Health, Environment and Development Foundation, Lagos, Nigeria.
Midwestern University, Glendale, AZ, USA.
Malar J. 2020 Feb 5;19(1):61. doi: 10.1186/s12936-020-3143-x.
Malnutrition is appreciated as a global leading paediatric burden that indirectly or directly contributes to child mortality. In children, malnutrition has profound effects on health and development; and has been associated with poor outcomes in paediatric diseases. However, it is not clear if malnourished children are at an increased risk of having malaria. This study was conducted to evaluate the risk of malaria infection in children with malnutrition.
The study design was pre-post. A protective clothing against mosquitoes (pCAM) was given to 102 under-five children in two coastal communities, after screening for malaria parasitaemia. The children's weight, height and body temperature were measured at recruitment. Blood was also taken at recruitment and monthly for malaria parasitaemia, haemoglobin concentration and random blood sugar. The parents/care-givers were visited daily for 1 month only, after recruitment, to ensure that the children wore the pCAM daily from 5 pm and the children were followed up monthly for 2 months.
Of the 102 study participants, 60 (24 males and 36 females) were rapid diagnostic test (RDT)-positive at recruitment, indicating 58.8% prevalence of malaria parasitaemia. The prevalence of malnutrition and of stunting were 32.3% (33/102) and 54.9% (56/102), respectively, while 7.8% (8/108) children were wasted. Twenty (60.6%) of the malnourished children and 30 (53.6%) of those stunted were RDT-positive at recruitment. At the first post-intervention screening, only 7 (31.8%) of the malnourished and 13 (28.9%) of those stunted were RDT-positive. Malnourished and stunted children were 2.57 times and 2.31 times more likely to be malaria infected (OR = 2.57, 95% CI 0.97, 6.79; OR = 2.31, 95% CI 1.01, 5.26 respectively). Malnourished females were 2.72 times more likely to be RDT-positive compared to malnourished males (OR = 2.72, 95% CI 0.54, 11.61) and stunted females were 1.73 times more likely to the positive for malaria parasites than stunted males (OR 1.73, 95% CI 0.59, 5.03). The prevalence of anaemia at recruitment decreased from 82.4 to 69.6% after intervention. The mean haemoglobin concentration (g/dl) at recruitment was significantly lower (P < 0.05) than that at 1st and 2nd post-intervention measurements (9.6 ± 1.4, t = - 3.17, P-value = 0.0009 and 10.2 ± 1.3, t = - 2.64, P-value = 0.004, respectively). Mean random blood sugar (mg/dl) of females (91.8 ± 12.7) was significantly lower (t = 2.83, P-value = 0.003) than that of males (98.5 ± 11.2).
Results from this study suggest a higher risk of malaria infection among malnourished and lower risks among stunted and wasted children. Females were at a higher risk of malnutrition, stunting and wasting than males. Protective clothing against malaria seemed to reduce malaria infection and improve anaemia status.
营养不良被认为是全球范围内导致儿童死亡的主要负担，它间接或直接导致了儿童死亡率的上升。在儿童中，营养不良对健康和发育有深远的影响，并与儿科疾病的不良结局有关。然而，目前尚不清楚营养不良的儿童是否更容易感染疟疾。本研究旨在评估营养不良儿童感染疟疾的风险。
本研究设计为前后对照研究。在两个沿海社区，对 102 名五岁以下儿童进行疟疾寄生虫感染筛查后，为他们提供了一种防蚊服（pCAM）。在招募时测量儿童的体重、身高和体温。在招募时和每月采集一次血液，用于疟疾寄生虫感染、血红蛋白浓度和随机血糖检测。在招募后的 1 个月内，仅对儿童的父母/照顾者进行每日访问，以确保儿童每天下午 5 点穿 pCAM，并在接下来的 2 个月内每月对儿童进行随访。
在 102 名研究参与者中，有 60 名（24 名男性和 36 名女性）在招募时快速诊断测试（RDT）呈阳性，表明疟疾寄生虫感染的患病率为 58.8%。营养不良和发育迟缓的患病率分别为 32.3%（33/102）和 54.9%（56/102），而 7.8%（8/108）的儿童消瘦。在招募时，20 名（60.6%）营养不良儿童和 30 名（53.6%）发育迟缓儿童的 RDT 呈阳性。在第一次干预后筛查中，只有 7 名（31.8%）营养不良儿童和 13 名（28.9%）发育迟缓儿童的 RDT 呈阳性。与未感染疟疾的儿童相比，营养不良和发育迟缓的儿童感染疟疾的风险分别增加了 2.57 倍和 2.31 倍（OR=2.57，95%CI 0.97，6.79；OR=2.31，95%CI 1.01，5.26）。与营养不良的男性相比，营养不良的女性 RDT 阳性的可能性增加了 2.72 倍（OR=2.72，95%CI 0.54，11.61），与发育迟缓的男性相比，发育迟缓的女性 RDT 阳性的可能性增加了 1.73 倍（OR=1.73，95%CI 0.59，5.03）。在干预后，招募时的贫血患病率从 82.4%下降到 69.6%。招募时的平均血红蛋白浓度（g/dl）显著降低（P<0.05），而在第 1 次和第 2 次干预后测量时，平均血红蛋白浓度（g/dl）分别显著升高（t=-3.17，P 值=0.0009 和 t=-2.64，P 值=0.004）。女性的随机血糖（mg/dl）平均值（91.8±12.7）显著低于男性（98.5±11.2）（t=2.83，P 值=0.003）。
本研究结果表明，营养不良的儿童感染疟疾的风险较高，而发育迟缓的儿童和消瘦的儿童感染疟疾的风险较低。女性比男性更容易营养不良、发育迟缓或消瘦。防疟服似乎可以降低疟疾感染风险，改善贫血状况。
