed the prevalence of and risk factors for P. falciparum infection and anaemia and the associations between health status and measures of cognition and educational achievement. Results are presented for 2400 randomly selected children who were enrolled in the 51 intervention schools.
  
  
  RESULTS
  The overall prevalence of P. falciparum infection and anaemia was 13.0% and 45.5%, respectively. There was marked heterogeneity in the prevalence of P. falciparum infection by school. In multivariable analysis, being male, younger age, not sleeping under a mosquito net and household crowding were adjusted risk factors for P. falciparum infection, whilst P. falciparum infection, being male and indicators of poor nutritional intake were risk factors for anaemia. No association was observed between either P. falciparum or anaemia and performance on tests of sustained attention, cognition, literacy or numeracy.
  
  
  CONCLUSIONS
  The results indicate that in this moderate malaria transmission setting, P. falciparum is strongly associated with anaemia, but there is no clear association between health status and education. Intervention studies are underway to investigate whether removing the burden of chronic asymptomatic P. falciparum and related anaemia can improve education outcomes.
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK. katherine.halliday@lshtm.ac.uk
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Halliday
authors.forename: Peris
authors.initials: P
authors.lastname: Karanja
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Turner
authors.forename: George
authors.initials: G
authors.lastname: Okello
authors.forename: Kiambo
authors.initials: K
authors.lastname: Njagi
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Dubeck
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Allen
authors.forename: Matthew C H
authors.initials: MC
authors.lastname: Jukes
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Brooker
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology*; D001288:Attention; D015984:Causality; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003072:Cognition Disorders / Q000453:epidemiology* / Q000469:parasitology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006304:Health Status; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D057147:Mosquito Nets / Q000706:statistics & numerical data; D010963:Plasmodium falciparum / Q000302:isolation & purification; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution