Malaria and Under-Nutrition: A Community Based Study Among Under-Five Children at Risk of Malaria, South-West Ethiopia Malaria and nutritional status in children living on the coast of Kenya. Childhood asymptomatic malaria and nutritional status among Port Harcourt children. Nutritional and socio-demographic risk indicators of malaria in children under five: a cross-sectional study in a Sudanese rural community. Effect of Nutritional Status on Response to Treatment with Artemisinin-Based Combination Therapy in Young Ugandan Children with Malaria The relationship between Plasmodium infection, anaemia and nutritional status in asymptomatic children aged under five years living in stable transmission zones in Kinshasa, Democratic Republic of Congo Comparability of treatment groups and risk factors for parasitemia at the first antenatal clinic visit in a study of malaria treatment and prevention in pregnancy in rural Malawi. The impact of anthelmintic treatment intervention on malaria infection and anaemia in school and preschool children in Magu district, Tanzania: an open label randomised intervention trial A health and nutritional profile of rural school children in KwaZulu-Natal, South Africa Malaria and intestinal helminthiasis in school children of Kumba Urban Area, Cameroon. Nutritional status, intestinal parasite infection and allergy among school children in Northwest Ethiopia Dynamics of anemia in relation to parasitic infections, micronutrient status, and increasing age in South-Central Côte d'Ivoire. The effects of malaria control on nutritional status in infancy. Living conditions and occurrence of malaria in a rural community. Distinct clinical and immunologic profiles in severe malarial anemia and cerebral malaria in Zambia. Parasitic infections, anaemia and nutritional status: a study of their interrelationships and the effect of prophylaxis and treatment on workers in Kwale District, Kenya. Effect of supplementary vitamins and iron on malaria indices in rural Gambian children.
Background The interaction between malaria and under-nutrition is not well eluci date d in Ethiopia . The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia . Methods This cross-sectional study was undertaken during March – February , 2009 as part of the baseline assessment of a cluster r and omized trial around Gilgel Gibe Hydroelectric dam , south-west Ethiopia . A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia . The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics ( NCHS ) . Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer ( HemoCue Hb 301 , Sweden ) . Results Significant proportion ( 40.4 % ) of under-five children were stunted ( height-for-age<−2SD ) . The prevalence of under-weight was 34.2 % . One third and one tenth of the children had anemia and malaria parasite respectively . Older children were more likely to have under-nutrition . There was no association between malaria and under-nutrition . Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite , [ OR = 1.5 , ( 95 % CI : 1.1–2.0 ) ] . Conclusion In this study , there is no association between malaria and under-nutrition . Children who have malaria are more likely to be anaemic . Malaria prevention and control program should consider nutrition interventions particularly anemia BACKGROUND The relation between malnutrition and malaria is controversial . On the one h and , malaria may cause malnutrition , whereas on the other h and , malnutrition itself may modulate susceptibility to the disease . OBJECTIVE The objective was to investigate the association between Plasmodium falciparum malaria and malnutrition in a cohort of Kenyan children . DESIGN The study involved the longitudinal follow-up of children aged 0 - 95 [ corrected ] mo for clinical malaria episodes and anthropometric measurements through 4  cross-sectional surveys . We used Poisson regression analysis to investigate the association between malaria and nutritional status . RESULTS The crude incidence rate ratios ( IRRs ) for malaria during the 6-mo period before assessment in children defined as malnourished on the basis of low height-for-age or low weight-for-age z scores ( < -2 ) were 1.17 ( 95 % CI : 0.91 , 1.50 ; P=0.21 ) and 0.94 ( 0.71 , 1.25 ; P=0.67 ) , respectively , which suggests no association between malaria and the subsequent development of protein-energy malnutrition . However , we found that age acted as an effect modifier in the association between malaria episodes and malnutrition on prospect i ve follow-up . The IRR for malaria in children aged 