Detection of malaria in relation to fever and grade of malnutrition among malnourished children in Ethiopia

Khogali, Mohamed Ahmed; Zachariah, Rony; Keiluhu, A.; Brande, Karoline Van den; Tayler‐Smith, Katie; Ayada, L.; Jima, Daddi; Hinderaker, Sven Gudmund; Harries, Anthony

doi:10.5588/pha.11.0008

Cited by 6 publications

(4 citation statements)

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“…A retrospective analysis of routine programme data on forty-eight nutritional rehabilitation centres in southern Ethiopia showed that 28 % of malnourished children with fever (Temperature >37.5 °C) were positive for malaria on RDT. Even though this study did not compare malaria in malnourished and well nourished children, the study revealed a significant positive association between malaria prevalence and increasing grades of malnutrition which is consistent with our finding [ 17 ].…”

Section: Discussionsupporting

confidence: 90%

Association between malaria and malnutrition among children aged under-five years in Adami Tulu District, south-central Ethiopia: a case–control study

2016

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BackgroundMalaria and malnutrition are the major causes of morbidity and mortality in under-five children in developing countries such as Ethiopia. Malnutrition is the associated cause for about half of the deaths that occur among under-five children in developing countries. However, the relationship between malnutrition and malaria is controversial still, and it has also not been well documented in Ethiopia. The aim of this study was to assess whether malnutrition is associated with malaria among under-five children.MethodsA case–control study was conducted in Adami Tulu District of East Shewa Zone in Oromia Regional State, Ethiopia. Cases were all under-five children who are diagnosed with malaria at health posts and health centres. The diagnosis was made using either rapid diagnostic tests or microscopy. Controls were apparently healthy under-five children recruited from the community where cases resided. The selection of the controls was based on World Health Organization (WHO) cluster sampling method. A total of 428 children were included. Mothers/caretakers of under-five children were interviewed using pre-tested structured questionnaire prepared for this purpose. The nutritional status of the children was assessed using an anthropometric method and analyzed using WHO Anthro software. A multivariate logistic analysis model was used to determine predictors of malaria.ResultsFour hundred twenty eight under-five children comprising 107 cases and 321 controls were included in this study. Prevalence of wasting was higher among cases (17.8 %) than the controls (9.3 %). Similarly, the prevalence of stunting was 50.5 % and 45.2 % among cases and controls, respectively. Severe wasting [Adjusted Odds Ratio (AOR) =2.9, 95 % CI (1.14, 7.61)] and caretakers who had no education [AOR = 3, 95 % CI (1.27, 7.10)] were independently associated with malarial attack among under-five children.ConclusionChildren who were severely wasted and had uneducated caretakers had higher odds of malarial attack. Therefore, special attention should be given for severely wasted children in the prevention and control of malaria.

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Section: Discussionsupporting

confidence: 90%

Association between malaria and malnutrition among children aged under-five years in Adami Tulu District, south-central Ethiopia: a case–control study

2016

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“…In humans, malaria severity correlates with the levels of free heme, and sepsis-related mortality is associated with decreased levels of the heme binding protein hemopexin (Larsen et al 2010;Dalko et al 2015). These diseases frequently affect children with SAM in the developing world, and malaria in particular is significantly associated with malnutrition (Berkley et al 2009;Khogali et al 2011). Our findings indicate elevated heme during SAM may contribute to increased severity of these infections, and therefore treatments targeting free heme may be beneficial.…”

Section: Discussionmentioning

confidence: 83%

Metabolic derangements identified through untargeted metabolomics in a cross-sectional study of Nigerian children with severe acute malnutrition

