The association between malnutrition and the incidence of malaria among young HIV-infected and -uninfected Ugandan children: a prospective study

Abstract

BackgroundIn sub-Saharan Africa, malnutrition and malaria remain major causes of morbidity and mortality in young children. There are conflicting data as to whether malnutrition is associated with an increased or decreased risk of malaria. In addition, data are limited on the potential interaction between HIV infection and the association between malnutrition and the risk of malaria.MethodsA cohort of 100 HIV-unexposed, 203 HIV-exposed (HIV negative children born to HIV-infected mothers) and 48 HIV-infected children aged 6 weeks to 1 year were recruited from an area of high malaria transmission intensity in rural Uganda and followed until the age of 2.5 years. All children were provided with insecticide-treated bed nets at enrolment and daily trimethoprim-sulphamethoxazole prophylaxis (TS) was prescribed for HIV-exposed breastfeeding and HIV-infected children. Monthly routine assessments, including measurement of height and weight, were conducted at the study clinic. Nutritional outcomes including stunting (low height-for-age) and underweight (low weight-for-age), classified as mild (mean z-scores between -1 and -2 during follow-up) and moderate-severe (mean z-scores < -2 during follow-up) were considered. Malaria was diagnosed when a child presented with fever and a positive blood smear. The incidence of malaria was compared using negative binomial regression controlling for potential confounders with measures of association expressed as an incidence rate ratio (IRR).ResultsThe overall incidence of malaria was 3.64 cases per person year. Mild stunting (IRR = 1.24, 95% CI 1.06-1.46, p = 0.008) and moderate-severe stunting (IRR = 1.24, 95% CI 1.03-1.48, p = 0.02) were associated with a similarly increased incidence of malaria compared to non-stunted children. Being mildly underweight (IRR = 1.09, 95% CI 0.95-1.25, p = 0.24) and moderate-severe underweight (IRR = 1.12, 95% CI 0.86-1.46, p = 0.39) were not associated with a significant difference in the incidence of malaria compared to children who were not underweight. There were no significant interactions between HIV-infected, HIV-exposed children taking TS and the associations between malnutrition and the incidence of malaria.ConclusionsStunting, indicative of chronic malnutrition, was associated with an increased incidence of malaria among a cohort of HIV-infected and -uninfected young children living in an area of high malaria transmission intensity. However, caution should be made when making causal inferences given the observational study design and inability to disentangle the temporal relationship between malnutrition and the incidence of malaria.Trial RegistrationClinicalTrials.gov: NCT00527800.

Elevated prevalence of malnutrition and malaria among school-aged children and adolescents in war-ravaged South Sudan

“…8 and a specificity of 93% (95%CI 84-97%) to predict malaria in this cohort. However, a higher grade fever (T > 38.0 °C) was present in only 5% of students with malaria, which was not statistically significantly different from negative controls.…”

“…22 We did not observe an association between underweight and malaria in our cross-sectional survey, similar to a recent study in Ethiopia 11 but unlike other studies from Uganda. 7,8 A among children under 5. Our study, which focused on school-aged children rather than children under 5, likewise found high rates of underweight, consistent with widespread food insecurity across childhood age groups.…”

“…7,8 However, this interaction between malnutrition and malaria is complex and varies depending on the definitions and indicators used for malnutrition measurements. [9][10][11] More specifically, the literature has supported that stunting (low height-forage), the indicator of chronic malnutrition, may increase the risk of malaria.…”

Measuring Socioeconomic Inequalities in Relation to Malaria Risk: A Comparison of Metrics in Rural Uganda

“…Wealth indices often include food security and house construction variables, 34 but these factors may be independently associated with malaria in the study area. 35,36 To evaluate whether including food security and house construction variables altered the association between the wealth index and malaria outcomes, Wealth Index II additionally included five variables: 10) main roof material, 11) main wall material, 12) main floor material, 13) frequency of meat consumption, and 14) number of meals per day. Households were ranked by wealth scores and grouped into tertiles.…”

Incidence of Nutritional Health Associated Diseases Amongst Children in the Health District of Abong Mbang, Cameroon.

“…It can be one of the main etiological factors of diarrhoea and this latter can lead to poor absorption in the gut, lack of appetite vomiting etc which can lead to malnutrition in general and micronutrient insufficiencies in particular; for instance iron deficiency leading to anemia in children (6). Furthermore, Malnutrition is a predisposing factor to vulnerability to common infections which in this context is malaria (4,14). The cross sectional aspect of this study and the fact that it was a documentary investigation did not permit the advent of these relationships though a 69 moderate correlation was noted between malnutrition and diarrhoea.…”