疟疾增加了埃塞俄比亚幼儿发育迟缓及消瘦的风险：一项队列研究的结果
Malaria increased the risk of stunting and wasting among young children in Ethiopia: Results of a cohort study.
作者信息
Gari Taye, Loha Eskindir, Deressa Wakgari, Solomon Tarekegn, Lindtjørn Bernt
机构信息
School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Centre for International Health, University of Bergen, Bergen, Norway.
出版信息
PLoS One. 2018 Jan 11;13(1):e0190983. doi: 10.1371/journal.pone.0190983. eCollection 2018.
INTRODUCTION
Given the high prevalence of malnutrition in a malaria-endemic setting, improving nutritional status could serve as a tool to prevent malaria. However, the relationship between the two conditions remains unclear. Therefore, this study assessed the association between under-nutrition and malaria among a cohort of children aged 6 to 59 months old.
METHODS
Two cohorts of children were followed for 89 weeks in a rural Rift Valley area of Ethiopia. In the first approach (malaria-malnutrition), a cohort of 2,330 non-stunted and 4,204 non-wasted children were included to assess under-nutrition (outcome) based on their previous malaria status (exposure). In the second approach (malnutrition-malaria), a cohort of 4,468 children were followed-up to measure malaria (outcome), taking under-nutrition as an exposure. A weekly home visit was carried out to identify malaria cases. Four anthropometry surveys were conducted, and generalized estimating equation (GEE) method was used to measure the association between undernutrition and malaria.
RESULTS
The prevalence of stunting was 44.9% in December 2014, 51.5% in August 2015, 50.7% in December 2015 and 48.1% in August 2016. We observed 103 cases with 118 episodes of malaria, 684 new stunting and 239 new wasting cases. The incidence rate per 10,000 weeks of observation was 3.8 for malaria, 50.4 for stunting and 8.2 for wasting. Children with malaria infection, [Adjusted Odds Ratio (AOR) = 1.9; 95% Confidence Interval (CI), 1.2-2.9)] and younger age (AOR = 1.3; 95% CI, 1.1-1.5) were more likely to be stunted. Furthermore, children with malaria infection (AOR = 8.5; 95% CI, 5.0-14.5) and young age group (AOR = 1.6; 95% CI, 1.2-2.1) were more likely to be wasted. However, stunting and wasting were not risk factors of subsequent malaria illness.
CONCLUSIONS
Malaria infection was a risk factor for stunting and wasting, but stunting or wasting was not associated with subsequent malaria illness. As our study shows that malaria is a risk factor for stunting and wasting, a close follow-up of the nutritional status of such children may be needed.
TRIAL REGISTRATION
PACT R2014 11000 882128 (8 September 2014).
引言
鉴于疟疾流行地区营养不良的高患病率，改善营养状况可作为预防疟疾的一种手段。然而，这两种情况之间的关系仍不明确。因此，本研究评估了6至59个月大儿童队列中营养不良与疟疾之间的关联。
方法
在埃塞俄比亚裂谷地区的一个农村地区，对两组儿童进行了89周的随访。在第一种方法（疟疾-营养不良）中，纳入了2330名无发育迟缓且无消瘦的儿童队列，根据他们之前的疟疾状况（暴露因素）评估营养不良情况（结果）。在第二种方法（营养不良-疟疾）中，对4468名儿童进行随访以测量疟疾情况（结果），将营养不良作为暴露因素。每周进行一次家访以确定疟疾病例。进行了四次人体测量调查，并使用广义估计方程（GEE）方法来衡量营养不良与疟疾之间的关联。
结果
2014年12月发育迟缓患病率为44.9%，2015年8月为51.5%，2015年12月为50.7%，2016年8月为48.1%。我们观察到103例疟疾病例，共118次发作，684例新发发育迟缓病例和239例新发消瘦病例。每10000周观察期的发病率分别为：疟疾3.8例、发育迟缓50.4例、消瘦8.2例。感染疟疾的儿童[调整优势比（AOR）=1.9；95%置信区间（CI），1.2 - 2.9]以及年龄较小的儿童（AOR = 1.3；95%CI，1.1 - 1.5）更易出现发育迟缓。此外，感染疟疾的儿童（AOR = 8.5；95%CI，5.0 - 14.5）和年龄较小的儿童组（AOR = 1.6；95%CI，1.2 - 2.1）更易出现消瘦。然而，发育迟缓和消瘦并非后续疟疾发病的危险因素。
结论
疟疾感染是发育迟缓和消瘦的危险因素，但发育迟缓或消瘦与后续疟疾发病无关。正如我们的研究表明疟疾是发育迟缓和消瘦的危险因素，可能需要密切随访此类儿童的营养状况。
试验注册
PACT R2014 11000 882128（2014年9月8日）。
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