et al. 2016

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Introduction: Severe acute malnutrition (SAM) is a major cause of child mortality worldwide, however the pathogenesis of SAM remains poorly understood. Recent studies have uncovered an altered gut microbiota composition in children with SAM, suggesting a role for microbes in the pathogenesis of malnutrition. Objectives: To elucidate the metabolic consequences of SAM and whether these changes are associated with changes in gut microbiota composition. Methods: We applied an untargeted multi-platform metabolomics approach (gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS)) to stool and plasma samples from 47 Nigerian children with SAM and 11 control children. The composition of the stool microbiota was assessed by 16S rRNA gene sequencing. Results: The plasma metabolome discriminated children with SAM from controls, while no significant differences were observed in the microbial or small molecule composition of stool. The abundance of 585 features in plasma were significantly altered in malnourished children (Wilcoxon test, FDR corrected P < 0.1), representing approximately 15% of the metabolome. Consistent with previous studies, children with SAM exhibited a marked reduction in amino acids/dipeptides and phospholipids, and an increase in acylcarnitines. We also identified numerous metabolic perturbations Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporationwhich have not been reported previously, including increased disaccharides, truncated fibrinopeptides, angiotensin I, dihydroxybutyrate, lactate, and heme, and decreased bioactive lipids belonging to the eicosanoid and docosanoid family. Conclusion: Our findings provide a deeper understanding of the metabolic consequences of malnutrition. Further research is required to determine if specific metabolites may guide improved management, and/or act as novel biomarkers for assessing response to treatment. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems CorporationDear Royston Goodacre, Editor-in-Chief MetabolomicsWe are very grateful for the valuable comments raised by the reviewers. Please see our responses below; we trust that these are appropriate. I have also attached a revised version of the manuscript with the changes highlighted.Please note that, in response to comments by reviewer 3, we have moved details of methodology to the main manuscript. This has increased the length of the manuscript but we trust that this is acceptable.Please do let me know if there are any remaining issues. Sincerely, Stephen AllenReviewer #1: This study is about metabolic derangements identified through untargeted metabolomics in a cross-sectional study of Nigerian children with severe acute malnutrition. It is an interesting and relevant study because studies investigating the pathogenesis of SAM are lacking. To this respect the study presented in the manuscript has some qualities, however as the authors point it out it has several limitations. Only the plasma samples gave some resu...

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“…Other people living in moderate to high malaria transmission regions of the country experience many infective bites throughout the year, and the children that survive repeated malaria infections in their first five years of life develop partial protective immunity to severe P. falciparum malaria [5] , [19] , [20] , [21] . Periods of drought also cause widespread malnutrition and there is evidence that malaria prevalence is further increased in such circumstances [22] .…”

Section: Discussionmentioning

confidence: 99%

Can Timely Vector Control Interventions Triggered by Atypical Environmental Conditions Prevent Malaria Epidemics? A Case-Study from Wajir County, Kenya

et al. 2014

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BackgroundAtypical environmental conditions with drought followed by heavy rainfall and flooding in arid areas in sub-Saharan Africa can lead to explosive epidemics of malaria, which might be prevented through timely vector-control interventions.ObjectivesWajir County in Northeast Kenya is classified as having seasonal malaria transmission. The aim of this study was to describe in Wajir town the environmental conditions, the scope and timing of vector-control interventions and the associated resulting burden of malaria at two time periods (1996–1998 and 2005–2007).MethodsThis is a cross-sectional descriptive and ecological study using data collected for routine program monitoring and evaluation.ResultsIn both time periods, there were atypical environmental conditions with drought and malnutrition followed by massive monthly rainfall resulting in flooding and animal/human Rift Valley Fever. In 1998, this was associated with a large and explosive malaria epidemic (weekly incidence rates peaking at 54/1,000 population/week) with vector-control interventions starting over six months after the massive rainfall and when the malaria epidemic was abating. In 2007, vector-control interventions started sooner within about three months after the massive rainfall and no malaria epidemic was recorded with weekly malaria incidence rates never exceeding 0.5 per 1,000 population per week.Discussion and ConclusionDid timely vector-control interventions in Wajir town prevent a malaria epidemic? In 2007, the neighboring county of Garissa experienced similar climatic events as Wajir, but vector-control interventions started six months after the heavy un-seasonal rainfall and large scale flooding resulted in a malaria epidemic with monthly incidence rates peaking at 40/1,000 population. In conclusion, this study suggests that atypical environmental conditions can herald a malaria outbreak in certain settings. In turn, this should alert responsible stakeholders about the need to act rapidly and preemptively with appropriate and wide-scale vector-control interventions to mitigate the risk.

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Detection of malaria in relation to fever and grade of malnutrition among malnourished children in Ethiopia

Cited by 6 publications

References 6 publications

Association between malaria and malnutrition among children aged under-five years in Adami Tulu District, south-central Ethiopia: a case–control study

Association between malaria and malnutrition among children aged under-five years in Adami Tulu District, south-central Ethiopia: a case–control study

Metabolic derangements identified through untargeted metabolomics in a cross-sectional study of Nigerian children with severe acute malnutrition

Can Timely Vector Control Interventions Triggered by Atypical Environmental Conditions Prevent Malaria Epidemics? A Case-Study from Wajir County, Kenya

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