0 - 2 y , who were subsequently characterized as underweight , was 1.65 ( 1.10 , 2.20 ; P=0.01 ) , and a significant overall relation between malaria and stunting was found on regression analysis after adjustment for the interaction with age ( IRR : 1.91 ; 1.01 , 3.58 ; P=0.04 ) . CONCLUSION Although children living on the coast of Kenya continue to experience clinical episodes of uncomplicated malaria throughout the first decade of life , the effect of malaria on nutritional status appears to be greatest during the first 2 y of life OBJECTIVE Our study in Port Harcourt children with asymptomatic malaria aim ed at assessing the baseline anthropometric indices of nutritional status , and whether their nutritional status ( especially under nutrition ) offers any advantage for living in malaria endemic areas . DESIGN Cross-sectional study was used . SETTING Rumueme Community in Port Harcourt , Nigeria . SUBJECTS Apparently healthy children aged 1 - 8 years of both sexes ( Boys = 117 , Girls = 123 ; Ratio 1:1.05 ) , 240 children from r and omly selected households within the study community participated in the study . RESULTS Of the 240 children , 66 ( 27.5 % ) were infected with malaria ( P falciparum ) . Children below 5 years had a higher parasitaemic rate ( 36.36 % ) than those in 5 - 8 years group ( 21.27 % ) . Our baseline data showed that 17.5 % were underweight ( WFA Z < -2 ) , 3.75 % were stunted ( HFA Z < -2 ) and 22.5 % were wasting ( WFH Z < -2 ) . Children who are underweight were found to be at higher risk of acquiring malaria infection than the well nourished children ( RR = 1.02 , chi2 = 0.320 , p < 0.02 , 95 % CI 0.34 - 2.37 ) . Under nutrition was more prominent in the children below 5 years than the older children ( RR = 3.625 , chi2 = 10.36 , p < 0.006 , 95 % CI 1.81 - 5.43 ) . The haemoglobin value of parasitized children ( 10.8 + /- 1.9 g/dl ) was significantly lower than the non-parasitized group ( 11.3 + /- 1.7 g/dl , ) ( p < 0.01 ) . CONCLUSION We concluded that the presence of under nutrition places children ( especially below 5 years of age ) at higher risk of malaria related morbidity . Children in malaria endemic areas need adequate nutrition to withst and the negative impact of malaria This paper reports the results of a cross-sectional study of the association between nutritional , environmental and socio-demographic factors , and malaria occurrence among 445 children under 5 years of age in a Sudanese rural community . The overall frequency of malaria as defined by a history of clinical illness during the previous 2 months was 27 % . Malaria occurrence was positively associated with the degree of malnutrition as assessed by weight-for-age . The age-adjusted odds ratio for mild malnutrition and history of malaria was 1.2 ( 95 % confidence interval ( CI ) : 0.7 - 2.0 ) and for moderate malnutrition and malaria was 2.1 ( 95 % CI : 1.1 - 4.0 ) . Malaria was less frequent among children 0 - 11 months of age relative to older children ( OR = 0.4 ; 95 % CI:0.2 - 0.7 ) , and was inversely associated with ownership of a refrigerator ( OR = 0.5 ; 95 % CI:0.36 - 0.94 ) , an indicator of socio-economic status . Indicators of crowding were the best predictors of the risk of malaria . Less malaria was observed in households with three or more rooms ( OR = 0.6 ; 95 % CI:0.37 - 0.98 ) and more malaria was observed in households with more than five people ( OR = 2.5 ; 95 % CI:1.4 - 4.5 ) . Malaria was slightly , but not significantly , more frequent among boys and was associated with anaemia , which was probably an outcome of malaria in the past . These data suggest that undernutrition may increase the risk of malaria , and draw attention to the importance of socio-economic and environmental factors in relation to this disease . These relationships deserve further examination in prospect i ve follow-up studies that are better able to evaluate the temporal relations of malnutrition and malaria ABSTRACT The relationship between malnutrition and malaria in young children is under debate , and no studies evaluating the association between malnutrition and response to artemisinin-based combination therapies ( ACTs ) have been published . We evaluated the association between malnutrition and response to antimalarial therapy in Ug and an children treated with ACTs for repeated episodes of malaria . Children aged 4 to 12 months diagnosed with uncomplicated malaria were r and omized to dihydroartemisinin-piperaquine ( DP ) or artemether-lumefantrine ( AL ) and followed for up to 2 years . All