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Agho KE, Chitekwe S, Rijal S, Paudyal N, Sahani SK, Akombi-Inyang BJ. Association between Child Nutritional Anthropometric Indices and Iron Deficiencies among Children Aged 6-59 Months in Nepal. Nutrients 2024; 16:698. [PMID: 38474829 DOI: 10.3390/nu16050698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Developmental impairment remains an important public health problem among children in many developing countries, including Nepal. Iron deficiency in children may affect development and lead to anaemia. This study on 1702 children aged 6-59 months aimed to assess the association between nutritional anthropometric indices and iron deficiencies. Data for this study were extracted from the 2016 Nepal National Micronutrient Status Survey. Three nutritional anthropometric indices (stunting, wasting and underweight) and their association with anaemia and iron deficiencies (ferritin and sTfR biomarkers) were assessed by conducting multivariate statistical analyses. The prevalence of stunting, wasting and underweight among children aged 6-59 months was 35.6%, 11.7% and 29.0%, respectively. Most of the children were not stunted (64.4%), not wasted (71.0%) and not underweight (88.3%). Belonging to castes other than the Janajati, Dalit and Brahmin castes increased the odds of anaemia and iron deficiency (ferritin biomarker). Children in the age group 6-23 months were significantly at higher odds of having anaemia and iron deficiency (ferritin and sTfR biomarkers). Stunting significantly increased the odds of anaemia [adjusted odds ratio (OR): 1.55; 95% confidence interval (CI): (1.11, 2.17)], iron deficiency (ferritin biomarker [OR: 1.56; 95% CI: (1.16, 2.08)] and sTfR biomarker [OR: 1.60; 95% CI: (1.18, 2.15)]). Further, underweight significantly increased the odds of anaemia [OR: 1.69; 95% CI: (1.12, 2.54)] and iron deficiency (sTfR biomarker [OR: 1.48; 95% CI: (1.14, 1.93)]). Interventions to minimise the occurrence of anaemia and iron deficiencies among children in Nepal should focus on providing appropriate healthcare services that would reduce the burden of stunting and underweight.
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Affiliation(s)
- Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
- Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
| | - Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF) Ethiopia, Addis Ababa 1169, Ethiopia
| | - Sanjay Rijal
- United Nations Children's Fund (UNICEF), Nepal Country Office P.O. Box 1187, United Nations (UN) House, Pulchowk, Kathmandu P.O. Box 107, Nepal
| | - Naveen Paudyal
- United Nations Children's Fund (UNICEF), Nepal Country Office P.O. Box 1187, United Nations (UN) House, Pulchowk, Kathmandu P.O. Box 107, Nepal
| | - Sanjeev Kumar Sahani
- United Nations Children's Fund (UNICEF), Nepal Country Office P.O. Box 1187, United Nations (UN) House, Pulchowk, Kathmandu P.O. Box 107, Nepal
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Mhango EKG, Snorradottir BS, Kachingwe BHK, Katundu KGH, Gizurarson S. Estimation of Pediatric Dosage of Antimalarial Drugs, Using Pharmacokinetic and Physiological Approach. Pharmaceutics 2023; 15:1076. [PMID: 37111562 PMCID: PMC10140824 DOI: 10.3390/pharmaceutics15041076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
Most of the individuals who die of malaria in sub-Saharan Africa are children. It is, therefore, important for this age group to have access to the right treatment and correct dose. Artemether-lumefantrine is one of the fixed dose combination therapies that was approved by the World Health Organization to treat malaria. However, the current recommended dose has been reported to cause underexposure or overexposure in some children. The aim of this article was, therefore, to estimate the doses that can mimic adult exposure. The availability of more and reliable pharmacokinetic data is essential to accurately estimate appropriate dosage regimens. The doses in this study were estimated using the physiological information from children and some pharmacokinetic data from adults due to the lack of pediatric pharmacokinetic data in the literature. Depending on the approach that was used to calculate the dose, the results showed that some children were underexposed, and others were overexposed. This can lead to treatment failure, toxicity, and even death. Therefore, when designing a dosage regimen, it is important to know and include the distinctions in physiology at various phases of development that influence the pharmacokinetics of various drugs in order to estimate the dose in young children. The physiology at each time point during the growth of a child may influence how the drug is absorbed, gets distributed, metabolized, and eliminated. From the results, there is a very clear need to conduct a clinical study to further verify if the suggested (i.e., 0.34 mg/kg for artemether and 6 mg/kg for lumefantrine) doses could be clinically efficacious.
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Affiliation(s)
- Ellen K. G. Mhango
- Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, 107 Reykjavik, Iceland (B.S.S.)
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, P/Bag 360, Blantyre 3, Malawi
| | - Bergthora S. Snorradottir
- Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, 107 Reykjavik, Iceland (B.S.S.)
| | - Baxter H. K. Kachingwe
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, P/Bag 360, Blantyre 3, Malawi
| | - Kondwani G. H. Katundu
- Biomedical Sciences Department, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, P/Bag 360, Blantyre 3, Malawi
| | - Sveinbjorn Gizurarson
- Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, 107 Reykjavik, Iceland (B.S.S.)
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, P/Bag 360, Blantyre 3, Malawi
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Yadav CP, Hussain SSA, Pasi S, Sharma S, Bharti PK, Rahi M, Sharma A. Linkages between malaria and malnutrition in co-endemic regions of India. BMJ Glob Health 2023; 8:bmjgh-2022-010781. [PMID: 36653068 PMCID: PMC9853155 DOI: 10.1136/bmjgh-2022-010781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Malaria and malnutrition are key public health challenges in India. However, the relationship between them is poorly understood. Here, we aimed to elucidate the potential interactions between the two health conditions by identifying the areas of their spatial overlap. METHODS We have analysed the district-wise undernutrition and malaria data of 638 districts of India across 28 states and 8 union territories. Data on malnutrition parameters viz. stunting, wasting, underweight and anaemia, sourced from the fourth National Family Health Survey (2015-2016), and malaria Annual Parasite Index (API) data of the same year (i.e, 2015), sourced from National Center of Vector Borne Diseases Control were analysed using local Moran's I Index and logistic regression. RESULTS Among all the malnutrition parameters, we found underweight in children and anaemia in men to co-occur with malaria in the districts of Chhattisgarh, Jharkhand, Madhya Pradesh and Odisha. Further, districts with more than 36% underweight children (OR (95% CI): 2.31 (1.53 to 3.48)) and/or more than 23.6% male population with anaemia (OR (95% CI): 2.06 (1.37 to 3.11)) had higher odds of being malaria endemic districts (ie, Annual Parasite Index >1). CONCLUSION Malaria and malnutrition co-occur in the malaria-endemic parts of India. The high prevalence of undernutrition in children and anaemia among men may contribute to malaria endemicity in a particular region. Therefore, future research should be prioritised to generate data on the individual level. Further, malaria control interventions could be tailored to integrate nutrition programmes to disrupt indigenous malaria transmission in endemic districts.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India,Epidemiology and Biostatistics, ICMR-National Institute of Cancer Prevention & Reserch, Noida, Uttar Pradesh, India
| | - Syed Shah Areeb Hussain
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Shweta Pasi
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Shweta Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Praveen K Bharti
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India,Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India .,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India.,Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Smith MR, Gbedande K, Johnson CM, Campbell LA, Onjiko RS, Domingo ND, Opata MM. Model of severe malaria in young mice suggests unique response of CD4 T cells. Parasite Immunol 2022; 44:e12952. [PMID: 36131528 PMCID: PMC9787679 DOI: 10.1111/pim.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
Severe malaria occurs most in young children but is poorly understood due to the absence of a developmentally-equivalent rodent model to study the pathogenesis of the disease. Though functional and quantitative deficiencies in innate response and a biased T helper 1 (Th1) response are reported in newborn pups, there is little information available about this intermediate stage of the adaptive immune system in murine neonates. To fill this gap in knowledge, we have developed a mouse model of severe malaria in young mice using 15-day old mice (pups) infected with Plasmodium chabaudi. We observe similar parasite growth pattern in pups and adults, with a 60% mortality and a decrease in the growth rate of the surviving young mice. Using a battery of behavioral assays, we observed neurological symptoms in pups that do not occur in infected wildtype adults. CD4+ T cells were activated and differentiated to an effector T cell (Teff) phenotype in both adult and pups. However, there were relatively fewer and less terminally differentiated pup CD4+ Teff than adult Teff. Interestingly, despite less activation, the pup Teff expressed higher T-bet than adults' cells. These data suggest that Th1 cells are functional in pups during Plasmodium infection but develop slowly.
