1921
Volume 73, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Protein-energy malnutrition (PEM) affects millions of children in the developing world. The relationship between malaria and PEM is controversial. The goal of this study was to evaluate whether undernutrition is associated with increased or decreased malaria attributable morbidity. Three cross-sectional surveys were conducted using insecticide-treated bed nets (ITNs) among children aged 0–36 months living in an area with intense malaria transmission. Data were collected on nutritional status, recent history of clinical illness, socioeconomic status, current malaria infection status, and hemoglobin. In multivariate models, stunted children had more malaria parasitemia (odds ratio [OR] 1.98, < 0.0001), high-density parasitemia (OR 1.84; < 0.0001), clinical malaria (OR 1.77; < 0.06), and severe malarial anemia (OR 2.65; < 0.0001) than nonstunted children. The association was evident in children with mild-to-moderate (−3 < height-for-age Z-score [HAZ] < −2) and severe stunting (HAZ < −3). The cross-sectional nature of the study limits the interpretation of causality, but the data provide further observational support that the presence of undernutrition, in particular chronic undernutrition, places children at higher, not lower risk of malaria-related morbidity.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2005.73.698
2005-10-01
2017-09-20
Loading full text...

Full text loading...

/deliver/fulltext/14761645/73/4/0730698.html?itemId=/content/journals/10.4269/ajtmh.2005.73.698&mimeType=html&fmt=ahah

