Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
Malar J. 2013 Jan 8;12:12. doi: 10.1186/1475-2875-12-12.
Despite major progress made over the past 10 years, malaria remains one of the primary causes of ill health in developing countries in general, and in sub-Saharan Africa in particular. Whilst a large literature has documented the frequency and severity of malaria infections for children under-five years, relatively little evidence is available regarding the impact of early childhood malaria exposure on subsequent child development.
The objective of the study was to assess the associations between early childhood exposure to malaria and pre-school development. Child assessment data for 1,410 children in 70 clusters collected through the 2010 Zambian Early Childhood Development Project was linked with malaria parasite prevalence data from the 2006 Zambia Malaria Indicator Survey. Linear and logistic models were used to estimate the effect of early childhood exposure to malaria on anthropometric outcomes as well as on a range of cognitive and behavioural development measures.
No statistically significant associations were found between parasite exposure and children's height and weight. Exposure to the malaria parasite was, however, associated with lower ability to cope with cognitive tasks administered by interviewers (z-score difference -1.11, 95% CI -2.43-0.20), as well as decreased overall socio-emotional development as assessed by parents (z-score difference -1.55, 95% CI -3.13-0.02). No associations were found between malaria exposure and receptive vocabulary or fine-motor skills.
The results presented in this paper suggest potentially large developmental consequences of early childhood exposure to malaria. Continued efforts to lower the burden of malaria will not only reduce under-five mortality, but may also have positive returns in terms of the long-term well-being of exposed cohorts.
尽管在过去 10 年中取得了重大进展，但疟疾仍然是发展中国家，尤其是撒哈拉以南非洲国家健康不良的主要原因之一。虽然大量文献记录了五岁以下儿童疟疾感染的频率和严重程度，但关于儿童早期疟疾暴露对后续儿童发育的影响的证据相对较少。
本研究的目的是评估儿童早期暴露于疟疾与学前发展之间的关联。通过 2010 年赞比亚幼儿发展项目收集了 70 个群组中 1410 名儿童的评估数据，并将其与 2006 年赞比亚疟疾指标调查中的疟疾寄生虫流行率数据相关联。使用线性和逻辑模型来估计儿童早期暴露于疟疾对儿童的身高和体重等人体测量学结果以及一系列认知和行为发展指标的影响。
寄生虫暴露与儿童的身高和体重之间没有统计学上的显著关联。然而，暴露于疟原虫与应对面试官进行的认知任务的能力较低有关（得分差异-1.11，95%CI-2.43-0.20），以及父母评估的整体社会情感发展下降（得分差异-1.55，95%CI-3.13-0.02）。疟疾暴露与接受性词汇或精细运动技能之间没有关联。
本文提出的结果表明，儿童早期暴露于疟疾可能会产生潜在的重大发育后果。继续努力降低疟疾负担不仅会降低五岁以下儿童的死亡率，而且可能会对暴露人群的长期福祉产生积极影响。