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Affiliation(s)
- Margaret R. Smith
- Department of Biology, College of Arts and SciencesAppalachian State UniversityBooneNorth CarolinaUSA
- Present address:
Cancer Biology Ph.D. ProgramWake Forest College of MedicineWinston SalemNorth CarolinaUSA
| | - Komi Gbedande
- Division of Infectious Diseases, Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Corey M. Johnson
- Department of Biology, College of Arts and SciencesAppalachian State UniversityBooneNorth CarolinaUSA
| | - Logan A. Campbell
- Department of Biology, College of Arts and SciencesAppalachian State UniversityBooneNorth CarolinaUSA
| | - Robert S. Onjiko
- Department of Biology, College of Arts and SciencesAppalachian State UniversityBooneNorth CarolinaUSA
| | - Nadia D. Domingo
- Division of Infectious Diseases, Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Michael M. Opata
- Department of Biology, College of Arts and SciencesAppalachian State UniversityBooneNorth CarolinaUSA
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Chuljerm H, Maneekesorn S, Punsawad C, Somsak V, Ma Y, Ruangsuriya J, Srichairatanakool S, Koonyosying P. Deferiprone-Resveratrol Hybrid, an Iron-Chelating Compound, Acts as an Antimalarial and Hepatoprotective Agent in Plasmodium berghei-Infected Mice. Bioinorg Chem Appl 2022; 2022:3869337. [PMID: 36466999 PMCID: PMC9715320 DOI: 10.1155/2022/3869337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 09/10/2024] Open
Abstract
Free heme in plasma acts as a prooxidant; thus, it is bound to hemopexin and eliminated by the liver. High iron content in the liver can support Plasmodium growth and cause oxidative liver injury. Inversely, the withholding of excessive iron can inhibit this growth and protect the liver against malaria infection. This study examined the effects of a deferiprone-resveratrol (DFP-RVT) hybrid on malaria parasites and its relevant hepatoprotective properties. Mice were infected with P. berghei, gavage DFP-RVT, deferiprone (DFP), and pyrimethamine (PYR) for 8 consecutive days. Blood and liver parameters were then evaluated. The presence of blood-stage parasites was determined using the microscopic Giemsa staining method. Subsequently, plasma liver enzymes, heme, and concentrations of thiobarbituric acid-reactive substances (TBARS) were determined. The liver tissue was examined pathologically and heme and TBARS concentrations were then quantified. The results indicate that the suppression potency against P. berghei growth occurred as follows: PYR > DFP-RVT hybrid > DFP. Importantly, DFP-RVT significantly improved RBC size, restored alanine aminotransferase and alkaline activities, and increased heme and TBARS concentrations. The compound also reduced the liver weight index, heme, and TBARS concentrations significantly when compared to mice that were untreated. Our findings support the contention that the hepatoprotective effect of DFP-RVT is associated with parasite burden, iron depletion, and lipid peroxidation in the host.
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Affiliation(s)
- Hataichanok Chuljerm
- School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
- School of Health Sciences Research, Research Institute for Health Sciences Chiang Mai University, Chiang Mai 50200, Thailand
- Environmental and Occupational Health Sciences and Non Communicable Diseases Research Group (EOHS and NCD Research Group), Research Institute for Health Sciences Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Chuchard Punsawad
- School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Voravuth Somsak
- School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Yongmin Ma
- School of Pharmaceutical Sciences, Taizhou University, Zhejiang 318000, China
| | - Jetsada Ruangsuriya
- Department of Biochemistry, Faculty of Medicine Chiang Mai University, Chiang Mai 50200, Thailand
| | - Somdet Srichairatanakool
- Department of Biochemistry, Faculty of Medicine Chiang Mai University, Chiang Mai 50200, Thailand
| | - Pimpisid Koonyosying
- Department of Biochemistry, Faculty of Medicine Chiang Mai University, Chiang Mai 50200, Thailand
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Nauriyal D, Kumar D. Study of complex associations between severe malaria and malnutrition in pediatric age group. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Achouri I, Aboussaleh Y, Sbaibi R, Ahami A. Anthropometry, food consumption and iron deficiency anemia, among primary school children (6-15 years) in Kenitra city (North-Western Morocco). Pan Afr Med J 2021; 38:374. [PMID: 34367453 PMCID: PMC8309009 DOI: 10.11604/pamj.2021.38.374.10008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/14/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION the problem of malnutrition among children is a phenomenon associated with a rapid nutrition transition in Morocco and all developing countries. The objective of this study is to evaluate the nutritional status by anthropometry, food consumption and iron deficiency anemia among primary school children aged 6-12 years in Kenitra city (Morocco). METHODS the survey covered 271 students (55% of boys and 45% girls) aged 6 to 12. Information concerning food consumption patterns, socioeconomic status and other lifestyle factors was obtained using questionnaires and interviews. Anemia was defined when haemoglobin < 11.5 g/dl. RESULTS the results showed that, 6.3%, 2.2% and 17.3% children were stunted, thin and overweight respectively. No significant association was found between gender and nutritional status of children. 16.2% children were anemic and food consumption found not to be varied and below recommendations. CONCLUSION the finding in this study showed that overweight and obesity occurred more frequently than the various forms of under nutrition in the population studied. The finding support the urgent need to improve the nutritional status of children by implementing preventive strategy for the problem of malnutrition among school-aged children.
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Affiliation(s)
- Imane Achouri
- Behavioral Neurosciences and Nutritional Health Unit, Nutrition and Health Laboratory, Department of Biology, Faculty of Sciences, University Ibn Tofail, BP 133 14000 Kenitra, Morocco
| | - Youssef Aboussaleh
- Behavioral Neurosciences and Nutritional Health Unit, Nutrition and Health Laboratory, Department of Biology, Faculty of Sciences, University Ibn Tofail, BP 133 14000 Kenitra, Morocco
| | - Rachid Sbaibi
- Behavioral Neurosciences and Nutritional Health Unit, Nutrition and Health Laboratory, Department of Biology, Faculty of Sciences, University Ibn Tofail, BP 133 14000 Kenitra, Morocco
| | - Ahmed Ahami
- Behavioral Neurosciences and Nutritional Health Unit, Nutrition and Health Laboratory, Department of Biology, Faculty of Sciences, University Ibn Tofail, BP 133 14000 Kenitra, Morocco
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Plasmodium chabaudi Infection Alters Intestinal Morphology and Mucosal Innate Immunity in Moderately Malnourished Mice. Nutrients 2021; 13:nu13030913. [PMID: 33799736 PMCID: PMC7998862 DOI: 10.3390/nu13030913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/29/2022] Open
Abstract
Plasmodium falciparum is a protozoan parasite which causes malarial disease in humans. Infections commonly occur in sub-Saharan Africa, a region with high rates of inadequate nutrient consumption resulting in malnutrition. The complex relationship between malaria and malnutrition and their effects on gut immunity and physiology are poorly understood. Here, we investigated the effect of malaria infection in the guts of moderately malnourished mice. We utilized a well-established low protein diet that is deficient in zinc and iron to induce moderate malnutrition and investigated mucosal tissue phenotype, permeability, and innate immune response in the gut. We observed that the infected moderately malnourished mice had lower parasite burden at the peak of infection, but damaged mucosal epithelial cells and high levels of FITC-Dextran concentration in the blood serum, indicating increased intestinal permeability. The small intestine in the moderately malnourished mice were also shorter after infection with malaria. This was accompanied with lower numbers of CD11b+ macrophages, CD11b+CD11c+ myeloid cells, and CD11c+ dendritic cells in large intestine. Despite the lower number of innate immune cells, macrophages in the moderately malnourished mice were highly activated as determined by MHCII expression and increased IFNγ production in the small intestine. Thus, our data suggest that malaria infection may exacerbate some of the abnormalities in the gut induced by moderate malnutrition.
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Alwajeeh TS, Abdul-Ghani R, Allam AF, Farag HF, Khalil SSM, Shehab AY, El-Sayad MH, Alharbi RA, Almalki SSR, Azazy AA. Uncomplicated falciparum malaria among schoolchildren in Bajil district of Hodeidah governorate, west of Yemen: association with anaemia and underweight. Malar J 2020; 19:358. [PMID: 33028361 PMCID: PMC7542704 DOI: 10.1186/s12936-020-03431-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria, malnutrition and anaemia are major public health problems in Yemen, with Hodeidah being the most malaria-afflicted governorate. To address the lack of relevant studies, this study was conducted to determine the prevalence of Plasmodium falciparum and its relation to nutritional status and haematological indices among schoolchildren in Bajil district of Hodeidah governorate, west of Yemen. METHODS A cross-sectional study was conducted among 400 schoolchildren selected randomly from four schools in Bajil district. Data about demographic characteristics, risk factors and anthropometric measurements of age, height and weight were collected. Duplicate thick and thin blood films were prepared, stained with Giemsa and examined microscopically for malaria parasites. The density of P. falciparum asexual stages was estimated on thick films. EDTA-blood samples were examined for the haematological indices of haemoglobin (Hb) and blood cell counts. RESULTS Plasmodium falciparum was prevalent among 8.0% (32/400) of schoolchildren with a mean parasite density of 244.3 ± 299.3/µL of blood and most infections showing low-level parasitaemia, whereas Plasmodium vivax was detected in one child (0.25%). Residing near water collections was a significant independent predictor of falciparum malaria [adjusted odds ratio (AOR) = 2.6, 95.0% CI 1.20-5.72; p = 0.016] in schoolchildren. Mild anaemia was prevalent among more than half of P. falciparum-infected schoolchildren and significantly associated with falciparum malaria (AOR = 5.8, 95.0% CI 2.39-14.17; p < 0.001), with a mean Hb concentration of 10.7 ± 1.0 g/dL. Although the mean values of the total white blood cells, monocytes and platelets were significantly lower in infected than non-infected schoolchildren, they were within normal ranges. More than half of the children were malnourished, with stunting (39.3%) and underweight (36.0%) being the most prevalent forms of malnutrition; 6.3% of children were wasted. Underweight (AOR = 5.3, 95.0% CI 2.09-13.62; p < 0.001) but not stunting or wasting, was a significant predictor of falciparum malaria among schoolchildren. CONCLUSION Asymptomatic falciparum malaria is prevalent among schoolchildren in Bajil district of Hodeidah Governorate, with predominance of low parasitaemic infections and significant association with mild anaemia and underweight. Residence near water collection is a significant predictor of infection with falciparum malaria among schoolchildren. Further studies among children with severe malaria and those with high parasite densities are recommended.
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Affiliation(s)
- Talal S Alwajeeh
- Laboratory Department, Kuwait University Hospital, Sana'a University, Sana'a, Yemen
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen.
| | - Amal F Allam
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Hoda F Farag
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Safia S M Khalil
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Amel Y Shehab
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mona H El-Sayad
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Raed A Alharbi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Al Baha University, Al Baha, Saudi Arabia
| | - Shaia S R Almalki
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Al Baha University, Al Baha, Saudi Arabia
| | - Ahmed A Azazy
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Al Baha University, Al Baha, Saudi Arabia
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Association between Malaria Infection and Early Childhood Development Mediated by Anemia in Rural Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030902. [PMID: 32024214 PMCID: PMC7037381 DOI: 10.3390/ijerph17030902] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 02/08/2023]
Abstract
Malaria is a leading cause of morbidity and mortality among children under five years of age, with most cases occurring in Sub-Saharan Africa. Children in this age group in Africa are at greatest risk worldwide for developmental deficits. There are research gaps in quantifying the risks of mild malaria cases, understanding the pathways linking malaria infection and poor child development, and evaluating the impact of malaria on the development of children under five years. We analyzed the association between malaria infection and gross motor, communication, and personal social development in 592 children age 24 months in rural, western Kenya as part of the WASH Benefits environmental enteric dysfunction sub-study. Eighteen percent of children had malaria, 20% were at risk for gross motor delay, 21% were at risk for communication delay, and 23% were at risk for personal social delay. Having a positive malaria test was associated with increased risk for gross motor, communication, and personal social delay while adjusting for child characteristics, household demographics, study cluster, and intervention treatment arm. Mediation analyses suggested that anemia was a significant mediator in the pathway between malaria infection and risk for gross motor, communication, and personal social development delays. The proportion of the total effect of malaria on the risk of developmental delay that is mediated by anemia across the subscales was small (ranging from 9% of the effect on gross motor development to 16% of the effect on communication development mediated by anemia). Overall, malaria may be associated with short-term developmental delays during a vulnerable period of early life. Therefore, preventative malaria measures and immediate treatment are imperative for children’s optimal development, particularly in light of projections of continued high malaria transmission in Kenya and Africa.
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Das D, Grais RF, Okiro EA, Stepniewska K, Mansoor R, van der Kam S, Terlouw DJ, Tarning J, Barnes KI, Guerin PJ. Complex interactions between malaria and malnutrition: a systematic literature review. BMC Med 2018; 16:186. [PMID: 30371344 PMCID: PMC6205776 DOI: 10.1186/s12916-018-1177-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/20/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition. METHODS Database searches were conducted in PubMed, Global Health and Cochrane Libraries and articles published in English, French or Spanish between Jan 1980 and Feb 2018 were accessed and screened. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the risk of bias across studies was assessed using the GRADE approach. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline were followed. RESULTS Of 2945 articles screened from databases, a total of 33 articles were identified looking at the association between malnutrition and risk of malaria and/or the impact of malnutrition in antimalarial treatment efficacy. Large methodological heterogeneity of studies precluded conducting meaningful aggregated data meta-analysis. Divergent results were reported on the effect of malnutrition on malaria risk. While no consistent association between risk of malaria and acute malnutrition was found, chronic malnutrition was relatively consistently associated with severity of malaria such as high-density parasitemia and anaemia. Furthermore, there is little information on the effect of malnutrition on therapeutic responses to artemisinin combination therapies (ACTs) and their pharmacokinetic properties in malnourished children in published literature. CONCLUSIONS The evidence on the effect of malnutrition on malaria risk remains inconclusive. Further analyses using individual patient data could provide an important opportunity to better understand the variability observed in publications by standardising both malaria and nutritional metrics. Our findings highlight the need to improve our understanding of the pharmacodynamics and pharmacokinetics of ACTs in malnourished children. Further clarification on malaria-malnutrition interactions would also serve as a basis for designing future trials and provide an opportunity to optimise antimalarial treatment for this large, vulnerable and neglected population. TRIAL REGISTRATION PROSPERO CRD42017056934 .