HIV-exposed and HIV-infected children received trimethoprim-sulfamethoxazole prophylaxis ( TS ) . The primary exposure variables included height-for-age and weight-for-age z scores . Outcomes included parasite clearance at days 2 and 3 and risk of recurrent parasitemia after 42 days of follow-up . Two hundred ninety-two children were r and omized to DP or AL , result ing in 2,013 malaria treatments . Fewer than 1 % of patients had a positive blood smear by day 3 ( DP , 0.2 % ; AL , 0.6 % [ P = 0.18 ] ) . There was no significant association between height-for-age or weight-for-age z scores and a positive blood smear 2 days following treatment . For children treated with DP but not on TS , decreasing height-for-age z scores of < −1 were associated with a higher risk of recurrent parasitemia than a height-for-age z score of > 0 ( hazard ratio [ HR ] for height-for-age z score of < −1 and ≥−2 = 2.89 [ P = 0.039 ] ; HR for height-for-age z score of < −2 = 3.18 [ P = 0.022 ] ) . DP and AL are effective antimalarial therapies in chronically malnourished children in a high-transmission setting . However , children with mild to moderate chronic malnutrition not taking TS are at higher risk for recurrent parasitemia and may be considered a target for chemoprevention Background Malaria is preventable and treatable when recommended interventions are properly implemented . Thus , diagnosis and treatment focus on symptomatic individuals while asymptomatic Plasmodium infection ( PI ) plays a role in the sustainability of the transmission and may also have an impact on the morbidity of the disease in terms of anaemia , nutritional status and even cognitive development of children . The objective of this study was to assess PI prevalence and its relationship with known morbidity factors in a vulnerable but asymptomatic stratum of the population . Methods A simple r and om sample , household survey in asymptomatic children under the age of five was conducted from April to September 2012 in two health areas of the health zone of Mont Ngafula 1 , Kinshasa , Democratic Republic of Congo . Results The PI prevalence were 30.9 % ( 95 % CI : 26.5 - 35.9 ) and 14.3 % ( 95 % CI : 10.5 - 18.1 ) in Cité Pumbu and Kindele health areas , respectively , ( OR : 2.7 ; p < 0.001 ) . All were Plasmodium falciparum infected and 4 % were co-infected with Plasmodium malariae . In Cité Pumbu and Kindele , the prevalence of anaemia ( haemoglobin < 11 g/dL ) was 61.6 % ( 95 % CI : 56.6 - 66.5 ) and 39.3 % ( 95 % CI : 34.0 - 44.6 ) , respectively , ( OR : 2.5 ; p < 0.001 ) . The health area of Cité Pumbu had 32 % ( 95 % CI : 27.5 - 37.0 ) of chronic malnutrition ( HAZ score ≤ −2SD ) compared to 5.1 % ( 95 % CI : 2.8 - 7.6 ) in Kindele . PI was predictor factor for anaemia ( aOR : 3.5 , p = 0.01 ) and within infected children , there was an inverse relationship between parasite density and haemoglobin level ( β = −5 * 10−5 , p < 0.001 ) . Age older than 12 months ( aOR : 3.8 , p = 0.01 ) , presence of anaemia ( aOR : 3.4 , p = 0.001 ) , chronic malnutrition ( aOR : 1.8 , p = 0.01 ) , having a single parent/guardian ( aOR : 1.6 , p = 0.04 ) , and the non-use of insecticide-treated nets ( aOR : 1.7 , p = 0.04 ) were all predictors for PI in the overall population . Conclusion PI in asymptomatic children was correlated with anaemia and chronic malnutrition and was thus a harmful condition in the study population . Malaria control initiatives should not only focus on treatment of symptomatic infections but also take into consideration asymptomatic but infected children The problems of Plasmodium falciparum infection in pregnant women have been described in numerous sub-Saharan African countries , but the frequency of parasitemia at the first antenatal visit and risk factors for infection have not been fully investigated . During a prospect i ve antimalarial treatment and prophylaxis trial in pregnant women in Malawi ( three groups receiving a chloroquine regimen and one group receiving a mefloquine regimen ) , we examined women at their first antenatal clinic visit to evaluate these issues and to verify that subjects in the study treatment/prevention arms were similar . Among 4,127 women with enrollment blood smear results , 1,836 ( 44.5 % ) were parasitemic . The highest infection rates and densities were observed in primigravidas ( 66 % infected , geometric mean parasite density [ GMPD ] = 1,588 parasites/mm3 of whole blood ) , followed by second pregnancies ( 46 % infected , GMPD = 615 parasites/mm3 ) and subsequent pregnancies ( 29 % infected , GMPD = 238 parasites/mm3 ) , ( P < 10(-6 ) for both infection prevalence and density , by chi-square test for trend ) . Significant risk factors for parasitemia at first antenatal clinic visit in a multivariate model included low gravidity , high transmission season , no use of prophylaxis before first antenatal clinic visit , young age ( < 20 years ) , human immunodeficiency virus ( HIV ) infection , low hematocrit , short stature , and second trimester ( compared with third trimester ) . Women in the different treatment arms of the study were generally similar in many characteristics ; statistically significant differences , where present , were small . Targeting malaria control efforts to women in their first or second pregnancy and during the high transmission season will be an important strategy to reach most parasitemic women and minimize re source expenditure . Women infected with HIV had a 55 % increased risk of parasitemia at their first antenatal clinic visit and may represent an additional important risk group whose numbers may be increasing and who may benefit from identification and management for malaria Background Some studies have suggested that helminth infections increase the risk of malaria infection and are associated with increased number of malaria attacks and anaemia . Thus interventions to control helminth infections may have an impact on incidence of clinical malaria and anaemia . The current study assessed the impact of two anthelmintic treatment approaches on malaria infection and on anaemia in school and pre-school children in Magu district , Tanzania . Methods A total of 765 children were enrolled into a prospect i ve r and omized anthelmintic intervention trial following a baseline study of 1546 children . Enrolled children were r and omized to receive either repeated treatment with praziquantel and albendazole four times a year ( intervention group , 394 children ) or single dose treatment with praziquantel and albendazole once a year ( control group , 371 children ) . Follow up examinations were conducted at 12 and 24 months after baseline to assess the impact of the intervention . Stool and urine sample s were collected and examined for schistosome and soil transmitted helminth infections . Blood sample s were also collected and examined for malaria parasites and haemoglobin concentrations . Monitoring of clinical malaria attacks was performed at each school during the two years of the intervention . Results Out of 1546 children screened for P. falciparum , S. mansoni , S. haematobium , hookworm and T. Trichiura at baseline , 1079 ( 69.8 % ) were infected with at least one of the four parasites . There was no significant difference in malaria infection ( prevalence , parasite density and frequency of malaria attacks ) and in the prevalence of anaemia between the repeated and single dose anthelmintic treatment groups at 12 and 24 months follow up ( p > 0.05 ) . However , overall , there was significant improvement in mean haemoglobin concentrations ( p < 0.001 ) from baseline levels of 122.0g/L and 123.0g/L to 136.0g/L and 136.8g/L for the repeated and single dose treatment groups , respectively , at 24 months follow-up which result ed in significant reduction in prevalence of anaemia . Conclusions These results suggest that repeated anthelmintic treatment did not have an impact on malaria infection compared to single dose treatment . However , both treatment approaches had overall impact in terms of improvements of haemoglobin levels and hence reductions in prevalence of anaemia Summary A community-based cross-sectional study was undertaken to measure anthropometric indices , micronutrient status and prevalence of parasite infections in 579 rural South African primary school children . Eleven schools were selected r and omly from a Magisterial District in southern KwaZulu-Natal ( KZN ) . In each school , all pupils aged between 8 and 10 years were selected . The following outcome measures were obtained : anthropometric — height for age , weight for age and body mass index ; micronutrient status — anaemia , serum ferritin and vitamin A ; and prevalence of parasite infections — Ascaris lumbricoides , Trichuris trichiura and Schistosoma haematobium . The observed prevalences were : stunting 7.3 % , underweight for age 0.7 % , and obesity 3.1 % ; anaemia 16.5 % ( Hb < 12 g/dl ) , vitamin A deficiency 34.7 % ( serum retinol < 20 μg/dl ) and 28.1 % with reduced serum ferritin ( < 12 ng/ml ) ; Trichuris trichiura 53.9 % , Ascaris lumbricoides 27.3 % and Schistosoma haematobium 24.5 % . We conclude that micronutrient deficiency , parasitic infestations and stunting remain significant problems among school-aged children in South Africa .  