Is chronic malnutrition associated with an increase in malaria incidence? A cohort study in children aged under 5 years in rural Gambia

Wilson, Anne L.; Bradley, John; Kandeh, Ballah; Salami, Kolawole; D’Alessandro, Umberto; Pinder, Margaret; Lindsay, Steve W.

doi:10.1186/s13071-018-3026-y

Cited by 14 publications

(17 citation statements)

References 49 publications

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“…However, several other ethnic groups live in The Gambia, including Fula and Wolof ethic groups [78]. Variability in disease risk and nutrition status between the Fula and the Mandinka ethnic groups has been reported [79]. This finding is consistent with the inter-population genetic variability within African populations, which may also influence differences in disease susceptibility.…”

Section: Plos Onesupporting

confidence: 60%

Differences in the frequency of genetic variants associated with iron imbalance among global populations

et al. 2020

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Iron deficiency anaemia is a major health problem affecting approximately 1.2 billion people worldwide. Young children, women of reproductive age and pregnant women living in sub-Saharan Africa are the most vulnerable. It is estimated that iron deficiency accounts for half of anaemia cases. Apart from nutritional deficiency, infection, inflammation and genetic factors are the major drivers of anaemia. However, the role of genetic risk factors has not been thoroughly investigated. This is particularly relevant in African populations, as they carry high genetic diversity and have a high prevalence of anaemia. Multiple genetic variations in iron regulatory genes have been linked to impaired iron status. Here we conducted a literature review to identify genetic variants associated with iron imbalance among global populations. We compare their allele frequencies and risk scores and we investigated populationspecific selection among populations of varying geographic origin using data from the Keneba Biobank representing individuals in rural Gambia and the 1000 Genomes Project. We identified a significant lack of data on the genetic determinants of iron status in sub-Saharan Africa. Most of the studies on genetic determinants of iron status have been conducted in Europeans. Also, we identified population differences in allele frequencies in candidate putative genetic risk factors. Given the disproportionately high genetic diversity in African populations coupled with their high prevalence of iron deficiency, there is need to investigate the genetic influences of low iron status in Sub-Saharan Africa. The resulting insights may inform the future implementation of iron intervention strategies.

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Section: Plos Onesupporting

confidence: 60%

Differences in the frequency of genetic variants associated with iron imbalance among global populations

et al. 2020

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“…The finding of no association between stuntedness at 6 months and malaria in the subsequent 12-month period is similar to results of previous studies [42–45], which suggests that stunting may be of little significance in malaria epidemiology. These results are however different from those of other studies that reported an increased risk of malaria associated with stunting.…”

Section: Discussionsupporting

confidence: 89%

Does anthropometric status at 6 months predict the over-dispersion of malaria infections in children aged 6–18 months? A prospective cohort study

Bendabenda

Patson

Hallamaa

et al. 2019

Malar J

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Background In malaria-endemic settings, a small proportion of children suffer repeated malaria infections, contributing to most of the malaria cases, yet underlying factors are not fully understood. This study was aimed to determine whether undernutrition predicts this over-dispersion of malaria infections in children aged 6–18 months in settings of high malaria and undernutrition prevalence. Methods Prospective cohort study, conducted in Mangochi, Malawi. Six-months-old infants were enrolled and had length-for-age z-scores (LAZ), weight-for-age z-scores (WAZ), and weight-for-length z-scores (WLZ) assessed. Data were collected for ‘presumed’, clinical, and rapid diagnostic test (RDT)-confirmed malaria until 18 months. Malaria microscopy was done at 6 and 18 months. Negative binomial regression was used for malaria incidence and modified Poisson regression for malaria prevalence. Results Of the 2723 children enrolled, 2561 (94%) had anthropometry and malaria data. The mean (standard deviation [SD]) of LAZ, WAZ, and WLZ at 6 months were − 1.4 (1.1), − 0.7 (1.2), and 0.3 (1.1), respectively. The mean (SD) incidences of ‘presumed’, clinical, and RDT-confirmed malaria from 6 to 18 months were: 1.1 (1.6), 0.4 (0.8), and 1.3 (2.0) episodes/year, respectively. Prevalence of malaria parasitaemia was 4.8% at 6 months and 9.6% at 18 months. Higher WLZ at 6 months was associated with lower prevalence of malaria parasitaemia at 18 months (prevalence ratio [PR] = 0.80, 95% confidence interval [CI] 0.67 to 0.94, p = 0.007), but not with incidences of ‘presumed’ malaria (incidence rate ratio [IRR] = 0.97, 95% CI 0.92 to 1.02, p = 0.190), clinical malaria (IRR = 1.03, 95% CI 0.94 to 1.12, p = 0.571), RDT-confirmed malaria (IRR = 1.00, 95% CI 0.94 to 1.06, p = 0.950). LAZ and WAZ at 6 months were not associated with malaria outcomes. Household assets, maternal education, and food insecurity were significantly associated with malaria. There were significant variations in hospital-diagnosed malaria by study site. Conclusion In children aged 6–18 months living in malaria-endemic settings, LAZ, WAZ, and WLZ do not predict malaria incidence. However, WLZ may be associated with prevalence of malaria. Socio-economic and micro-geographic factors may explain the variations in malaria, but these require further study. Trial registration NCT00945698. Registered July 24, 2009, https://clinicaltrials.gov/ct2/show/NCT00945698 , NCT01239693. Registered Nov 11, 2010, https://clinicaltrials.gov/ct2/show/NCT01239693

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“…Because wealth impacts other indices like education, housing, household nutrition, area of residence and health seeking behaviour, it is arguably a major determinant of U5 malaria (25,27). Although malaria can be rightly described as a disease of poverty (28), no association was found in some studies between chronic malnutrition and U5 malaria (29), suggesting a more complex relationship.…”

Section: Discussionmentioning

confidence: 99%

Multilevel modelling of the risk of malaria among children aged under five years in Nigeria

Oguoma

Anyasodor

Adeleye

et al. 2020

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background Malaria is still a major cause of morbidity and mortality among children aged <5 y (U5s). This study assessed individual, household and community risk factors for malaria in Nigerian U5s. Methods Data from the Nigerian Malaria Health Indicator Survey 2015 were pooled for analyses. This comprised a national survey of 329 clusters. Children aged 6–59 mo who were tested for malaria using microscopy were retained. Multilevel logit model accounting for sampling design was used to assess individual, household and community factors associated with malaria parasitaemia. Results A total of 5742 children were assessed for malaria parasitaemia with an overall prevalence of 27% (95% CI 26 to 28%). Plasmodium falciparum constituted 98% of the Plasmodium species. There was no significant difference in parasitaemia between older children and those aged ≤12 mo. In adjusted analyses, rural living, northwest region, a household size of >7, dependence on river and rainwater as primary water source were associated with higher odds of parasitaemia, while higher wealth index, all U5s who slept under a bed net and dependence on packaged water were associated with lower odds of parasitaemia. Conclusion Despite sustained investment in malaria control and prevention, a quarter of the overall study population of U5s have malaria. Across the six geopolitical zones, the highest burden was in children living in the poorest rural households.

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Is chronic malnutrition associated with an increase in malaria incidence? A cohort study in children aged under 5 years in rural Gambia

Cited by 14 publications

References 49 publications

Differences in the frequency of genetic variants associated with iron imbalance among global populations

Differences in the frequency of genetic variants associated with iron imbalance among global populations

Does anthropometric status at 6 months predict the over-dispersion of malaria infections in children aged 6–18 months? A prospective cohort study

Multilevel modelling of the risk of malaria among children aged under five years in Nigeria

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