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Affiliation(s)
- D Das
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - E A Okiro
- Kemri Wellcome Trust Research Programme, Kilifi, Kenya
| | - K Stepniewska
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - R Mansoor
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - D J Terlouw
- Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - J Tarning
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - K I Barnes
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,WorldWide Antimalarial Resistance Network (WWARN) Pharmacology, University of Cape Town, Cape Town, South Africa
| | - P J Guerin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
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12
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Amoah B, Giorgi E, Heyes DJ, van Burren S, Diggle PJ. Geostatistical modelling of the association between malaria and child growth in Africa. Int J Health Geogr 2018; 17:7. [PMID: 29482559 PMCID: PMC5828493 DOI: 10.1186/s12942-018-0127-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 02/20/2018] [Indexed: 11/11/2022] Open
Abstract
Background Undernutrition among children under 5 years of age continues to be a public health challenge in many low- and middle-income countries and can lead to growth stunting. Infectious diseases may also affect child growth, however their actual impact on the latter can be difficult to quantify. In this paper, we analyse data from 20 Demographic and Health Surveys (DHS) conducted in 13 African countries to investigate the relationship between malaria and stunting. Our objective is to make inference on the association between malaria incidence during the first year of life and height-for-age Z-scores (HAZs). Methods We develop a geostatistical model for HAZs as a function of both measured and unmeasured child-specific and spatial risk factors. We visualize stunting risk in each of the 20 analysed surveys by mapping the predictive probability that HAZ is below − 2. Finally, we carry out a meta-analysis by modelling the estimated effects of malaria incidence on HAZ from each DHS as a linear regression on national development indicators from the World Bank. Results A non-spatial univariate linear regression of HAZ on malaria incidence showed a negative association in 18 out of 20 surveys. However, after adjusting for spatial risk factors and controlling for confounding effects, we found a weaker association between HAZ and malaria, with a mix of positive and negative estimates, of which 3 out of 20 are significantly different from zero at the conventional 5% level. The meta-analysis showed that this variation in the estimated effect of malaria incidence on HAZ is significantly associated with the amount of arable land. Conclusion Confounding effects on the association between malaria and stunting vary both by country and over time. Geostatistical analysis provides a useful framework that allows to account for unmeasured spatial confounders. Establishing whether the association between malaria and stunting is causal would require longitudinal follow-up data on individual children. Electronic supplementary material The online version of this article (10.1186/s12942-018-0127-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Amoah
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Emanuele Giorgi
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK.
| | - Daniel J Heyes
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Stef van Burren
- Department of Child Health, Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands.,Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Peter John Diggle
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
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13
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Jackson BD, Black RE. A Literature Review of the Effect of Malaria on Stunting. J Nutr 2017; 147:2163S-2168S. [PMID: 28904111 DOI: 10.3945/jn.116.242289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/30/2016] [Accepted: 05/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background: The current version of the Lives Saved Tool (LiST) maternal and child health impact modeling software does not include an effect of malaria on stunting.Objective: This literature review was undertaken to determine whether such a causal link should be included in the LiST model.Methods: The PubMed, Embase, and Scopus databases were searched by using broad search terms. The searches returned a total of 4281 documents. Twelve studies from among the retrieved documents were included in the review according to the inclusion and exclusion criteria.Results: There was mixed evidence for an effect of malaria on stunting among longitudinal observational studies, and none of the randomized controlled trials of malaria interventions found an effect of the interventions on stunting.Conclusions: There is insufficient evidence to include malaria as a determinant of stunting or an effect of malaria interventions on stunting in the LiST model. The paucity and heterogeneity of the available literature were a major limitation. In addition, the studies included in the review consistently fulfilled their ethical responsibility to treat children under observation for malaria, which may have interfered with the natural history of the disease and prevented any observable effect on stunting or linear growth.
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Affiliation(s)
- Bianca D Jackson
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, MD
| | - Robert E Black
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, MD
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14
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Akiyama T, Pongvongsa T, Phrommala S, Taniguchi T, Inamine Y, Takeuchi R, Watanabe T, Nishimoto F, Moji K, Kano S, Watanabe H, Kobayashi J. Asymptomatic malaria, growth status, and anaemia among children in Lao People's Democratic Republic: a cross-sectional study. Malar J 2016; 15:499. [PMID: 27756399 PMCID: PMC5070163 DOI: 10.1186/s12936-016-1548-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/05/2016] [Indexed: 12/20/2022] Open
Abstract
Background Asymptomatic malaria can be observed in both stable endemic areas and unstable transmission areas. However, although much attention has been given to acute malaria infections, relatively little attention has been paid to asymptomatic malaria. Nonetheless, because the asymptomatic host serves as a reservoir for the malaria parasite, asymptomatic malaria is now recognized as an important obstacle to malaria elimination. Asymptomatic malaria is also associated with anaemia, a global public health problem with serious consequences on human health as well as social and economic development. In Lao People’s Democratic Republic (Lao PDR), malaria, anaemia, and malnutrition are serious public health concerns. However, few studies have focused on the relationship between these variables. Therefore, this study investigated the relationship between asymptomatic malaria, growth status, and the prevalence of anaemia among children aged 120 months old or younger in rural villages in Lao PDR. Methods In December 2010 and March 2011, data were collected from five villages in Savannakhet province. Anthropometric measurements, blood samples, and malaria rapid diagnostic tests were conducted. The presence of malaria was confirmed with polymerase chain reaction assays for Plasmodium falciparum. Underweight status, stunting, and anaemia were defined according to World Health Organization standards. Results The mean age of participants (n = 319) was 88.3 months old (Standard Deviation: 20.6, ranged from 30–119 months old), and 20 participants (6.3 %) had an asymptomatic malaria infection, 92 (28.8 %) were anaemic, 123 (38.6 %) were underweight, and 137 (42.9 %) were stunted. Stunted children were more likely to be infected with asymptomatic malaria [odds ratio (OR) 3.34, 95 % confidence interval (CI) 1.25–8.93], and asymptomatic malaria was associated with anaemia [OR 5.17, 95 % CI 1.99–13.43]. Conclusions These results suggest a significant association between asymptomatic malaria and anaemia in children. Furthermore, stunted children were more likely to have lower Hb levels and to be infected with asymptomatic malaria than children without stunting. However, further studies examining the impact of asymptomatic malaria infection on children’s nutritional and development status are necessary.
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Affiliation(s)
- Takeshi Akiyama
- Center of Molecular Bioscineces, Tropical Biosphere Research Center, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa, Japan. .,Nagano College of Nursing, Komagane, Nagano, Japan.
| | - Tiengkham Pongvongsa
- Station of Malariology, Parasitology and Entomology, Savannakhet Health Department, Savannakhet, Lao People's Democratic Republic
| | - Souraxay Phrommala
- National Institute of Public Health, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Tomoyo Taniguchi
- Center for Medical Education, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Yuba Inamine
- Center of Molecular Bioscineces, Tropical Biosphere Research Center, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa, Japan
| | - Rie Takeuchi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Tadashi Watanabe
- Department of Cell Biology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Futoshi Nishimoto
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Kazuhiko Moji
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Shigeyuki Kano
- Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hisami Watanabe
- Center of Molecular Bioscineces, Tropical Biosphere Research Center, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa, Japan.,Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Niigata, Japan
| | - Jun Kobayashi
- Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
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15
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McCuskee S, Brickley EB, Wood A, Mossialos E. Malaria and macronutrient deficiency as correlates of anemia in young children: a systematic review of observational studies. Ann Glob Health 2016; 80:458-65. [PMID: 25960095 DOI: 10.1016/j.aogh.2015.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Anemia is a leading cause of pediatric mortality and impaired development and is highly prevalent in young children in sub-Saharan Africa. Populations most affected by anemia also often are at high risk for malaria and macronutrient deficiency, conditions that may exacerbate anemia. Due to its multifactorial etiology, anemia presents a significant global health challenge, and successful interventions targeting anemia require a greater understanding of the relative and interacting contributions of malaria and undernutrition. OBJECTIVES The aim of this study was to assess the associations of malaria and undernutrition, indicated by stunting and wasting, with anemia in young children using a systematic review of observational studies. METHODS Searches were conducted in MEDLINE and Scopus. Articles were screened and reviewed for inclusion by two reviewers. Studies published after 1990 that measured anemia, Plasmodium falciparum malaria, and stunting or wasting in children aged 5 years or under were included. FINDINGS Of 620 articles reviewed, 15 studies from 9 countries in sub-Saharan Africa were included. Statistical approaches and anemia measurement varied widely, so synthesis was qualitative. Thirteen studies found that malaria infection was associated with anemia or lowered hemoglobin; in these studies, malaria accounted for more of the variation in anemia than nutritional status. In contrast, only 7 of the 13 studies investigating stunting and 3 of the 6 studies investigating wasting as correlates of anemia observed statistically significant associations at α = 0.05. The role of nutrition in anemia may differ by country. CONCLUSIONS Observational epidemiologic studies consistently demonstrate that malaria is an important correlate of anemia in young children; however, the roles of stunting and wasting and interactions between malaria and nutrition require further investigation. Based on the current evidence, these findings suggest that global health strategies to reduce the burden of anemia should prioritize malaria prevention and support research on alternative causes of anemia that reflect local conditions.