Micronutrient supplementation and de-worming provide opportunities for school-based health promotion and primary health care interventions , and might produce significant health and educational benefits BACKGROUND Malaria and intestinal helminthiasis are parasitic diseases causing high morbidity and mortality in most tropical parts of the world , where climatic conditions and sanitation practice s favour their prevalence . These infections do co-exist and have different effects on infected individuals . OBJECTIVES To assess the level of endemicity of malaria and helminth infections in school children of the Kumba Urban Area of Cameroon , and to determine how these infections relate to each other . DESIGN Cross sectional study . SETTING Four primary schools in the Kumba urban area . SUBJECTS Two hundred and forty three r and omly selected pupils aged four and fifteen years of both sexes . RESULTS All two hundred and forty three pupils had malaria parasites in their blood . The geometric mean parasite load was 1282 parasites per microl of blood . Only 17 pupils were  anaemic ( PCV<30 % ) , The helminth infections showed a 38.3 % prevalence , with a geometric mean parasite load of 687 eggs per gram of faeces . Co-infections were recorded in 38.3 % of the pupils . There was no significant correlation between the helminth and malaria parasite densities ( r=0.04 , P=0.7337 ) . CONCLUSION Both malaria and helminth parasites do co-exist without clinical symptoms of infection in school children of the Kumbi Urban Area Background Parasitic infections have been shown to have deleterious effects on host nutritional status . In addition , although helmintic infection can modulate the host inflammatory response directed against the parasite , a causal association between helminths and allergy remains uncertain . The present study was therefore design ed to evaluate the relationship between nutritional status , parasite infection and prevalence of allergy among school children . Methods A cross sectional study was performed involving school children in two elementary schools in Gondar , Ethiopia . Nutritional status of these children was determined using anthropometric parameters ( weight-for-age , height-for-age and BMI -for-age ) . Epi-Info software was used to calculate z-scores . Stool sample s were examined using st and ard parasitological procedures . The serum IgE levels were quantified by total IgE ELISA kit following the manufacturer ’s instruction . Result A total of 405 children ( with mean age of 12.09.1 ± 2.54 years ) completed a self-administered allergy question naire and provided stool sample s for analysis . Overall prevalence of underweight , stunting and thinness/wasting was 15.1 % , 25.2 % , 8.9 % , respectively . Of the total , 22.7 % were found to be positive for intestinal parasites . The most prevalent intestinal parasite detected was Ascaris lumbricoides ( 31/405 , 7.6 % ) . There was no statistically significant association between prevalence of malnutrition and the prevalence of parasitic infections . Median total serum IgE level was 344 IU/ml ( IQR 117–2076 , n = 80 ) and 610 IU/ml ( 143–1833 , n = 20 ) , respectively , in children without and with intestinal parasite infection ( Z = −0.198 , P > 0.8 ) . The prevalence of self reported allergy among the subset was 8 % . IgE concentration was not associated either with the presence of parasitic infection or history of allergy . Conclusion The prevalence of malnutrition , intestinal parasitism and allergy was not negligible in this population . In addition , there was no significant association between the prevalence of allergy and their nutritional status , and parasite infection . Further research prospect i ve observational and intervention studies are required to address the question of causality between nutritional factors , parasites , and allergy BACKGROUND Parasitic diseases ( eg , malaria and helminthiases ) exert enormous burdens on public health and social well-being . Moreover , parasitic infections are important causes of anemia in tropical Africa , exacerbated by lack of a diversified diet and inflammatory and genetic diseases . There is a paucity of longitudinal studies monitoring the dynamics of anemia in relation to the aforementioned parameters . METHODS We design ed a 14-month prospect i ve longitudinal study in 3 cohorts ( ie , infants aged 6 - 23 months , children aged 6 - 8 years , and women aged 15 - 25 years ) in the Taabo health demographic surveillance system located in south- central Côte d'Ivoire .  