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We determined the nutritional status of children less than five years of age in an area in rural western Kenya with intense malaria transmission, a high prevalence of severe anemia and human immunodeficiency virus, and high infant and under-five mortality (176/1,000 and 259/1,000). No information is available on the prevalence of malnutrition in this area. Three cross-sectional surveys were conducted between 1996 and 1998 to monitor the effect of insecticide-treated bed nets on child morbidity. Anthropometric indices are presented for 2,103 children collected prior to and during intervention (controls only). The prevalence of stunting (Z-scores for height-for-age [HAZ] <-2), wasting (Z-scores for weight-for-height [WHZ] <-2) and being underweight (Z-scores for weight-for-age [WAZ] <-2) was 30%, 4%, and 20%, respectively. This was severe (Z-score <-3) in 12% (stunting), 1% (wasting), and 5% (underweight) of the children. Few children less than three months of age were malnourished (<2%), but height-for-age and weight-for-age deficits increased rapidly in children 3–18 months of age, and were greatest in children 18–23 months old (44% stunted and 34% underweight). While the mean HAZ and WAZ stabilized from 24 months of age onwards, they still remained substantially below the reference median with no evidence of catch-up growth. Malnutrition is likely to interact with infectious diseases, placing children 3–24 months of age at high risk of premature death in this area.
Acknowledgments: We express our gratitude to the parents and guardians of the children who participated in the study and the many people that assisted with this project. We are grateful to Dr. Margarette S. Kolczak (Centers for Disease Control and Prevention, Atlanta, GA) for statistical advice. We thank the Director of the Kenya Medical Research Institute for his permission to publish this work.
Financial support: The bed net project was funded by the United States Agency for International Development. Arthur M. Kwena acknowledges support from the Netherlands Organization for International Cooperation in Higher Education (NUFFIC). Dianne J. Terlouw and Feiko O. ter Kuile were partially supported by a grant from the Netherlands Foundation for the Advancement of Tropical Research (WOTRO) (The Hague, The Netherlands). Jennifer F. Friedman was supported by a United States Fulbright Award.
Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by the U.S. Public Health Service or Department of Health and Human Services.
Authors’ addresses: Arthur M. Kwena, Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya. Dianne J. Terlouw, Penelope A. Phillips-Howard, William A. Hawley, and Feiko O. ter Kuile, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. Sake J. de Vlas, Department of Public Health, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Jennifer F. Friedman, International Health Institute, Brown University, Box G-B 495, Providence, RI 02912. John M. Vulule, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Robert W. Sauerwein, Department of Medical Microbiology, University Medical Center, St. Radboud, PO Box 9101, 6500HB, Nijmegen, The Netherlands. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, 1211 Geneva 27, Switzerland.
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