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Affiliation(s)
- Sarah McCuskee
- LSE Health, London School of Economics and Political Science, London, UK.
| | - Elizabeth B Brickley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Angela Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Elias Mossialos
- LSE Health, London School of Economics and Political Science, London, UK
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16
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Zayed AA, Beano AM, Haddadin FI, Radwan SS, Allauzy SA, Alkhayyat MM, Al-Dahabrah ZA, Al-Hasan YG, Yousef AMF. Prevalence of short stature, underweight, overweight, and obesity among school children in Jordan. BMC Public Health 2016; 16:1040. [PMID: 27716150 PMCID: PMC5048690 DOI: 10.1186/s12889-016-3687-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/20/2016] [Indexed: 01/03/2023] Open
Abstract
Background The prevalence of short stature (SS) and underweight in Jordan on a national level is unknown. This study aimed to investigate, on a national level, the prevalence of short stature (SS), underweight, overweight, and obesity among school aged children in Jordan. Methods This cross-sectional study was conducted from May 2015 to January 2016 and included 2702 subjects aged 6–17 years. Jordan was classified into 3 regions; North, Center (urban), and South (rural). Public and private schools were randomly selected from a random sample of cities from each region. The socioeconomic status of the sampling locations was assessed using several indicators including education, income, healthcare and housing conditions. For each participating subject, anthropometrics were obtained. SS, underweight, overweight and obesity were defined using Center of Disease Control’s (CDC) growth charts. Median Z-scores for each region, age and gender were calculated. Results The Central and Northern regions enjoyed higher socioeconomic status compared to rural Southern regions. The overall prevalence of SS, underweight, overweight, and obesity were 4.9 %, 5.7 %, 17.3 %, and 15.7 %, respectively. SS and underweight were most prevalent in the rural South, while obesity was highest in the Central region. Females were more likely to be overweight, while males were more likely to be obese. Private schools had higher prevalence of obesity and overweight than public ones. Conclusions Variations in height and weight among Jordanian school children might be affected by socioeconomic status.
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Affiliation(s)
- Ayman A Zayed
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, The University of Jordan/Jordan University Hospital, PO Box 13046, Amman, 11942, Jordan.
| | - Abdallah M Beano
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Faris I Haddadin
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Sohab S Radwan
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Suhaib A Allauzy
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Motasem M Alkhayyat
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Zaid A Al-Dahabrah
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
| | - Yanal G Al-Hasan
- School of Medicine, University of Jordan, PO Box 13046, Amman, 11942, Jordan
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17
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Ayeh-Kumi PF, Addo-Osafo K, Attah SK, Tetteh-Quarcoo PB, Obeng-Nkrumah N, Awuah-Mensah G, Abbey HNA, Forson A, Cham M, Asare L, Duedu KO, Asmah RH. Malaria, helminths and malnutrition: a cross-sectional survey of school children in the South-Tongu district of Ghana. BMC Res Notes 2016; 9:242. [PMID: 27118136 PMCID: PMC4847346 DOI: 10.1186/s13104-016-2025-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background As part of malaria characterization study in the South-Tongu district of Ghana, the current study was conducted to explore relationships between malaria, schistosomiasis, soil transmitted helminths and malnutrition in riparian community settings that had hitherto encountered episodes of mass deworming exercises. Methods School-age children were enrolled in a cross-sectional study from April through July 2012. Stool and urine samples were examined respectively for helminths and Schistosoma haematobium. Blood samples were analyzed for malaria parasites and haemoglobin (Hb) concentrations, respectively. Anthropometric indices were measured. Relationships were determined using generalized linear models. Results The results show low numbers of asymptomatic Plasmodium falciparum (9.2 %, n = 37/404) and S. haematobium (2.5 %, n = 10/404) infections. The associations between significance terms in the multivariate analysis for P. falciparum infections were further assessed to test the significance of the product terms directly i.e., age in years [adjusted odds ratio (AOR), 3.1; 95 % confidence interval (CI) 1.1–5.6], Hb concentration (AOR = 0.71; 95 % CI 0.42–2.3), and stunted malnutrition (AOR, 8.72; 95 % CI 4.8–25.1). The P. falciparum-associated decrease in mean Hb concentration was 2.82 g/dl (95 % CI 1.63–4.1 g/dl; P = 0.001) in stunted children, and 0.75 g/dl (95 % CI 1.59–0.085 g/dl; P = 0.076) in the non-stunted cohort. The anaemia-associated decrease in mean parasitaemia in stunted children was 3500 parasites/µl of blood (95 % CI 262.46–6737.54 parasites/µl of blood; P = 0.036), and in non-stunted children 2127 parasites/µl of blood (95 % CI −0.27 to 4.53; P = 0.085). Stunted malnutrition was the strongest predictor of S. haematobium infection (AOR = 11; 95 % CI 3.1–33.6) but significant associations as described for P. falciparum infections were absent. The population attributable risk of anaemia due to P. falciparum was 6.3 % (95 % CI 2.5–9.3), 0.9 % (95 % CI 0.4–2.3) for S. haematobium, and 12.5 % (95 % CI 9.11–19.52) for stunted malnutrition. Conclusion Plasmodium falciparum, S. haematobium, intestinal helminths and their co-infections were uncommon in our school-age children. Stunting exacerbated the extent to which malaria was associated with loss in Hb concentration. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2025-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick Ferdinand Ayeh-Kumi
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Korle-bu, Accra, Ghana
| | - Kantanka Addo-Osafo
- Department of Microbiology, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana
| | - Simon Kwaku Attah
- Department of Microbiology, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana.
| | | | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana
| | - Georgina Awuah-Mensah
- Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana
| | - Harriet Naa Afia Abbey
- Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana
| | - Akua Forson
- Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana
| | | | | | - Kwabena Obeng Duedu
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health & Allied Sciences, Ho, Ghana
| | - Richard Harry Asmah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Korle-bu, Accra, Ghana
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18
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Mitangala PN, D'Alessandro U, Donnen P, Hennart P, Porignon D, Bisimwa Balaluka G, Zozo Nyarukweba D, Cobohwa Mbiribindi N, Dramaix Wilmet M. [Malaria infection and nutritional status: results from a cohort survey of children from 6-59 months old in the Kivu province, Democratic Republic of the Congo]. Rev Epidemiol Sante Publique 2013; 61:111-20. [PMID: 23489948 DOI: 10.1016/j.respe.2012.06.404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 06/16/2012] [Accepted: 06/21/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey. METHODS A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at -3 and -2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. RESULTS After adjustment for season, children with severe stunting (height for age Z score<-3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/μL of blood as compared to those in with a better nutritional status (height for age Z score≥-2) (OR=0.48, 95% CI: 0.25-0.91). CONCLUSION Severely stunted children are at a lower risk of high-level malaria parasitemia.
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Affiliation(s)
- P N Mitangala
- École de santé publique, département de biostatistique, Université libre de Bruxelles, campus Erasme, route de Lennik 808, 1070 Brussels, Belgium.
