Keita Soumba, Thiero Oumar, Toure Mahamoudou, Kane Fousseyni, Keita Moussa, Konate Drissa, Sanogo Daouda, Diawara Sory Ibrahim, Coulibaly Hamady, Thiam Sidibé M'Baye, Sogoba Nafomon, Diakite Mahamadou, Bamako Mali
University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako.
Department of Health Research and Education, Faculty of Medicine and Odonto Stomatology, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako.
Res Sq. 2023 Nov 15:rs.3.rs-3604955. doi: 10.21203/rs.3.rs-3604955/v1.
In Africa, the relationship between nutritional status and malaria remains complex and difficult to interpret in children. Understanding it is important in the development of malaria control strategies. This study evaluated the effect of nutritional status on the occurrence of multiple malaria episodes in children aged 6 to 59 months between 2013 and 2017 living in the village of Dangassa, Mali.
A community-based longitudinal study was conducted using cross-sectional surveys (SSCs) at the beginning (June) and end (November) of the malaria transmission season associated with passive case detection (PCD) at the Dangassa Community Health Center. Children with asymptomatic malaria infection during cross-sectional surveys were selected and their malaria episodes followed by PCD. Palustrine indicators in person-months were estimated using an ordinal-logistic model repeated on subjects during follow-up periods.
The incidence rate (IR) during the period of high transmission (June to October), for 1 episode and for 2 + episodes peaked in 2013 with 65 children (IR = 95.73 per 1000 person-months) and 24 cases (IR = 35.35 per 1000 person-months), respectively. As expected, the risk of multiple episodes occurring during the period of high transmission was 3.23 compared to the period of low transmission after adjusting for other model parameters (95% CI = [2.45-4.26], p = 0.000). Children with anemia were at high risk of having multiple episodes (OR = 1.6, 95% CI [1.12-2.30], p = 0.011). However, the risk of having 2 + episodes for anemic children was higher during the period of low transmission (RR = 1.67, 95% CI [1.15-2.42], p = 0.007) compared to the period of high transmission (RR = 1.58, 95% CI [1.09-2.29], p = 0.016). The trend indicated that anemic and underweight children were significantly associated with multiple malaria episodes during the period of low transmission (p < = 0.001).
Our results indicate that multiple episodes of malaria are significantly related to the nutritional status (anemia and underweight) of the child during the two transmission seasons and more pronounced during the dry season (period of low transmission). Further research including other malnutrition parameters will be needed to confirm our findings.
在非洲，儿童的营养状况与疟疾之间的关系仍然复杂且难以解读。了解这一关系对于制定疟疾控制策略至关重要。本研究评估了2013年至2017年生活在马里丹加萨村的6至59个月大儿童的营养状况对多次疟疾发作的影响。
在疟疾传播季节开始时（6月）和结束时（11月），在丹加萨社区卫生中心进行基于社区的纵向研究，采用横断面调查（SSC）并结合被动病例检测（PCD）。选择横断面调查中无症状疟疾感染的儿童，并通过PCD跟踪其疟疾发作情况。在随访期间，对受试者重复使用有序逻辑模型估计按人月计算的沼泽指标。
在高传播期（6月至10月），1次发作和2次及以上发作的发病率在2013年达到峰值，分别有65名儿童（发病率=每1000人月95.73）和24例（发病率=每1000人月35.35）。正如预期的那样，在调整其他模型参数后，高传播期发生多次发作的风险是低传播期的3.23倍（95%置信区间=[2.45 - 4.26]，p = 0.000）。贫血儿童发生多次发作的风险较高（比值比=1.6，95%置信区间[1.12 - 2.30]，p = 0.011）。然而，与高传播期相比，贫血儿童在低传播期发生2次及以上发作的风险更高（相对危险度=1.67，95%置信区间[1.15 - 2.42]，p = 0.007）（高传播期相对危险度=1.58，95%置信区间[1.09 - 2.29]，p = 0.016）。趋势表明，贫血和体重不足的儿童在低传播期与多次疟疾发作显著相关（p <= 0.001）。
我们的结果表明，在两个传播季节中，多次疟疾发作与儿童的营养状况（贫血和体重不足）显著相关，在旱季（低传播期）更为明显。需要进一步研究包括其他营养不良参数来证实我们的发现。
