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BMC Pediatr. 2018 Dec 28;18(1):396. doi: 10.1186/s12887-018-1378-2.

The association of malaria morbidity with linear growth, hemoglobin, iron status, and development in young Malawian children: a prospective cohort study.

Author information

1
College of Medicine, Department of Public Health, School of Public Health, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi. jbendabenda@gmail.com.
2
Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland. jbendabenda@gmail.com.
3
College of Medicine, Department of Public Health, School of Public Health, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi.
4
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
5
Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland.
6
Department of Applied Studies, Malawi University of Science and Technology, Thyolo, Malawi.
7
Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
8
Department of Nutrition, University of California, Davis, Davis, CA, USA.
9
Program in Health Services and Systems Research and Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.

Abstract

BACKGROUND:

Although poor complementary feeding is associated with poor child growth, nutrition interventions only have modest impact on child growth, due to high burden of infections. We aimed to assess the association of malaria with linear growth, hemoglobin, iron status, and development in children aged 6-18 months in a setting of high malaria and undernutrition prevalence.

METHODS:

Prospective cohort study, conducted in Mangochi district, Malawi. We enrolled six-months-old infants and collected weekly data for 'presumed' malaria, diarrhea, and acute respiratory infections (ARI) until age 18 months. Change in length-for-age z-scores (LAZ), stunting, hemoglobin, iron status, and development were assessed at age 18 months. We used ordinary least squares regression for continuous outcomes and modified Poisson regression for categorical outcomes.

RESULTS:

Of the 2723 children enrolled, 2016 (74.0%) had complete measurements. The mean (standard deviation) incidences of 'presumed' malaria, diarrhea, and ARI, respectively were: 1.4 (2.0), 4.6 (10.1), and 8.3 (5.0) episodes/child year. Prevalence of stunting increased from 27.4 to 41.5% from 6 to 18 months. 'Presumed' malaria incidence was associated with higher risk of stunting (risk ratio [RR] = 1.04, 95% confidence interval [CI] = 1.01 to 1.07, p = 0.023), anemia (RR = 1.02, 95%CI = 1.00 to 1.04, p = 0.014) and better socio-emotional scores (B = - 0.21, 95%CI = - 0.39 to - 0.03, p = 0.041), but not with change in LAZ, haemoglobin, iron status or other developmental outcomes. Diarrhea incidence was associated with change in LAZ (B = - 0.02; 95% CI = - 0.03 to - 0.01; p = 0.009), stunting (RR = 1.02; 95% CI = 1.01 to 1.03; p = 0.005), and slower motor development. ARI incidence was not associated with any outcome except for poorer socio-emotional scores.

CONCLUSION:

In this population of young children living in a malaria-endemic setting, with active surveillance and treatment, 'presumed' malaria is not associated with change in LAZ, hemoglobin, or iron status, but could be associated with stunting and anemia. Diarrhea was more consistently associated with growth than was malaria or ARI. The findings may be different in contexts where active malaria surveillance and treatment is not provided.

TRIAL REGISTRATION:

NCT00945698 (July 24, 2009) and NCT01239693 (November 11, 2010).

KEYWORDS:

Children; Growth faltering; Infections; Longitudinal studies; Malaria; Morbidity; Stunting; iLiNS studies

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