Parasitological , hematological , and micronutrient data were obtained from repeated cross-sectional surveys , utilizing st and ardized , quality -controlled methods . RESULTS We found that young age , Plasmodium and Schistosoma infections , cellular iron deficiency , and stunting were significantly negatively associated with hemoglobin concentration . Moreover , iron status biomarkers ( ie , ferritin and soluble transferrin receptor ) were significantly associated with inflammatory parameters . CONCLUSIONS Based on our results , effective prevention and control measures that target parasitic diseases and iron deficiency are needed . These measures might include the distribution of long-lasting insecticidal nets , intermittent preventive treatment for malaria , regular anthelmintic drug administration , and improved intake of bioavailable iron , coupled with health and nutritional education and improved hygiene , water , and sanitation Both malaria and undernutrition are major causes of paediatric mortality and morbidity in sub-Saharan Africa . The introduction of insecticide-treated bed nets ( ITBN ) during a r and omized controlled trial on the Kenyan coast significantly reduced severe , life-threatening malaria and all-cause childhood mortality . This paper describes the effects of the intervention upon the nutritional status of infants aged between 1 and 11 months of age . Seven hundred and eighty seven infants who slept under ITBN and 692 contemporaneous control infants , were seen during one of three cross-sectional surveys conducted during a one year period . St and ardized weight-for-age and mid-upper arm circumference measures were significantly higher among infants who used ITBN compared with control infants . Whether these improvements in markers of nutritional status were a direct result of concomitant reductions in clinical malaria episodes remains uncertain . Never-the-less evidence suggests that even moderate increases in weight-for-age scores can significantly reduce the probability of mortality in childhood and ITBN may provide additional gains to child survival beyond their impressive effects upon malaria-specific events Results of a prospect i ve study of the association between environmental factors and malaria occurrence among 1461 individuals in an Indian rural community are reported . A multiplicative model was fitted by relating malaria positivity with different environmental risk factors as categorical variables . The risk of acquiring malaria infections varied significantly within a village stratified by proximity of breeding sources to human dwellings ( chi 2 = 19.87 , df = 5 , p = 0.0000 ) and different types of houses ( chi 2 = 11.32 , df = 2 , p = 0.0035 ) . People residing in thatched houses with [ Relative Risk ( RR ) = 6.72 ] and without false ceiling ( RR = 11.27 ) are exposed to greater risk of contracting malaria infections when compared to tiled houses ( RR = 1.00 ) . However , malaria infection was not significantly associated with proximity of cattlesheds to human dwellings ( chi 2 = 1.54 , df = 2 , p = 0.46 ) . A significantly high risk was observed in zones where the cattle to man ratio was very low and vice versa ( chi 2 = 15.32 , df = 6 , p = 0.018 ) . These data suggest and corroborate with earlier studies that transmission is a local problem and it varies within a village according to the microepidemiological factors BACKGROUND The mechanisms of severe malarial anemia and cerebral malaria , which are extreme manifestations of Plasmodium falciparum malaria , are not fully understood . METHODS Children aged < 6 years from southern Zambia presenting to the hospital with severe malarial anemia ( n = 72 ) , cerebral malaria ( n = 28 ) , or uncomplicated malaria ( n = 66 ) were studied prospect ively . Children with overlapping severe anemia and cerebral malaria were excluded . RESULTS Low interleukin 10 concentrations had the strongest association with severe anemia ( st and ard β = .61 ; P < .001 ) followed by high tumor necrosis factor α and sFas concentrations , low weight-for-age z scores , presence of stool parasites , and splenomegaly ( st and ard β = .15-.25 ; P ≤ .031 ) ; most of these factors were also associated with lower reticulocytes . Greater parasitemia was associated with higher interleukin 10 and tumor necrosis factor α concentrations , whereas sulfadoxizole/pyrimethamine therapy and