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19
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Sumbele IUN, Samje M, Nkuo-Akenji T. A longitudinal study on anaemia in children with Plasmodium falciparum infection in the Mount Cameroon region: prevalence, risk factors and perceptions by caregivers. BMC Infect Dis 2013; 13:123. [PMID: 23497273 PMCID: PMC3600988 DOI: 10.1186/1471-2334-13-123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 03/01/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In heavily endemic malaria areas, it is almost inevitable that malarial infection will be associated with anaemia, although malaria may not be the prime cause of it. Anaemia is a major public health problem in Cameroon. We hypothesized that, factors other than falciparum malaria account for anaemia in the study area. METHODS A longitudinal study was conducted among 351 Plasmodium falciparum positive children to determine the prevalence, risk factors and the perception of anaemia by the caregivers in a semi-rural community. The investigative methods included the use of a structured questionnaire, clinical evaluation and laboratory investigations. RESULTS At enrolment the overall prevalence of anaemia as assessed by Hb concentration (Hb < 11 g/dl) was 80.3% (282). Following treatment the prevalence of persistent anaemia was 6% and 46.2% of the children achieved haematological recovery by day 42. Exploratory multiple linear regression analysis showed the following; parasitaemia density (P < 0.01), enlarged spleen (P < 0.05), duration of fever > 2 days (P < 0.01), high white blood cell count (P < 0.001), sex (P < 0.05), iron status indicators (ferritin and transferrin) (P < 0.001), level of education of the caregiver (P < 0.05), management of onset of malaria by caregiver (P < 0.005) and wasting (P < 0.05) to be risk factors for anaemia in children with falciparum infection. Approximately 75.5% (265) of the caregivers had some knowledge about anaemia. CONCLUSION The identified risk factors revealed the important contributors to the pathogenesis of anaemia in the Mount Cameroon region. Control efforts should therefore be directed towards proper health education emphasizing on proper health seeking behaviour and attitudes of the population.
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Affiliation(s)
- Irene Ule Ngole Sumbele
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P. O. Box 63, Buea, Cameroon
| | - Moses Samje
- Department of Medicine, Faculty of Health Sciences, University of Bamenda, P. O. Box 39, Bambili, Cameroon
| | - Theresa Nkuo-Akenji
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, P. O. Box 63, Buea, Cameroon
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20
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Novelli EM, Hittner JB, Davenport GC, Ouma C, Were T, Obaro S, Kaplan S, Ong'echa JM, Perkins DJ. Clinical predictors of severe malarial anaemia in a holoendemic Plasmodium falciparum transmission area. Br J Haematol 2010; 149:711-21. [PMID: 20408849 PMCID: PMC3095459 DOI: 10.1111/j.1365-2141.2010.08147.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Severe malarial anaemia (SMA) is a common complication of Plasmodium falciparum infections, resulting in mortality rates that may exceed 30% in paediatric populations residing in holoendemic transmission areas. One strategy for reducing the morbidity and mortality associated with SMA is to identify clinical predictors that can be readily recognized by caregivers for prompt therapeutic interventions. To determine clinical predictors of SMA, Kenyan children (3-36 months, n = 671) presenting with acute illness at a rural hospital in Siaya District were recruited. Demographic, clinical, laboratory and haematological parameters were measured upon enrolment. As human immunodeficiency virus-1 and bacteraemia promote reduced haemoglobin (Hb) concentrations, children with these infections were excluded from the analyses. Children with P. falciparum mono-infections (n = 355) were stratified into three groups: uncomplicated malaria (Hb >or= 110 g/l); non-SMA (60
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Affiliation(s)
- Enrico M Novelli
- Division of Haematology/Oncology, Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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21
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Crookston BT, Alder SC, Boakye I, Merrill RM, Amuasi JH, Porucznik CA, Stanford JB, Dickerson TT, Dearden KA, Hale DC, Sylverken J, Snow BS, Osei-Akoto A, Ansong D. Exploring the relationship between chronic undernutrition and asymptomatic malaria in Ghanaian children. Malar J 2010; 9:39. [PMID: 20122258 PMCID: PMC2837055 DOI: 10.1186/1475-2875-9-39] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 02/02/2010] [Indexed: 11/15/2022] Open
Abstract
Background A moderate association has been found between asymptomatic parasitaemia and undernutrition. However, additional investigation using the gold standard for asymptomatic parasitaemia confirmation, polymerase chain reaction (PCR), is needed to validate this association. Anthropometric measurements and blood samples from children less than five years of age in a rural Ghanaian community were used to determine if an association exists between chronic undernutrition and PCR-confirmed cases of asymptomatic malaria. Methods This was a descriptive cross-sectional study of 214 children less than five years of age from a community near Kumasi, Ghana. Blood samples and anthropometric measurements from these children were collected during physical examinations conducted in January 2007 by partners of the Barekuma Collaborative Community Development Programme. Results Findings from the logistic model predicting the odds of asymptomatic malaria indicate that children who experienced mild, moderate or severe stunting were not more likely to have asymptomatic malaria than children who were not stunted. Children experiencing anaemia had an increased likelihood (OR = 4.15; 95% CI: 1.92, 8.98) of asymptomatic malaria. Similarly, increased spleen size, which was measured by ultrasound, was also associated with asymptomatic malaria (OR = 2.17; 95% CI: 1.44, 3.28). Fast breathing, sex of the child, and age of the child were not significantly associated with the asymptomatic malaria. Conclusions No significant association between chronic undernutrition and presence of asymptomatic malaria was found. Children who experience anaemia and children who have splenomegaly are more likely to present asymptomatic malaria. Programmes aimed at addressing malaria should continue to include nutritional components, especially components that address anaemia.
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Affiliation(s)
- Benjamin T Crookston
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT 84108, USA.
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Sowunmi A, Gbotosho GO, Happi CT, Fateye BA. Factors contributing to anaemia after uncomplicated Plasmodiumfalciparum malaria in children. Acta Trop 2010; 113:155-61. [PMID: 19874795 DOI: 10.1016/j.actatropica.2009.10.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 06/15/2009] [Accepted: 10/20/2009] [Indexed: 11/16/2022]
Abstract
The factors contributing to anaemia in falciparum malaria were characterized in 1261 prospectively studied children in an endemic area of southwestern Nigeria. Of these, 487 (39%) presented with anaemia (haematocrit <30%). The following were found to be independent risk factors for anaemia at presentation: age <5 years, history of illness >3 days before presentation, presence of fever, a palpable liver, >parasitaemia 10,000/microl blood, and gametocytaemia. The mean maximum fractional fall in haematocrit (FFH) after treatment was 13.8% (95% confidence interval [CI] 13-14.6) of the baseline value. This occurred 3 days after treatment began and correlated positively with enrolment haematocrit. In children whose haematocrit was >30% at enrolment, the following were found to be independent risk factors associated with subsequent development of anaemia during follow-up: age <5 years and parasitaemia > or =100,000 parasites/microl. Haematological recovery was usually complete by 4-5 weeks, but was slower in children who were anaemic at enrolment and in those with recrudescence of their infections. Half of the children with recrudescence were still anaemic at 4 weeks. These findings have implications for the control of the burden of malarial anaemia in children in sub-Saharan African countries.
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Affiliation(s)
- Akintunde Sowunmi
- Department of Pharmacology & Therapeutics, Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.