References

  1. United Nations Administrative Committee on Coordination, Standing Committee on Nutrition (ACC/SCN), 2000. Fourth Report on the World Nutrition. Geneva: ACC/SCN.
  2. Agarwal DK, Upadhyay SK, Agarwal KN, 1989. Influence of malnutrition on cognitive development assessed by Piagetian tasks. Acta Paediatr Scand 78 : 115–122.
  3. Sigman M, Neumann C, Jansen AA, Bwibo N, 1989. Cognitive abilities of Kenyan children in relation to nutrition, family characteristics, and education. Child Dev 60 : 1463–1474.
  4. Sigman M, Neumann C, Baksh M, Bwibo N, McDonald MA, 1989. Relationship between nutrition and development in Kenyan toddlers. J Pediatr 115 : 357–364.
  5. Hutchinson SE, Powell CA, Chang SPW, Grantham-Mc SM, Gregor SM, 1997. Nutrition, anaemia, geohelminth infection and school achievement in rural Jamaican primary school children. Eur J Clin Nutr 51 : 729–735.
  6. Hall A, Khanh LN, Son TH, Dung NQ, Lansdown RG, Dar DT, Hanh NT, Moestue H, Khoi HH, Bundy DA, 2001. An association between chronic undernutrition and educational test scores in Vietnamese children. Eur J Clin Nutr 55 : 801–804.
  7. Mendez MA, Adair LS, 1999. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr 129 : 1555–1562.
  8. Sigman M, McDonald MA, Neumann C, Bwibo N, 1991. Prediction of cognitive competence in Kenyan children from toddler nutrition, family characteristics and abilities. J Child Psychol Psychiatry 32 : 307–320.
  9. Pelletier DL, Frongillo EA Jr, Habicht JP, 1993. Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. Am J Public Health 83 : 1130–1133.
  10. Pelletier DL, Frongillo EJ, Schroeder DG, Habicht JP, 1995. The effects of malnutrition on child mortality in developing countries. Bull World Health Organ 73 : 443–448.
  11. ter Kuile FO, Terlouw DJ, Phillips-Howard PA, Hawley WA, Friedman JF, Kolczak MS, Kariuki SK, Shi YP, Kwena AM, Vulule JM, Nahlen BL, 2003. Impact of permethrin-treated bed nets on malaria and all-cause morbidity in young children in an area of intense perennial malaria transmission in western Kenya: cross-sectional survey. Am J Trop Med Hyg 68 : 100–107.
  12. ter Kuile FO, Terlouw DJ, Kariuki SK, Phillips-Howard PA, Mirel LB, Hawley WA, Friedman JF, Shi YP, Kolczak MS, Lal AA, Vulule JM, Nahlen BL, 2003. Impact of permethrin-treated bed nets on malaria, anemia, and growth in infants in an area of intense perennial malaria transmission in western Kenya. Am J Trop Med Hyg 68 : 68–77.
  13. Snow R, Molyneux C, Njeru E, Omumbo J, Nevill C, Muniu E, March K, 1997. The effects of malaria control on nutritional status in infancy. Acta Tropica 65 : 1–10.
  14. Bradley-Moore AM, Greenwood BM, Bradley AK, Kirkwood BR, Gilles HM, 1985. Malaria chemoprophylaxis with chloroquine in young Nigerian children. III. Its effect on nutrition. Ann Trop Med Parasitol 79 : 575–584.
  15. Nyakeriga AM, Troye-Blomberg M, Chemtai AK, Marsh K, Williams TN, 2004. Malaria and nutritional status in children living on the coast of Kenya. Am J Clin Nutr 80 : 1604–1610.
  16. Colbourne MJ, 1955. The effect of malaria suppression in a group of Accra schoolchildren. Trans R Soc Trop Med Hyg 49 : 356–369.
  17. Verhoef H, West CE, Veenemans J, Beguin Y, Kok FJ, 2002. Stunting may determine the severity of malaria-associated anemia in African children. Pediatrics 110 : e48.
  18. Deen JL, Walraven GE, von Seidlein L, 2002. Increased risk for malaria in chronically malnourished children under 5 years of age in rural Gambia. J Trop Pediatr 48 : 78–83.
  19. Man WD, Weber M, Palmer A, Schneider G, Wadda R, Jaffar S, Mulholland EK, Greenwood BM, 1998. Nutritional status of children admitted to hospital with different diseases and its relationship to outcome in The Gambia, West Africa. Trop Med Int Health 3 : 678–686.
  20. Hendrickse RG, Hasan AH, Olumide LO, Akinkunmi A, 1971. Malaria in early childhood. An investigation of five hundred seriously ill children in whom a “clinical” diagnosis of malaria was made on admission to the children’s emergency room at University College Hospital, Ibadan. Ann Trop Med Parasitol 65 : 1–20.
  21. Murray MJ, Murray AB, Murray MB, Murray CJ, 1976. Somali food shelters in the Ogaden famine and their impact on health. Lancet 1 : 1283–1285.
  22. Murray MJ, Murray NJ, Murray AB, Murray MB, 1975. Refeeding-malaria and hyperferraemia. Lancet 1 : 653–654.
  23. Murray MJ, Murray AB, Murray NJ, Murray MB, 1978. Diet and cerebral malaria: the effect of famine and refeeding. Am J Clin Nutr 31 : 57–61.
  24. Genton B, Al-Yaman F, Ginny M, Taraika J, Alpers MP, 1998. Relation of anthropometry to malaria morbidity and immunity in Papua New Guinean children. Am J Clin Nutr 68 : 734–741.
  25. Tshikuka JG, Gray-Donald K, Scott M, Olela KN, 1997. Relationship of childhood protein-energy malnutrition and parasite infections in an urban African setting. Trop Med Int Health 2 : 374–382.
  26. Shankar AH, 2000. Nutritional modulation of malaria morbidity and mortality. J Infect Dis 182 (Suppl 1): S37–S53.
  27. Caulfield LE, Richard SA, Black RE, 2004. Undernutrition as an underlying cause of malaria morbidity and mortality in children less than five years old. Am J Trop Med Hyg 71 : 55–63.
  28. Espo M, Kulmala T, Maleta K, Cullinan T, Salin ML, Ashorn P, 2002. Determinants of linear growth and predictors of severe stunting during infancy in rural Malawi. Acta Paediatr 91 : 1364–1370.
