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Plasmodium vivax: a cause of malnutrition in young children
T N Williams1, K Maitland, L Phelps
1Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK. tom.williams@imm.ox.ac.uk
Insights
Plasmodium vivax malaria significantly predicts acute malnutrition in children under 10 in Vanuatu. This finding highlights the severe impact of P. vivax, often considered benign, on child health and mortality.
Area of Science:
- Tropical medicine
- Pediatric nutrition
- Infectious disease epidemiology
Background:
- Malnutrition remains a significant global health challenge, particularly in resource-limited settings.
- The aetiology of malnutrition is multifactorial, involving nutritional, infectious, and socioeconomic factors.
- Plasmodium vivax malaria is prevalent in many tropical regions and is often perceived as less severe than Plasmodium falciparum malaria.
Purpose of the Study:
- To investigate the aetiology of malnutrition in children under 10 years old in Espiritu Santo, Vanuatu.
- To determine the association between Plasmodium vivax and Plasmodium falciparum malaria infections and different forms of malnutrition (underweight, wasting, stunting).
Main Methods:
- A cohort study of 1511 children under 10 years old in Vanuatu.
- Malnutrition was assessed using standard anthropometric criteria: weight-for-age (WA), weight-for-height (WH), and height-for-age (HA) Z-scores.
- Multiple logistic regression and incidence rate ratio analyses were used to identify factors associated with malnutrition and malaria infection.
Main Results:
- Younger age (< 5 years) and recent clinical Plasmodium vivax malaria were significantly associated with wasting in children.
- Underweight children had a significantly higher incidence of P. vivax infection in the preceding 6 months compared to non-underweight children.
- Plasmodium falciparum infection incidence did not differ significantly between malnourished and non-malnourished children, nor did wasting predispose to or protect against malaria.
Conclusions:
- Plasmodium vivax malaria is a major predictor of acute malnutrition in this cohort of young children.
- Contrary to its benign perception, P. vivax malaria may contribute significantly to global child mortality through malnutrition.
- Public health strategies should consider the impact of P. vivax on nutritional status in endemic areas.
Abstract:
We studied the aetiology of malnutrition in a cohort of 1511 children < 10 years old in Espiritu Santo, Vanuatu. Malnutrition was categorized using standard anthropometric criteria as: underweight [weight-for-age (WA) Z score < -2], wasting [weight-for-height (WH) Z < -2], or stunting [height-for-age (HA) Z < -2]. On multiple logistic regression analysis, the only factors significantly associated with wasting were age < 5 years [OR (95% CI) 1.8 (1.2-2.9), p = 0.01] and having suffered one or more episodes of clinical P. vivax malaria in the 6 months preceding nutritional assessment [OR 2.4 (1.3-4.4), p = 0.006]. The incidence of P. vivax infection was significantly higher during the 6 months preceding assessment in underweight vs. non-underweight children [incidence rate ratio (IRR) 2.6 (1.5-4.4), p < or = 0.0001). These groups had similar incidences of clinical P. falciparum infection during the same period [IRR 1.1 (0.57-2.1) p = 0.8] and of either species during the 6 months following assessment [IRR P. vivax 1.3 (0.9-2.0) p = 0.2; IRR P. falciparum 1.3 (0.9-1.9) p = 0.2]. In these children, P. vivax malaria was a major predictor of acute malnutrition; P. falciparum was not. Wasting neither predisposed to nor protected against malaria of either species. Although P. vivax malaria is generally regarded as benign, it may produce considerable global mortality through malnutrition.