The online version of this article (doi:10.1186/1475-2875-11-432) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
BO participated in the coordination of the study, data analysis and manuscript preparation. JK participated in coordination of the study, data collection and manuscript preparation. VB, FM and SK participated in the coordination of the study and data collection. MRK participated in the study design and manuscript preparation. GD conceived of the study, participated in its design, coordination, data analysis and manuscript preparation. All authors read and approved the final manuscript.
Malaria, malnutrition and anaemia are major causes of morbidity and mortality in African children. The interplay between these conditions is complex and limited data exist on factors associated with these conditions among infants born to HIV-uninfected and infected women.
Two hundred HIV-exposed (HIV-uninfected infants born to HIV-infected mothers) and 400 HIV-unexposed infants were recruited from an area of high malaria transmission in rural Uganda. A cross-sectional survey was performed at enrolment to measure the prevalence of malaria parasitaemia, measures of malnutrition (z-scores <2 standard deviations below mean) and anaemia (haemoglobin <8 gm/dL). Multivariate logistic regression was used to measure associations between these conditions and risk factors of interest including household demographics, malaria prevention practices, breastfeeding practices, household structure and wealth index.
The prevalence of malaria parasitaemia was 20%. Factors protective against parasitaemia included female gender (OR = 0.66, p = 0.047), mother’s age (OR = 0.81 per five-year increase, p = 0.01), reported bed net use (OR = 0.63, p = 0.03) and living in a well-constructed house (OR = 0.25, p = 0.01). Although HIV-unexposed infants had a higher risk of parasitaemia compared to HIV-exposed infants (24% vs 14%, p = 0.004), there was no significant association between HIV-exposure status and parasitaemia after controlling for the use of malaria preventative measures including bed net use and trimethoprim-sulphamethoxazole prophylaxis. The prevalence of stunting, underweight, and wasting were 10%, 7%, and 3%, respectively. HIV-exposed infants had a higher odds of stunting (OR = 2.23, p = 0.005), underweight (OR = 1.73, p = 0.09) and wasting (OR = 3.29, p = 0.02). The prevalence of anaemia was 12%. Risk factors for anaemia included older infant age (OR = 2.05 per one month increase, p = 0.003) and having malaria parasitaemia (OR = 5.74, p < 0.001).
Compared to HIV-unexposed infants, HIV-exposed infants had a higher use of malaria preventative measures and lower odds of malaria parasitaemia. Having a better constructed house was also protective against malaria parasitaemia. HIV-exposure was the primary risk factor for measures of malnutrition. The primary risk factor for anaemia was malaria parasitaemia. These findings suggest the need to better target existing interventions for malaria, malnutrition and anaemia as well as the need to explore further the mechanisms behind the observed associations.
Additional file 1: Comparison of characteristics between HIV exposed and unexposed infants.(DOCX 13 KB)12936_2012_2585_MOESM1_ESM.docx
Additional file 2: Associations between variables of interest and malarial parasitaemia.(DOCX 13 KB)12936_2012_2585_MOESM2_ESM.docx
Additional file 3: Associations between variables of interest and measures of malnutrition.(DOCX 13 KB)12936_2012_2585_MOESM3_ESM.docx
Additional file 4: Associations between variables of interest and moderate-severe anaemia.(DOCX 13 KB)12936_2012_2585_MOESM4_ESM.docx
World Health Oragnization: World Malaria Report. 2010, Geneva: WHO
Uganda Bureau of Statistics (UBOS) and Macro International Inc: Uganda, Demographic and Health Survey, 2006. 2007, Kampala, Uganda: Uganda Bureau of Statistics
Ugandan Ministry of Health: National Antiretroviral Treatment Guidelines for Adults, Adolescents, and Children, 2009. 2009, Kampala, Uganda: Ugandan Ministry of Health
Okello PE, Van Bortel W, Byaruhanga AM, Correwyn A, Roelants P, Talisuna A, D’alessandro U, Coosemans M: Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg. 2006, 75: 219-225. PubMed
Young S, Murray K, Mwesigwa J, Natureeba P, Osterbauer B, Achan J, Arinaitwe E, Clark T, Ades V, Plenty A, Charlebois E, Ruel T, Kamya M, Havlir D, Cohan D: Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy. PLoS One. 2012, 7: e41934-10.1371/journal.pone.0041934. PubMedCentralCrossRefPubMed
UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance: Epidemiological Fact Sheet on HIV and AIDS, Core data on epidemiology and response, Uganda. 2009, October 2008 Geneva, Switzerland: UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance
Uganda Bureau of Statistics (UBOS) and ICF Macro 2010: Uganda Malaria Indicator Survey 2009. 2010, Calverton, Maryland, USA: UBOS and ICF Macro
Fillol F, Cournil A, Boulanger D, Cissé B, Sokhna C, Targett G, Trape J-F, Simondon F, Greenwood B, Simondon KB: Influence of wasting and stunting at the onset of the rainy season on subsequent malaria morbidity among rural preschool children in Senegal. Am J Trop Med Hyg. 2009, 80: 202-208. PubMed
Genton B, Al-Yaman F, Ginny M, Taraika J, Alpers MP: Relation of anthropometry to malaria morbidity and immunity in Papua New Guinean children. Am J Clin Nutr. 1998, 68: 734-741. PubMed
Carswell F, Hughes AO, Palmer RI, Higginson J, Harland PS, Meakins RH: Nutritional status, globulin titers, and parasitic infections of two populations of Tanzanian school children. Am J Clin Nutr. 1981, 34: 1292-1299. PubMed
Deribew A, Alemseged F, Tessema F, Sena L, Birhanu Z, Zeynudin A, Sudhakar M, Abdo N, Deribe K, Biadgilign S: Malaria and under-nutrition: a community based study among under-five children at risk of malaria, south-west Ethiopia. PLoS One. 2010, 5: e10775-10.1371/journal.pone.0010775. PubMedCentralCrossRefPubMed
Arinaitwe E, Gasasira A, Verret W, Homsy J, Wanzira H, Kakuru A, Sandison TG, Young S, Tappero JW, Kamya MR, Dorsey G: The association between malnutrition and the incidence of malaria among young HIV-infected and -uninfected Ugandan children: a prospective study. Malar J. 2012, 11: 90-10.1186/1475-2875-11-90. PubMedCentralCrossRefPubMed
Lartey A, Marquis GS, Mazur R, Perez-Escamilla R, Brakohiapa L, Ampofo W, Sellen D, Adu-Afarwuah S: Maternal HIV is associated with reduced growth in the first year of life among infants in the Eastern region of Ghana: the Research to Improve Infant Nutrition and Growth (RIING) Project. Matern Child Nutr. 2012, doi:10.1111/j.1740-8709.2012.00441.x.
McElroy PD, ter Kuile FO, Lal AA, Bloland PB, Hawley WA, Oloo AJ, Monto AS, Meshnick SR, Nahlen BL: Effect of Plasmodium falciparum parasitemia density on hemoglobin concentrations among full-term, normal birth weight children in western Kenya, IV. The Asembo Bay Cohort Project. Am J Trop Med Hyg. 2000, 62: 504-512. PubMed
Bloland PB, Boriga DA, Ruebush TK, McCormick JB, Roberts JM, Oloo AJ, Hawley W, Lal A, Nahlen B, Campbell CC: Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission II. Descriptive epidemiology of malaria infection and disease among children. Am J Trop Med Hyg. 1999, 60: 641-648. PubMed
- Factors associated with malaria parasitaemia, malnutrition, and anaemia among HIV-exposed and unexposed Ugandan infants: a cross-sectional survey
Moses R Kamya
- BioMed Central
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