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Am. J. Trop. Med. Hyg., 80(2), 2009, pp. 202-208
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Influence of Wasting and Stunting at the Onset of the Rainy Season on Subsequent Malaria Morbidity among Rural Preschool Children in Senegal

Florie Fillol*, Amandine Cournil, Denis Boulanger, Badara Cissé, Cheikh Sokhna, Geoffrey Targett, Jean-François Trape, François Simondon, Brian Greenwood, AND Kirsten B. Simondon
Epidemiology and Prevention Research Unit, Institut de Recherche pour le Développement, Montpellier, France; Department of Parasitology, Université Cheikh Anta Diop, Dakar, Senegal; Tropical Malaria Research Unit, Institut de Recherche pour le Développement, Dakar, Senegal; Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom

In sub-Saharan Africa, malaria and malnutrition are major causes of morbidity and mortality in children less than five years of age. To explore the impact of malnutrition on subsequent susceptibility to malaria, a cohort of 874 rural preschool children in Senegal was followed-up during one malaria transmission season from July through December. Data on nutritional status and Plasmodium falciparum parasitemia were collected at baseline. Malaria morbidity was monitored through weekly home visits. Wasted children (weight-for-height z-score < –2) were at lower risk of having at least one subsequent clinical malaria attack (odds ratio = 0.33; 95% confidence interval = 0.13–0.81, P = 0.02), whereas stunting (height-for-age z-score < –2) or being underweight (weight-for-age z-score < –2) was not associated with clinical malaria. Although non-biological explanations such as overprotection of wasted children by their mothers should be considered, immunomodulation according to nutritional status could explain the lower risk of malaria attack among wasted children.

Received July 11, 2008. Accepted for publication October 8, 2008.

Acknowledgments: We thank El Hadj Ba for assessment of parasitemia; Ernest Faye for field supervision; the malaria field team for monitoring of malaria morbidity; Tofène Ndiaye, Amady Ndiaye, and Bassirou Fall for assessment of anthropometric measurements; Adama Marra for help with identification of eligible children and data management; Frederic Capuano and Cécile Cames for preliminary data analysis; and Jo Lines and Neal Alexander for contributions to the design of the study.

Financial support: The study was supported by the Gates Malaria Partnership, which receives support from the Bill and Belinda Gates Foundation and the London School of Hygiene and Tropical Medicine Department for International Development Malaria Knowledge Programme, and by the Institut de Recherche pour le Développement.

* Address correspondence to Florie Fillol, Epidémiologie et Prévention, Institut de Recherche pour le Développement, Unité de Recherche 024, 911 Avenue Agropolis, BP 64501, 34394 Montpellier, France. E-mail: fillol{at}mpl.ird.fr

Authors’ addresses: Florie Fillol, Amandine Cournil, Denis Boulanger, François Simondon, and Kirsten B. Simondon, Epidémiologie et Prévention, Institut de Recherche pour le Développement, Unité de Recherche 024, 911 Avenue Agropolis, BP 64501, 34394 Montpellier, France, E-mails: fillol{at}mpl.ird.fr, cournil{at}mpl.ird.fr, boulanger{at}mpl.ird.fr, simondof{at}mpl.ird.fr, and kirsten{at}mpl.ird.fr. Badara Cissé, Département de Parasitologie, Université Cheikh Anta Diop, BP 5005, Dakar, Sénégal, E-mail: badara.cisse{at}lshtm.ac.uk. Cheikh Sokhna, Unité Mixte de Recherche 198, Institut de Recherche pour le Développement, BP 1386, CP 18524, Dakar Senegal, E-mail: cheikh.sokhna{at}ird.sn. Geoffrey Targett, London School of Hygiene and Tropical Medicine, M LG4, 50 Bedford Square, London WC1B 3DP, United Kingdom, E-mail: geoff.targett{at}lshtm.ac.uk. Jean-François Trape, Unité Mixte de Recherche 198, Institut de Recherche pour le Développement, Paludologie Afro-Tropicale, BP 1386, CP 18524, Dakar Senegal, E-mail: jean-francois.trape{at}ird.sn. Brian Greenwood, London School of Hygiene and Tropical Medicine, Room 400, Keppel Street, London WC1E 7HT, United Kingdom, E-mail: brian.greenwood{at}lshtm.ac.uk.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.