title: Could Plasmodium vivax malaria trigger malnutrition? Revisiting the Bradford Hill criteria to assess a causal relationship between two neglected problems.
abstract: The benign characteristics formerly attributed to Plasmodium vivax infections have recently changed owing to the increasing number of reports of severe vivax malaria resulting in a broad spectrum of clinical complications, probably including undernutrition. Causal inference is a complex process, and arriving at a tentative inference of the causal or non-causal nature of an association is a subjective process limited by the existing evidence. Applying classical epidemiology principles, such as the Bradford Hill criteria, may help foster an understanding of causality and lead to appropriate interventions being proposed that may improve quality of life and decrease morbidity in neglected populations. Here, we examined these criteria in the context of the available data suggesting that vivax malaria may substantially contribute to childhood malnutrition. We found the data supported a role for P. vivax in the etiology of undernutrition in endemic areas. Thus, the application of modern causal inference tools, in future studies, may be useful in determining causation.
authors.affiliation: Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.|Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil.
authors.forename: Wuelton Marcelo
authors.initials: WM
authors.lastname: Monteiro
authors.affiliation: Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.|Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil.
authors.forename: Márcia Araújo
authors.initials: MA
authors.lastname: Alexandre
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: André
authors.initials: A
authors.lastname: Siqueira
authors.affiliation: Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.|Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil.
authors.forename: Gisely
authors.initials: G
authors.lastname: Melo
authors.affiliation: Núcleo de Medicina Tropical, Universidade de Brasília, Brasília, Distrito Federal, Brasil.
authors.forename: Gustavo Adolfo Sierra
authors.initials: GA
authors.lastname: Romero
authors.affiliation: Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.|Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil.
authors.forename: Efrem
authors.initials: E
authors.lastname: d'Ávila
authors.affiliation: Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil.|Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil.
authors.forename: Silvana Gomes
authors.initials: SG
authors.lastname: Benzecry
authors.affiliation: Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil.
authors.forename: Heitor Pons
authors.initials: HP
authors.lastname: Leite
authors.affiliation: Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.|Instituto de Pesquisa Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brasil.
authors.forename: Marcus Vinícius Guimarães
authors.initials: MV
authors.lastname: Lacerda
mesh_terms: D015984:Causality; D006801:Humans; D016780:Malaria, Vivax / Q000150:complications / Q000453:epidemiology*; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology; D058069:Neglected Diseases