Role of malnutrition and parasite infections in the spatial variation in children’s anaemia risk in northern Angola

Magalhães, Ricardo J. Soares; Langa, António; Pedro, João Mário; Sousa-Figueiredo, José Carlos; Clements, Archie C. A.; Nery, Susana Vaz

doi:10.4081/gh.2013.91

Cited by 41 publications

(43 citation statements)

References 43 publications

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“…In Angola, a spatial model of anemia among children found that malnutrition and parasitological risk factors were highly heterogeneous and contributed to the spatial variation in individual-level anemia risk [44]; these factors are likely also important in Timor-Leste. A second possible explanation is that the observed differences are due to aggregation of data across either survey clusters or districts.…”

Section: Discussionmentioning

confidence: 99%

Demographic and Spatial Predictors of Anemia in Women of Reproductive Age in Timor-Leste: Implications for Health Program Prioritization

et al. 2014

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Anemia is a significant risk factor for poor health outcomes for both the mother and neonate; however, the determinants of anemia in many epidemiological settings are poorly understood. Using a subset of a nationally representative cluster survey (2010 Demographic and Health Survey) in combination with other non-contemporaneous survey data, the epidemiology of anemia among women of reproductive age in Timor-Leste has been explored. Logistic regression was used to identify risk factors, population-level impacts were estimated as population attributable fractions and spatial analytics were used to identify regions of highest risk. The DHS survey found that ∼21% of adult women in Timor-Leste are anemic (49,053; 95% CI: 37,095 to 61,035), with hemoglobin <12.0 g/dL. In this population, the main risk factors (adjusted odds ratio; 95% CI) are: currently abstaining from sex for any reason (2.25; 1.50 to 3.38); illiteracy (2.04; 1.49 to 2.80); giving birth within the previous year (1.80; 1.29 to 2.51); consumption of fruits/vegetables low in vitamin A (1.57; 1.13 to 2.20); and the district-level confirmed malaria incidence (1.31; 1.15 to 1.49). A review of prior soil-transmitted helminth surveys in Timor-Leste indicates low-to-moderate prevalence with generally low egg counts, suggesting a limited impact on anemia in this setting, although comprehensive survey data are lacking. Examination of the population-level effects highlights the impacts of both recent births and malaria on anemia, with more limited impacts from diet; the evidence does not suggest a large contribution from geohelminths within Timor-Leste. These patterns are divergent from some other settings in the Asia-Pacific region and highlight the need for further focused research. Targeting high-burden districts and by increasing access to pre/postnatal care, raising literacy levels, increasing access to family planning, and improving malaria control should be prioritized to maximize inherently limited health budgets in reaching these populations.

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Section: Discussionmentioning

confidence: 99%

Demographic and Spatial Predictors of Anemia in Women of Reproductive Age in Timor-Leste: Implications for Health Program Prioritization

et al. 2014

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“…Salient issues for future research include between-country and betweencontext differences in the etiology of anemia, the role of other infections (eg, helminths), unconfirmed interactions between malaria and nutrition, and links between macro-and micronutrition, malaria, and anemia. Use of more sophisticated malaria data, such as in a recent study using modelling of prevalence in holoendemic regions, could be used as a predictor for malariaassociated morbidity and to target interventions, 31 and seasonality and associations with other species of malaria should be investigated.…”

Section: Future Researchmentioning

confidence: 99%

Malaria and Macronutrient Deficiency as Correlates of Anemia in Young Children: A Systematic Review of Observational Studies

McCuskee

Brickley

Wood

et al. 2015

Annals of Global Health

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Observational epidemiologic studies consistently demonstrate that malaria is an important correlate of anemia in young children; however, the roles of stunting and wasting and interactions between malaria and nutrition require further investigation. Based on the current evidence, these findings suggest that global health strategies to reduce the burden of anemia should prioritize malaria prevention and support research on alternative causes of anemia that reflect local conditions.

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“…One possible explanation for this discrepancy is confounding by asymptomatic P. falciparum carriage at enrollment, which has been associated with a decrease in the subsequent risk of febrile malaria [14], [15] and likely accounted for a significant proportion of children in the Malian study [10] but not the Kenyan study [13]. Additional factors that have been shown to associate with both urogenital schistosomiasis and malaria while possibly affecting subsequent malaria outcomes are co-infection with helminths other than S. haematobium [13], [16], iron-deficiency anemia [17]–[20], and contextual factors related to geography and ecology [9], [21], [22].…”

Section: Introductionmentioning

confidence: 99%

Co-infection of Long-Term Carriers of Plasmodium falciparum with Schistosoma haematobium Enhances Protection from Febrile Malaria: A Prospective Cohort Study in Mali

et al. 2014

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BackgroundMalaria and schistosomiasis often overlap in tropical and subtropical countries and impose tremendous disease burdens; however, the extent to which schistosomiasis modifies the risk of febrile malaria remains unclear.MethodsWe evaluated the effect of baseline S. haematobium mono-infection, baseline P. falciparum mono-infection, and co-infection with both parasites on the risk of febrile malaria in a prospective cohort study of 616 children and adults living in Kalifabougou, Mali. Individuals with S. haematobium were treated with praziquantel within 6 weeks of enrollment. Malaria episodes were detected by weekly physical examination and self-referral for 7 months. The primary outcome was time to first or only malaria episode defined as fever (≥37.5°C) and parasitemia (≥2500 asexual parasites/µl). Secondary definitions of malaria using different parasite densities were also explored.ResultsAfter adjusting for age, anemia status, sickle cell trait, distance from home to river, residence within a cluster of high S. haematobium transmission, and housing type, baseline P. falciparum mono-infection (n = 254) and co-infection (n = 39) were significantly associated with protection from febrile malaria by Cox regression (hazard ratios 0.71 and 0.44; P = 0.01 and 0.02; reference group: uninfected at baseline). Baseline S. haematobium mono-infection (n = 23) did not associate with malaria protection in the adjusted analysis, but this may be due to lack of statistical power. Anemia significantly interacted with co-infection (P = 0.009), and the malaria-protective effect of co-infection was strongest in non-anemic individuals. Co-infection was an independent negative predictor of lower parasite density at the first febrile malaria episode.ConclusionsCo-infection with S. haematobium and P. falciparum is significantly associated with reduced risk of febrile malaria in long-term asymptomatic carriers of P. falciparum. Future studies are needed to determine whether co-infection induces immunomodulatory mechanisms that protect against febrile malaria or whether genetic, behavioral, or environmental factors not accounted for here explain these findings.

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Role of malnutrition and parasite infections in the spatial variation in children’s anaemia risk in northern Angola

Cited by 41 publications

References 43 publications

Demographic and Spatial Predictors of Anemia in Women of Reproductive Age in Timor-Leste: Implications for Health Program Prioritization

Demographic and Spatial Predictors of Anemia in Women of Reproductive Age in Timor-Leste: Implications for Health Program Prioritization

Malaria and Macronutrient Deficiency as Correlates of Anemia in Young Children: A Systematic Review of Observational Studies

Co-infection of Long-Term Carriers of Plasmodium falciparum with Schistosoma haematobium Enhances Protection from Febrile Malaria: A Prospective Cohort Study in Mali

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