West African International Center for Excellence in Malaria Research, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, UCRC-USTTB / Point-G, 1805, Bamako, Mali.
Malar J. 2024 Jun 13;23(1):186. doi: 10.1186/s12936-024-04999-8.
In Africa, the relationship between childhood nutritional status and malaria remains complex and difficult to interpret. Understanding it is important in the improvement of malaria control strategies. This study aimed to assess the influence 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 (CSSs) at the beginning (June) and end (November) of the malaria transmission season associated with passive case detection (PCD) at the Dangassa Community Health Centre. Children with asymptomatic malaria infection during cross-sectional surveys were selected and their malaria episodes followed by PCD. Malaria 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 anaemia 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).
Results show that multiple episodes of malaria are significantly related to the nutritional status (anaemia 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 these findings.
在非洲，儿童营养状况与疟疾之间的关系仍然复杂且难以解释。了解这一点对于改善疟疾控制策略非常重要。本研究旨在评估 2013 年至 2017 年间生活在马里 Dangassa 村的 6 至 59 个月龄儿童的营养状况对多次疟疾发作的影响。
采用基于社区的纵向研究，在疟疾传播季节的开始（6 月）和结束（11 月）进行横断面调查（CSS），并结合 Dangassa 社区卫生中心的被动病例检测（PCD）。在横断面调查期间选择无症状疟疾病例的儿童，并通过 PCD 对其疟疾发作进行随访。使用有序逻辑模型在随访期间对受试者进行重复估计疟疾指标的人月数。
在高传播期（6 月至 10 月），1 次发作和 2 次发作以上的发病率（IR）在 2013 年达到峰值，分别为 65 例（IR=95.73 人/1000 人月）和 24 例（IR=35.35 人/1000 人月）。如预期的那样，与低传播期相比，高传播期发生多次发作的风险为 3.23（调整其他模型参数后 95%CI[2.45-4.26]，p=0.000）。贫血儿童发生多次发作的风险较高（OR=1.6，95%CI[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 次发作以上的风险更高（RR=1.67，95%CI[1.15-2.42]，p=0.007）。趋势表明，在低传播期，贫血和体重不足的儿童与多次疟疾发作显著相关（p<0.001）。
结果表明，多次疟疾发作与两个传播季节儿童的营养状况（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的研究来证实这些发现。