lower weight-for-age z scores were associated with lower interleukin 10 levels . Thrombocytopenia and elevated tissue plasminogen activator inhibitor 1 levels had the strongest associations with cerebral malaria ( st and ard β = .37 or .36 ; P < .0001 ) , followed by exposure to traditional herbal medicine and hemoglobinuria ( st and ard β = .21-.31 ; P ≤ .006 ) . CONCLUSIONS Predictors of severe malarial anemia ( altered immune responses , poor nutrition , intestinal parasites , and impaired erythropoiesis ) differed from those of cerebral malaria ( thrombocytopenia , herbal medicine , and intravascular hemolysis ) . Improved preventive and therapeutic measures may need to consider these differences A study was conducted between January and August 1979 on 150 male roadworkers in Kwale District in the coastal lowl and s of Kenya . At the baseline examination 59 % had hookworm ( mean of 227 epg + /- 541 ) , 38 % had infections of Schistosoma haematobium ( mean 52 + /- 82 ova per 10 ml urine ) , 23 % had a blood film positive for malarial parasites , 47 % had anaemia ( Hb below 13g/dl ) , and 31 % had a percentage weight for height below 80 % of a reference value for healthy men . It was found that anaemia was significantly associated with hookworm infections and egg counts . Three interventions were evaluated . These consisted of providing pyrantel pamoate for hookworm to all men , treating the S. haematobium infections with metrifonate , and giving weekly chloroquine prophylaxis for suppression of malaria to one group of men . A final examination conducted 16 weeks later showed a significant improvement in haemoglobin levels in anaemic men treated for hookworm and in those receiving chloroquine compared with those receiving placebos . Multiple regression analyses revealed that both hookworm and S. haematobium egg counts were associated with anaemia at the baseline examinations , that factors related to the treatment of hookworm and prophylaxis for suppression of malaria were related to haemoglobin increases in anaemic men , and that successful treatment of urinary schistosomiasis was associated with weight gain . The feasibility of the interventions was good and the costs moderately low The effect of a combined supplement of iron , thiamine , riboflavin and vitamin C on  malarial incidence in 5 to 14-year-old children was tested in a malnourished rural community in a region of The Gambia noted for high prevalence of malaria during the rainy season . 190 children , divided into 2 matched groups , received either the supplement or a matching placebo for 3 months . No significant difference in malarial incidence was observed between the 2 groups , despite a major improvement in biochemical indices of nutrient status in the supplemented group , especially for riboflavin and vitamin C. Severity of episodes was also similar between groups , but in subjects who developed parasitaemias there was a trend towards higher parasite counts in those receiving the active supplement . Nutritional interventions in malarious areas may have adverse effects on malaria , and the increase in parasitaemia was compatible with the hypothesis that a small but significant reduction in defences had occurred . However , the absence of increases in the incidence of proven malaria cases and their severity must also be taken into account , in order to make a balanced assessment of the possible increase in risk . Further investigations are needed to measure the risk in benefit rates , and to consider the effects of individual nutrients in isolation
Conclusions This systematic review found that most of the evidence associating malaria and malnutrition comes from P. falciparum endemic areas , with a significant heterogeneity in studies ’ design .
Apparently malnutrition has not a great impact on malaria morbidity , but could have a negative impact on malaria mortality and severity .
Most studies show no association between malaria and subsequent malnutrition in P. falciparum areas .
In Plasmodium vivax endemic areas , malaria was associated with malnutrition in children .
Background Multiple studies in various parts of the world have analysed the association of nutritional status on malaria using anthropometric measures , but results differ due to the heterogeneity of the study population , species of the parasite , and other factors involved in the host and parasite relationship .
The aim of this study was to perform a systematic review on the inter-relationship of nutritional status based on anthropometry and malarial infection .