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A novel functional variant in the stem cell growth factor promoter protects against severe malarial anemia. Infect Immun 2009; 78:453-60. [PMID: 19884328 DOI: 10.1128/iai.00895-09] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Plasmodium falciparum malaria is a leading global cause of infectious disease burden. In areas in which P. falciparum transmission is holoendemic, such as western Kenya, severe malarial anemia (SMA) results in high rates of pediatric morbidity and mortality. Although the pathophysiological basis of SMA is multifactorial, we recently discovered that suppression of unexplored hematopoietic growth factors that promote erythroid and myeloid colony development, such as stem cell growth factor (SCGF) (C-type lectin domain family member 11A [CLEC11A]), was associated with enhanced development of SMA and reduced erythropoietic responses. To extend these investigations, the relationships between a novel SCGF promoter variant (-539C/T, rs7246355), SMA (hemoglobin [Hb] < 6.0 g/dl), and reduced erythropoietic responses (reticulocyte production index [RPI], <2.0) were investigated with Kenyan children (n = 486) with falciparum malaria from western Kenya. Circulating SCGF was positively correlated with hemoglobin levels (r = 0.251; P = 0.022) and the reticulocyte production index (RPI) (r = 0.268; P = 0.025). Children with SMA also had lower SCGF levels than those in the non-SMA group (P = 0.005). Multivariate logistic regression analyses controlling for covariates demonstrated that individuals with the homologous T allele were protected against SMA (odds ratio, 0.57; 95% confidence interval [95% CI] 0.34 to 0.94; P = 0.027) relative to CC (wild-type) carriers. Carriers of the TT genotype also had higher SCGF levels in circulation (P = 0.018) and in peripheral blood mononuclear cell culture supernatants (P = 0.041), as well as an elevated RPI (P = 0.005) relative to individuals with the CC genotype. The results presented here demonstrate that homozygous T at -539 in the SCGF promoter is associated with elevated SCGF production, enhanced erythropoiesis, and protection against the development of SMA in children with falciparum malaria.
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Suppression of a novel hematopoietic mediator in children with severe malarial anemia. Infect Immun 2009; 77:3864-71. [PMID: 19528216 DOI: 10.1128/iai.00342-09] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In areas of holoendemic Plasmodium falciparum transmission, severe malarial anemia (SMA) is a leading cause of pediatric morbidity and mortality. Although many soluble mediators regulate erythropoiesis, it is unclear how these factors contribute to development of SMA. Investigation of novel genes dysregulated in response to malarial pigment (hemozoin [PfHz]) revealed that stem cell growth factor (SCGF; also called C-type lectin domain family member 11A [CLEC11A]), a hematopoietic growth factor important for development of erythroid and myeloid progenitors, was one of the most differentially expressed genes. Additional experiments with cultured peripheral blood mononuclear cells (PBMCs) demonstrated that PfHz decreased SCGF/CLEC11A transcriptional expression in a time-dependent manner. Circulating SCGF levels were then determined for Kenyan children (n = 90; aged 3 to 36 months) presenting at a rural hospital with various severities of malarial anemia. SCGF levels in circulation (P = 0.001) and in cultured PBMCs (P = 0.004) were suppressed in children with SMA. Circulating SCGF also correlated positively with hemoglobin levels (r = 0.241; P = 0.022) and the reticulocyte production index (RPI) (r = 0.280; P = 0.029). In addition, SCGF was decreased in children with reduced erythropoiesis (RPI of <2) (P < 0.001) and in children with elevated levels of naturally acquired monocytic PfHz (P = 0.019). Thus, phagocytosis of PfHz promotes a decrease in SCGF gene products, which may contribute to reduced erythropoiesis in children with SMA.
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Achidi EA, Apinjoh TO, Mbunwe E, Besingi R, Yafi C, Wenjighe Awah N, Ajua A, Anchang JK. Febrile status, malarial parasitaemia and gastro-intestinal helminthiases in schoolchildren resident at different altitudes, in south-western Cameroon. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2008; 102:103-18. [PMID: 18318932 DOI: 10.1179/136485908x252287] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the many areas where human malaria and helminthiases are co-endemic, schoolchildren often harbour the heaviest infections and suffer much of the associated morbidity, especially when co-infected. In one such area, the Buea district, in south-western Cameroon, two cross-sectional surveys, together covering 263 apparently healthy schoolchildren aged 4-12 years, were recently conducted. The prevalences of fever, malarial parasitaemia and intestinal helminth infections, the seroprevalences of anti-Plasmodium falciparum IgG and IgE and anti-glycosylphosphatidylinositol (anti-GPI) IgG, plasma concentrations of total IgE, and the incidence of anaemia were all investigated. The mean (S.D.) age of the study children was 7.56 (1.82) years. Overall, 156 (59.3%) of the children were found parasitaemic, with a geometric mean parasitaemia of 565 parasites/microl. Parasitaemia and fever were significantly associated (P=0.042). The children who lived at low altitude, attending schools that lay 400-650 m above sea level, had significantly higher parasitaemias than their high-altitude counterparts (P<0.01). At low altitude, the children attending government schools had significantly higher parasitaemias than their mission-school counterparts (P=0.010). Of the 31 children (11.9%) found anaemic, 22 (70.4%) had mild anaemia and none had severe anaemia. A significant negative correlation (r=-0.224; P=0.005) was observed between haemoglobin concentration and level of parasitaemia. Infection with Plasmodium appeared to reduce erythrocyte counts (P=0.045), a condition that was exacerbated by co-infection with helminths (P=0.035). Plasma concentrations of total IgE were higher in the children found to be excreting helminth eggs than in those who appeared helminth-free, while levels of anti-P. falciparum IgE were higher in the children with low-grade parasitaemias than in those with more intense parasitaemias. Levels of anti-GPI IgG increased with age and were relatively high in the children who lived at low altitude and in those who were aparasitaemic. The survey results confirm that asymptomatic malarial parasitaemia frequently co-exists with helminth infections in schoolchildren and indicate links with fever, altitude and school type. Immunoglobulin E may play a role in immune protection against helminthiasis whereas anti-GPI antibodies may be important in the development of antimalarial immunity in such children. In Cameroon, as in other areas with endemic malaria, control programmes to reduce the prevalences of infections with intestinal helminths and malarial parasites in schoolchildren, which may effectively reduce the incidence of anaemia, are clearly needed.
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Affiliation(s)
- E A Achidi
- Department of Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
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Sanou D, Turgeon-O’Brien H, Desrosiers T. Prévalence et déterminants non alimentaires de l’anémie et de la carence en fer chez des orphelins et enfants vulnérables d’âge préscolaire du Burkina-Faso. NUTR CLIN METAB 2008. [DOI: 10.1016/j.nupar.2008.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ngnie-Teta I, Receveur O, Kuate-Defo B. Risk factors for moderate to severe anemia among children in Benin and Mali: insights from a multilevel analysis. Food Nutr Bull 2007; 28:76-89. [PMID: 17718015 DOI: 10.1177/156482650702800109] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anemia currently affects 2 billion people throughout the world. Although the immediate causes of anemia among children are known (including malnutrition and infections), the importance of contextual determinants and their relationships with individual effects have rarely been explored. OBJECTIVE To identify anemia risk factors at the individual, household, and community levels among Beninese and Malian children, using simple and multilevel regression methods. METHODS An analysis was undertaken of nationally representative data collected in 2001 in Benin (n = 2,284) and Mali (n = 2,826) by the Demographic and Health Surveys. Sixteen potential risk factors for anemia were considered at the individual, household, and community levels. Comparative analyses were carried out using simple and multilevel logistic regression models. RESULTS Simple and multilevel logistic regression analyses yielded broadly similar results. Risk factors for moderate to severe anemia included incomplete immunization, stunted growth, recent infection, absence of bednet, low household living standard, rural residency (Mali), low maternal education, and low community development index (Benin). In addition, multilevel analysis indicated a clustering level of anemia in communities (intraclass correlation) of 14% and 19% in Benin and Mali, respectively. CONCLUSIONS Risk factors for child anemia appeared at all three levels (individual, household and community). Community-level clustering seemed to be low. Therefore, interventions to address anemia need not be village- or region-specific. Identifying a successful and replicable program is now a priority in child survival endeavors. It is likely that such a program would include a focus on improving immunization coverage, increased bednet usage, and reduced protein-energy malnutrition.
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Affiliation(s)
- Ismael Ngnie-Teta
- PATH Canada, Suite 1105, One Nicholas Street, Ottawa, Ontario K1N 7B7, Canada.
