Malaria, anemia, and malnutrition in african children--defining intervention priorities

J Infect Dis. 2006 Jul 1;194(1):108-14. doi: 10.1086/504688. Epub 2006 May 26.


Background: Malaria, anemia, and malnutrition contribute substantially to childhood morbidity in sub-Saharan Africa, but their respective roles and interactions in conferring disease are complex. We aimed to investigate these interactions.

Methods: In 2002, we assessed plasmodial infection, anemia, and nutritional indices in 2 representative surveys comprising >4000 children in northern Ghana.

Results: Infection with Plasmodium species was observed in 82% and 75% of children in the rainy and dry season, respectively. The fraction of fever attributable to malaria was 77% in the rainy season and 48% in the dry season and peaked in children of rural residence. Anemia (hemoglobin level, <11 g/dL) was seen in 64% of children and was, in multivariate analysis, associated with young age, season, residence, parasitemia, P. malariae coinfection, and malnutrition (odds ratio [OR], 1.68 [95% confidence interval [CI], 1.38-2.04]). In addition, malnutrition was independently associated with fever (axillary temperature, > or = 37.5 degrees C; OR, 1.59 [95% CI, 1.13-2.23]) and clinical malaria (OR, 1.67 [95% CI, 1.10-2.50]).

Conclusions: Malnutrition is a fundamental factor contributing to malaria-associated morbidity and anemia, even if the latter exhibits multifactorial patterns. Our data demonstrate that malaria-control programs alone may not have the desired impact on childhood morbidity on a large scale without concomitant nutrition programs.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Anemia / epidemiology*
  • Anemia / etiology*
  • Animals
  • Child
  • Child Nutrition Disorders / complications*
  • Child Nutrition Disorders / epidemiology*
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Genotype
  • Ghana / epidemiology
  • Health Priorities / standards
  • Humans
  • Infant
  • Malaria / complications*
  • Malaria / epidemiology*
  • Male
  • Plasmodium / classification
  • Plasmodium / genetics
  • Prevalence
  • Risk Factors
  • Seasons