  29. de Villiers A, Senekal M, 2002. Determinants of growth failure in 12–24-month-old children in a high-density urban slum community in East London, South Africa. Eur J Clin Nutr 56 : 1231–1241.
  30. Phillips-Howard PA, ter Kuile FO, Nahlen BL, Alaii JA, Gimnig JE, Kolczak MS, Terlouw DJ, Kariuki SK, Shi YP, Kachur SP, Hightower AW, Vulule JM, Hawley WA, 2003. The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya II. Study design and methods. Am J Trop Med Hyg 68 : 10–15.
  31. Kwena AM, Terlouw DJ, de Vlas SJ, Phillips-Howard PA, Hawley WA, Friedman JF, Vulule JM, Nahlen BL, Sauerwein RW, ter Kuile FO, 2003. Prevalence and severity of malnutrition in pre-school children in a rural area of western Kenya. Am J Trop Med Hyg 68 : 94–99.
  32. Phillips-Howard PA, Nahlen BL, Alaii JA, ter Kuile FO, Gimnig JE, Terlouw DJ, Kachur SP, Hightower AW, Lal AA, Schoute E, Oloo AJ, Hawley WA, 2003. The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya I. Development of infrastructure and description of study site. Am J Trop Med Hyg 68 : 3–9.
  33. Beier JC, Oster CN, Onyango FK, Bales JD, Sherwood JA, Perkins PV, Chumo DK, Koech DV, Whitmire RE, Roberts CR, Diggs CL, Hoffman SL., 1994. Plasmodium falciparum incidence relative to entomologic inoculation rates at a site proposed for testing malaria vaccines in western Kenya. Am J Trop Med Hyg 50 : 529–536.
  34. Alaii JA, Hawley WA, Kolczak MS, ter Kuile FO, Gimnig JE, Vulule JM, Odhacha A, Oloo AJ, Nahlen BL, Phillips-Howard PA, 2003. Factors affecting use of permethrin-treated bed nets during a randomized controlled trial in western Kenya. Am J Trop Med Hyg 68 : 137–141.
  35. Meltzer MI, Terlouw DJ, Kolczak MS, Odhacha A, ter Kuile FO, Vulule JM, Alaii JA, Nahlen BL, Hawley WA, Phillips-Howard PA, 2003. The household-level economics of using permethrin-treated bed nets to prevent malaria in children less than five years of age. Am J Trop Med Hyg 68 : 149–160.
  36. Bloland PB, Boriga DA, Ruebush TK, McCormick JB, Roberts JM, Oloo AJ, Hawley W, Lal A, Nahlen B, Campbell CC, 1999. Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission II. Descriptive epidemiology of malaria infection and disease among children. Am J Trop Med Hyg 60 : 641–648.
  37. Hamill PV, Drizd TA, Johnson CL, Reed RB, Roche AF, 1977. NCHS growth curves for children birth-18 years. United States. Vital Health Stat 11 : 1–74.
  38. Snow RW, Molyneux CS, Njeru EK, Omumbo J, Nevill CG, Muniu E, Marsh K, 1997. The effects of malaria control on nutritional status in infancy. Acta Trop 65 : 1–10.
  39. Archibald HM, Bruce-Chwatt LJ, 1956. Suppression of malaria with pyrimethamine in Nigerian schoolchildren. Bull World Health Organ 15 : 775–784.
  40. Bradley-Moore A, Greenwood BM, Bradley AK, Kirkwood BR, Gilles HM, 1985. Malaria chemoprophylaxis with chloroquine in young Nigerian children. III. Its effect on nutrition. Ann Trop Med Parasitol 79 : 575–584.
  41. Muller O, Garenne M, Kouyate B, Becher H, 2003. The association between protein-energy malnutrition, malaria morbidity and all-cause mortality in West African children. Trop Med Int Health 8 : 507–511.
  42. Fishman S, Caulfield L, de Onis M, Blossner M, Hyder A, Mullany L, Black R, 2004. Malnutrition and the global burden of disease: underweight. Comparative Quantification of health Risks: The Global and Regional Burden of Disease due to 25 Selected Major Risk Factors. Cambridge: World Health Organization/Harvard University Press.
  43. ter Kuile FO, Parise ME, Verhoeff FH, Udhayakumar V, Newman RD, van Eijk AM, Rogerson SJ, Steketee RW, 2004. The burden of co-infection with human immunodeficiency virus type 1 and malaria in pregnant women in sub-saharan Africa. Am J Trop Med Hyg 71 : 41–54.
  44. Corbett EL, Steketee RW, ter Kuile FO, Latif AS, Kamali A, Hayes RJ, 2002. HIV-1/AIDS and the control of other infectious diseases in Africa. Lancet 359 : 2177–2187.
  45. Bailey RC, Kamenga MC, Nsuami MJ, Nieburg P, St Louis ME, 1999. Growth of children according to maternal and child HIV, immunological and disease characteristics: a prospective cohort study in Kinshasa, Democratic Republic of Congo. Int J Epidemiol 28 : 532–540.
  46. Rowland M, Cole T, Whitehead R, 1976. A quantitative study intoo the role of infection in determining nutritional status in Gambian village children. British Journal of Nutrition 37 : 441–450.
  47. Miller L, Warrell D, 1990. Malaria. Mahmoud D., Warren K., eds. Tropical and Geographic Medicine. New York: McGraw Hill.
  48. Kremsner PG, Feldmeier H, Zotter GM, Jansen-Rosseck R, Graninger W, Rocha RM, Bienzle U, 1989. Immunological alterations in uncomplicated Plasmodium falciparum malaria. Relationship between parasitaemia and indicators of macrophage activation. Acta Trop 46 : 351–359.
  49. Clark IA, Chaudhri G, 1988. The balance of useful and harmful effects of TNF, with special reference to malaria. Ann Inst Pasteur Immunol 139 : 305–306.
  50. Kwiatkowski D, Hill AV, Sambou I, Twumasi P, Castracane J, Manogue KR, Cerami A, Brewster DR, Greenwood BM, 1990. TNF concentration in fatal cerebral, non-fatal cerebral, and uncomplicated Plasmodium falciparum malaria. Lancet 336 : 1201–1204.
  51. Kotler DP, 2000. Cachexia. Ann Intern Med 133 : 622–634.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2005.73.698
Loading
/content/journals/10.4269/ajtmh.2005.73.698
Loading

Data & Media loading...

  • Received : 04 Mar 2005
  • Accepted : 02 Jun 2005

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error