The Association between Nutritional Status and Malaria in Children from a Rural Community in the Amazonian Region: A Longitudinal Study

Abstract

BackgroundThe relationship between malaria and undernutrition is controversial and complex. Synergistic associations between malnutrition and malaria morbidity and mortality have been suggested, as well as undernutrition being protective against infection, while other studies found no association. We sought to evaluate the relationship between the number of malaria episodes and nutritional statuses in a cohort of children below 15 years of age living in a rural community in the Brazilian Amazon.Methodology/Principal FindingsFollowing a baseline survey of clinical, malaria and nutritional assessment including anthropometry measurements and hemoglobin concentration, 202 children ranging from 1 month to 14 years of age were followed for one year through passive case detection for malaria episodes. After follow-up, all children were assessed again in order to detect changes in nutritional indicators associated with malaria infection. We also examined the risk of presenting malaria episodes during follow-up according to presence of stunting at baseline. Children who suffered malaria episodes during follow-up presented worse anthropometric parameters values during this period. The main change was a reduction of the linear growth velocity, associated with both the number of episodes and how close the last or only malaria episode and the second anthropometric assessment were. Changes were also observed for indices associated with chronic changes, such as weight-for-age and BMI-for-age, which conversely, were more frequently observed in children with the last or only episode occurring between 6 and 12 months preceding the second nutritional assessment survey. Children with inadequate height-for-age at baseline (Z-score < -2) presented lower risk of suffering malaria episodes during follow-up as assessed by both the log-rank test (p =0.057) and the multivariable Cox-proportional hazards regression (Hazard Ratio = 0.31, 95%CI [0.10; 0.99] p=0.049).ConclusionsMalaria was associated with impaired nutritional status amongst children in an endemic area of the Western Brazilian Amazon where P. vivax predominates. Our data all supports that the association presents differential effects for each age group, suggesting distinct pathophysiology pathways. We were also able to demonstrate that undernourishment at baseline was protective to malaria during follow-up. These findings support an intriguing interaction between these conditions in the rural Amazon and the need for a more integrative approach by health systems in endemic areas.

The association between malaria and malnutrition among under-five children in Shashogo District, Southern Ethiopia: a case-control study

“…These findings are similar to those of many other studies, which have reported that malaria can affect the nutritional status of children. A study conducted in the rural community of Amazonian region indicated that children who suffered malaria episodes presented worse anthropometric parameters [23]. Likewise, in a study carried out in a holoendemic malaria area of Tanzania, catch-up growth was seen in those children who used ITNs [12], which suggests that Plasmodium infection plays a role in the aetiology of malnutrition.…”

Time to Recovery from Severe Acute Malnutrition and Its Predictors among Admitted Children Aged 6-59 Months at the Therapeutic Feeding Center of Pawi General Hospital, Northwest Ethiopia: A Retrospective Follow-Up Study

“…This finding revealed that severely malnourished children with no malaria infection recovered early compared to children with malaria infection. This is supported by studies conducted in Niger, Amazon, and Rwanda [25,31,32]. The reason might be that malaria impairs gluconeogenesis and increases energy consumption, induces malabsorption, predisposes one to loss of immunity, and results in inability respond to standard treatments [32,33].…”

Could Plasmodium vivax malaria trigger malnutrition? Revisiting the Bradford Hill criteria to assess a causal relationship between two neglected problems

“…In Vanuatu, during the 6-month period before nutritional assessments, the incidence of P. vivax malaria was significantly higher among the underweight and wasting children than among healthy children (13) . Actually, for vivax malaria and undernutrition, the results suggest a monotonic relationship, i.e., more malaria episodes (14) or shorter periods until the nutritional measurement (14) (15) lead to greater likelihoods of underweight, wasting, and impaired growth in children. Vivax malaria led to decreases in ponderal velocity of 138.6, 108.0, and 61.0 g/episode over 2, 4, and 6 months, respectively (15) .…”

“…In Vanuatu, having P. vivax malaria within the previous 6-month period was a major predictor of underweight [weight/age, Z < -2; adjusted odds ratio (aOR), 2.4; 95% confidence interval (CI), 1.3-4.4; p = 0.006] and wasting (weight/height, Z < -2; aOR, 2.7; 95% CI, 1.4-5.2; p = 0.004) in children, after adjusting for age, sex, season, birth weight, parity, and α-thalassemia genotypes in a multiple logistic regression model (13) . In the Brazilian Amazon, among children who had vivax malaria (aOR, 4.0; 95% CI, 1.4-11.4; p = 0.008) and a period of 6-12 months between the last malarial episode and the second nutritional assessment (aOR, 4.4; 95% CI, 1.3-15.3; p = 0.020), there was a significant association with increased odds of inadequate growth velocity, after adjusting for the a priori-defined variables of age, sex, maternal education, and socioeconomic status (14) . These data support a non-negligible strength of association between vivax malaria and undernutrition in endemic areas.…”

“…In Vanuatu, Plasmodium vivax malaria was a major predictor of underweight and wasting in children <5 years of age (13) . In the Brazilian Amazon, among 5-10-year-old children, inadequate growth velocity was associated with vivax malaria episodes, with a period of 6-12 months between the last malarial episode and the second nutritional assessment (14) . These findings are also consistent with the effect of P. vivax episodes on the growth of children in Peru (15) .…”