The association of malaria morbidity with linear growth, hemoglobin, iron status, and development in young Malawian children: a prospective cohort study

Jaden Bendabenda, Noel Patson, Lotta Hallamaa, John Mbotwa, Charles Mangani, John Phuka, Elizabeth L Prado, Yin Bun Cheung, Ulla Ashorn, Kathryn G Dewey, Per Ashorn, Kenneth Maleta, Jaden Bendabenda, Noel Patson, Lotta Hallamaa, John Mbotwa, Charles Mangani, John Phuka, Elizabeth L Prado, Yin Bun Cheung, Ulla Ashorn, Kathryn G Dewey, Per Ashorn, Kenneth Maleta

Abstract

Background: Although poor complementary feeding is associated with poor child growth, nutrition interventions only have modest impact on child growth, due to high burden of infections. We aimed to assess the association of malaria with linear growth, hemoglobin, iron status, and development in children aged 6-18 months in a setting of high malaria and undernutrition prevalence.

Methods: Prospective cohort study, conducted in Mangochi district, Malawi. We enrolled six-months-old infants and collected weekly data for 'presumed' malaria, diarrhea, and acute respiratory infections (ARI) until age 18 months. Change in length-for-age z-scores (LAZ), stunting, hemoglobin, iron status, and development were assessed at age 18 months. We used ordinary least squares regression for continuous outcomes and modified Poisson regression for categorical outcomes.

Results: Of the 2723 children enrolled, 2016 (74.0%) had complete measurements. The mean (standard deviation) incidences of 'presumed' malaria, diarrhea, and ARI, respectively were: 1.4 (2.0), 4.6 (10.1), and 8.3 (5.0) episodes/child year. Prevalence of stunting increased from 27.4 to 41.5% from 6 to 18 months. 'Presumed' malaria incidence was associated with higher risk of stunting (risk ratio [RR] = 1.04, 95% confidence interval [CI] = 1.01 to 1.07, p = 0.023), anemia (RR = 1.02, 95%CI = 1.00 to 1.04, p = 0.014) and better socio-emotional scores (B = - 0.21, 95%CI = - 0.39 to - 0.03, p = 0.041), but not with change in LAZ, haemoglobin, iron status or other developmental outcomes. Diarrhea incidence was associated with change in LAZ (B = - 0.02; 95% CI = - 0.03 to - 0.01; p = 0.009), stunting (RR = 1.02; 95% CI = 1.01 to 1.03; p = 0.005), and slower motor development. ARI incidence was not associated with any outcome except for poorer socio-emotional scores.

Conclusion: In this population of young children living in a malaria-endemic setting, with active surveillance and treatment, 'presumed' malaria is not associated with change in LAZ, hemoglobin, or iron status, but could be associated with stunting and anemia. Diarrhea was more consistently associated with growth than was malaria or ARI. The findings may be different in contexts where active malaria surveillance and treatment is not provided.

Trial registration: NCT00945698 (July 24, 2009) and NCT01239693 (November 11, 2010).

Keywords: Children; Growth faltering; Infections; Longitudinal studies; Malaria; Morbidity; Stunting; iLiNS studies.

Conflict of interest statement

Ethics approval and consent to participate

The study was performed according to International Conference of Harmonization–Good Clinical Practice (ICH-GCP) guidelines and the ethical standards of the Helsinki Declaration. The protocol was reviewed and approved by the Institutional Review Boards of the University of Malawi, College of Medicine (IRB reference number P.01/09/722) and the Pirkanmaa Hospital District, Finland (IRB reference number R09130). At least one guardian signed or thumb-printed an informed consent form before enrolment of each participant. An independent data safety and monitoring board monitored the incidence of suspected SAE during the trial.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of the children enrolled and included in the final analysis. The figure shows the number of children enrolled, children lost to follow up, and children who were eventually included in the study from the iLiNS DOSE and iLiNS DYAD-M cohorts

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