title: Asymptomatic malaria, growth status, and anaemia among children in Lao People's Democratic Republic: a cross-sectional study.
abstract: BACKGROUND
  Asymptomatic malaria can be observed in both stable endemic areas and unstable transmission areas. However, although much attention has been given to acute malaria infections, relatively little attention has been paid to asymptomatic malaria. Nonetheless, because the asymptomatic host serves as a reservoir for the malaria parasite, asymptomatic malaria is now recognized as an important obstacle to malaria elimination. Asymptomatic malaria is also associated with anaemia, a global public health problem with serious consequences on human health as well as social and economic development. In Lao People's Democratic Republic (Lao PDR), malaria, anaemia, and malnutrition are serious public health concerns. However, few studies have focused on the relationship between these variables. Therefore, this study investigated the relationship between asymptomatic malaria, growth status, and the prevalence of anaemia among children aged 120 months old or younger in rural villages in Lao PDR.
  
  
  METHODS
  In December 2010 and March 2011, data were collected from five villages in Savannakhet province. Anthropometric measurements, blood samples, and malaria rapid diagnostic tests were conducted. The presence of malaria was confirmed with polymerase chain reaction assays for Plasmodium falciparum. Underweight status, stunting, and anaemia were defined according to World Health Organization standards.
  
  
  RESULTS
  The mean age of participants (n = 319) was 88.3 months old (Standard Deviation: 20.6, ranged from 30-119 months old), and 20 participants (6.3 %) had an asymptomatic malaria infection, 92 (28.8 %) were anaemic, 123 (38.6 %) were underweight, and 137 (42.9 %) were stunted. Stunted children were more likely to be infected with asymptomatic malaria [odds ratio (OR) 3.34, 95 % confidence interval (CI) 1.25-8.93], and asymptomatic malaria was associated with anaemia [OR 5.17, 95 % CI 1.99-13.43].
  
  
  CONCLUSIONS
  These results suggest a significant association between asymptomatic malaria and anaemia in children. Furthermore, stunted children were more likely to have lower Hb levels and to be infected with asymptomatic malaria than children without stunting. However, further studies examining the impact of asymptomatic malaria infection on children's nutritional and development status are necessary.
authors.affiliation: Center of Molecular Bioscineces, Tropical Biosphere Research Center, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa, Japan. takeshiak@nagano-nurs.ac.jp.|Nagano College of Nursing, Komagane, Nagano, Japan. takeshiak@nagano-nurs.ac.jp.
authors.forename: Takeshi
authors.identifier: http://orcid.org/0000-0003-3371-5830
authors.initials: T
authors.lastname: Akiyama
authors.affiliation: Station of Malariology, Parasitology and Entomology, Savannakhet Health Department, Savannakhet, Lao People's Democratic Republic.
authors.forename: Tiengkham
authors.initials: T
authors.lastname: Pongvongsa
authors.affiliation: National Institute of Public Health, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic.
authors.forename: Souraxay
authors.initials: S
authors.lastname: Phrommala
authors.affiliation: Center for Medical Education, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan.
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Taniguchi
authors.affiliation: Center of Molecular Bioscineces, Tropical Biosphere Research Center, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa, Japan.
authors.forename: Yuba
authors.initials: Y
authors.lastname: Inamine
authors.affiliation: Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Takeuchi
authors.affiliation: Department of Cell Biology, Kyoto Pharmaceutical University, Kyoto, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Nagasaki, Japan.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Nishimoto
authors.affiliation: School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Nagasaki, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Moji
authors.affiliation: Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kano
authors.affiliation: Center of Molecular Bioscineces, Tropical Biosphere Research Center, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa, Japan.|Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Niigata, Japan.
authors.forename: Hisami
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kobayashi
mesh_terms: D000740:Anemia / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology; D000886:Anthropometry; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D001769:Blood / Q000469:parasitology; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D007812:Laos / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D010963:Plasmodium falciparum
keywords: Anemia; Asymptomatic malaria; Lao PDR; Malnutrition; Plasmodium falciparum; Stunting; Underweight