Malaria, anemia, and malnutrition in African children - Defining intervention priorities

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 14000 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, >= 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.