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Sowunmi A, Gbotosho GO, Adedeji AA, Fateye BA, Sabitu MF, Happi CT, Fehintola FA. Effects of acute Plasmodium falciparum malaria on body weight in children in an endemic area. Parasitol Res 2007; 101:343-9. [PMID: 17323138 DOI: 10.1007/s00436-007-0494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
The impacts of acute falciparum malaria on body weight and the host and parasite factors predictive of change in body weight were characterized in 465 prospectively studied children in an endemic area of southwest Nigeria. Pre-treatment weights were significantly lower than the 14 to 28-day post-treatment weights (P = 0.0001). In 187 children, fractional fall in body weight (FFBW) exceeded 4.9%. FFBW correlated negatively with age and body weight (P = 0.014 and 0.0001, respectively), but not with enrollment parasitaemia. In a multiple regression model, an age < or =5 years (AOR = 2.03, 95% CI 1.2-3.2, P = 0.003), a hematocrit < or =29% (AOR = 1.6, 95% CI 1.0-2.3, P = 0.037), and a body weight < or =9.6 kg (AOR = 5.4, 95% CI 1.7-20, P = 0.003) were independent predictors of FFBW > or =5% at presentation. Children who, after initial clearance, had recurrence of their parasitaemia within 28 days had a significantly higher propensity not to gain weight than children who were aparasitaemic after treatment (log-rank statistic 6.76, df = 1, P = 0.009). These results indicate that acute malaria contribute to sub-optimal growth in young children and may have implications for malaria control efforts in sub-Saharan Africa.
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Affiliation(s)
- Akintunde Sowunmi
- Department of Pharmacology & Therapeutics and Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.
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Malaria and anaemia among children in two communities of Kumasi, Ghana: a cross-sectional survey. Malar J 2006; 5:105. [PMID: 17094806 PMCID: PMC1654171 DOI: 10.1186/1475-2875-5-105] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 11/09/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A survey in Kumasi, Ghana found a marked Plasmodium falciparum prevalence difference between two neighbouring communities (Moshie Zongo and Manhyia). The primary objective of this follow-up study was to determine whether this parasite rate difference was consistent over time. Secondary objectives were to compare prevalences of clinical malaria, anaemia, intestinal parasite infections, and malnutrition between these communities; and to identify potential risk factors for P. falciparum infection and anaemia. METHODS A cross-sectional house-to-house survey of P. falciparum parasitaemia, clinical malaria, anaemia, anthropometric indices, and intestinal helminths was conducted in April-May 2005. Data collection included child and household demographics, mosquito avoidance practices, distance to nearest health facility, child's travel history, symptoms, and anti-malarial use. Risk factors for P. falciparum and anaemia (Hb < 11 g/dl) were identified using generalized linear mixed models. RESULTS In total, 296 children were tested from 184 households. Prevalences of P. falciparum, clinical malaria, anaemia, and stunting were significantly higher in Moshie Zongo (37.8%, 16.9%, 66.2% and 21.1%, respectively) compared to Manhyia (12.8%, 3.4%, 34.5% and 7.4%). Of 197 children tested for helminths, four were positive for Dicrocoelium dendriticum. Population attributable risks (PAR%) of anaemia were 16.5% (P. falciparum) and 7.6% (malnutrition). Risk factors for P. falciparum infection were older age, rural travel, and lower socioeconomic status. Risk factors for anaemia were P. falciparum infection, Moshie Zongo residence, male sex, and younger age. CONCLUSION Heterogeneities in malariometric indices between neighbouring Kumasi communities are consistent over time. The low helminth prevalence, and the twofold higher PAR% of anaemia attributable to P. falciparum infection compared to malnutrition, indicate the importance of malaria as a cause of anaemia in this urban population.
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Carneiro IA, Smith T, Lusingu JPA, Malima R, Utzinger J, Drakeley CJ. Modeling the relationship between the population prevalence of Plasmodium falciparum malaria and anemia. Am J Trop Med Hyg 2006; 75:82-9. [PMID: 16931819 DOI: 10.4269/ajtmh.2006.75.82] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
More than half of all young children and pregnant women are affected by anemia. Although its etiology is multi-factorial, malaria is likely to be a major contributor to chronic anemia in endemic areas. Recent reviews have examined the effect of community-based malaria control interventions on anemia. We analyze how the prevalence of anemia depends on that of Plasmodium falciparum malaria by developing models of the excess risk of anemia caused by malaria at a population level in 24 villages in northeastern Tanzania. In that setting, we estimated that the prevalence of a hemoglobin level < 8 g/dL attributable to malaria was 4.6% in infants, 4.1% in children one year of age, 2.7% in children two years of age, and 3.3% in women of childbearing age. Successful validation of our models in other malaria-endemic settings would enable their use for predicting the impact of malaria control interventions on anemia, and for long-term monitoring and surveillance of malaria.
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Affiliation(s)
- Ilona A Carneiro
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Hoffman DJ, Lee SK. The prevalence of wasting, but not stunting, has improved in the Democratic People's Republic of Korea. J Nutr 2005; 135:452-6. [PMID: 15735077 DOI: 10.1093/jn/135.3.452] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Democratic People's Republic of Korea (DPRK) is one of the nutritionally vulnerable countries of the world. The objectives of this paper were to determine the current prevalence of undernutrition among children using data from the latest national survey and to compare the findings with those from the previous national survey in 1997. In 2002 with cooperation from UNICEF and the World Food Program (WFP), the government of the DPRK conducted a survey of 6000 households with children < 7 y old using multiple-stage sampling methods. Data were collected for sociodemographic variables, use of WFP food aid, and anthropometric measures of the youngest child in the household. The prevalence of stunting (height for age Z-score less than -2.0) in all children was 39.4% (40.2 and 38.5% for boys and girls, respectively). The prevalence of wasting (weight for height Z-score less than -2.0) was 8.2% in all children (9.1 and 7.3% for boys and girls, respectively). Although the prevalence of wasting has decreased from 1997 (16.5%) to 2002 (8.2%), the prevalence of stunting has not changed between those years, 38.2 vs. 39.4%. Thus, we conclude that acute undernutrition is decreasing in the DPRK, but chronic undernutrition that results in stunting is still highly prevalent. Continued surveillance of nutritional status of children in the DPRK is warranted given the continued state of undernutrition in that country.
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Affiliation(s)
- Daniel J Hoffman
- Department of Nutritional Sciences, Rutgers-the State University of New Jersey, New Brunswick, NJ, USA.
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Korenromp EL, Armstrong-Schellenberg JRM, Williams BG, Nahlen BL, Snow RW. Impact of malaria control on childhood anaemia in Africa -- a quantitative review. Trop Med Int Health 2004; 9:1050-65. [PMID: 15482397 DOI: 10.1111/j.1365-3156.2004.01317.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the impact of malaria control on haemoglobin (Hb) distributions and anaemia prevalences in children under 5 in malaria-endemic Africa. METHODS Literature review of community-based studies of insecticide-treated bednets, antimalarial chemoprophylaxis and insecticide residual spraying that reported the impact on childhood anaemia. Anaemia outcomes were standardized by conversion of packed cell volumes into Hb values assuming a fixed threefold difference, and by estimation of anaemia prevalences from mean Hb values by applying normal distributions. Determinants of impact were assessed in multivariate analysis. RESULTS Across 29 studies, malaria control increased Hb among children by, on average, 0.76 g/dl [95% confidence interval (CI): 0.61-0.91], from a mean baseline level of 10.5 g/dl, after a mean of 1-2 years of intervention. This response corresponded to a relative risk for Hb < 11 g/dl of 0.73 (95% CI: 0.64-0.81) and for Hb < 8 g/dl of 0.40 (95% CI: 0.25-0.55). The anaemia response was positively correlated with the impact on parasitaemia (P = 0.005, P = 0.008 and P = 0.01 for the three outcome measures), but no relationship with the type or duration of malaria intervention was apparent. Impact on the prevalence of Hb < 11 g/dl was larger in sites with a higher baseline parasite prevalence. Although no age pattern in impact was apparent across the studies, some individual trials found larger impacts on anaemia in children aged 6-35 months than in older children. CONCLUSION In malaria-endemic Africa, malaria control reduces childhood anaemia. Childhood anaemia may be a useful indicator of the burden of malaria and of the progress in malaria control.
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