Factors associated with malaria parasitaemia, malnutrition, and anaemia among HIV-exposed and unexposed Ugandan infants: a cross-sectional survey

Abstract

BackgroundMalaria, malnutrition and anaemia are major causes of morbidity and mortality in African children. The interplay between these conditions is complex and limited data exist on factors associated with these conditions among infants born to HIV-uninfected and infected women.MethodsTwo hundred HIV-exposed (HIV-uninfected infants born to HIV-infected mothers) and 400 HIV-unexposed infants were recruited from an area of high malaria transmission in rural Uganda. A cross-sectional survey was performed at enrolment to measure the prevalence of malaria parasitaemia, measures of malnutrition (z-scores <2 standard deviations below mean) and anaemia (haemoglobin <8 gm/dL). Multivariate logistic regression was used to measure associations between these conditions and risk factors of interest including household demographics, malaria prevention practices, breastfeeding practices, household structure and wealth index.ResultsThe prevalence of malaria parasitaemia was 20%. Factors protective against parasitaemia included female gender (OR = 0.66, p = 0.047), mother’s age (OR = 0.81 per five-year increase, p = 0.01), reported bed net use (OR = 0.63, p = 0.03) and living in a well-constructed house (OR = 0.25, p = 0.01). Although HIV-unexposed infants had a higher risk of parasitaemia compared to HIV-exposed infants (24% vs 14%, p = 0.004), there was no significant association between HIV-exposure status and parasitaemia after controlling for the use of malaria preventative measures including bed net use and trimethoprim-sulphamethoxazole prophylaxis. The prevalence of stunting, underweight, and wasting were 10%, 7%, and 3%, respectively. HIV-exposed infants had a higher odds of stunting (OR = 2.23, p = 0.005), underweight (OR = 1.73, p = 0.09) and wasting (OR = 3.29, p = 0.02). The prevalence of anaemia was 12%. Risk factors for anaemia included older infant age (OR = 2.05 per one month increase, p = 0.003) and having malaria parasitaemia (OR = 5.74, p < 0.001).ConclusionsCompared to HIV-unexposed infants, HIV-exposed infants had a higher use of malaria preventative measures and lower odds of malaria parasitaemia. Having a better constructed house was also protective against malaria parasitaemia. HIV-exposure was the primary risk factor for measures of malnutrition. The primary risk factor for anaemia was malaria parasitaemia. These findings suggest the need to better target existing interventions for malaria, malnutrition and anaemia as well as the need to explore further the mechanisms behind the observed associations.

Poor Housing Construction Associated with Increased Malaria Incidence in a Cohort of Young Ugandan Children

“…A detailed survey collecting information on household demographics and possessions was administered on the day of enrollment as described previously. 17 Specifically for this sub-study, a pretested, structured questionnaire to collect information on potential household risk factors was administered from June-August 2013 by trained interviewers in the local languages. The Uganda 2011 Demographic and Health Survey was used to develop the questionnaire.…”

“…A household wealth index was generated from the enrollment survey as previously described. 17 To determine the location of residences, geographic coordinates were entered into ArcGIS geographic information software. Houses were classified as being in or outside of town based on administrative boundaries.…”

Prevalence of underweight, overweight and obesity in poor children from Mato Grosso do Sul

“…The concern with overweight and obesity is owed to the fact that these are commonly associated with comorbidities such as type 2 diabetes mellitus, dyslipidemia, systemic arterial hypertension, cardiovascular diseases, osteoarthritis, and liver changes, and patients who are overweight or obese are more prone to developing psychosocial problems 6 . Being underweight also causes serious health conditions, such as the appearance of infectious diseases due to the low immunity originated from the lack of nutrients, increasing rates of children's mortality, delayed growth and psychomotor development, difficulties in school performance, and reduced productive capacity in adulthood 7 . Brazil is one of the most unfair countries in the world when it comes to the social division of the produced wealth.…”

Climate change and malaria control: the importance of mitigation and a call to action

“…39 Food insecurity and malnutrition debilitate the immune response, making people more susceptible to malaria (and other) infections. 40 For those already suffering from malaria, malnutrition worsens disease prognosis by exacerbating the severity of the infection. 41 Thus, through a direct positive impact on food security, climate change mitigation could contribute to the improved nutritional status which in turn enhances the success of malaria control through a synergistic relationship with other malaria control measures.…”

“…41 Thus, through a direct positive impact on food security, climate change mitigation could contribute to the improved nutritional status which in turn enhances the success of malaria control through a synergistic relationship with other malaria control measures. 40 Second, extreme events like heat waves, flooding and drought often result in population displacement. 11 Studies have suggested that large-scale migration of people is a significant risk factor in the spread of infectious diseases like HIV/AIDS and malaria.…”