Comparative effects of vivax malaria, fever and diarrhoea on child growth

Abstract

Background: The adverse impact of Plasmodium vivax on child health beyond acute febrile illness is poorly studied. The effect of vivax malaria on child growth was evaluated and compared with diarrhoeal disease and non-specific fever.

Methods: Using data from a 43-month longitudinal cohort of children 0-72 months of age (n = 442) in the Peruvian Amazon, ponderal and linear growth velocities over 2-, 4- and 6-month periods were examined using longitudinal models and related to the incidence of disease during the same period.

Results: An episode of vivax malaria led to 138.6 g (95% confidence interval (CI) 81.9-195.4), 108.6 g (62.8-153.2) and 61 g (20.9-101.1) less weight gain over 2-, 4- and 6-month intervals, respectively. These deficits were larger than both diarrhoea (21.9, 17.2 and 13.8 g less weight gain, respectively) and fever (39.0, 30.3 and 25.6 g less weight gain, respectively). An incident episode of vivax also led to 0.070 cm (0.004-0.137) and 0.083 cm (0.015-0.151) less linear growth over 4 and 6 months, respectively, which were also larger than deficits from diarrhoea (0.029 and 0.028 cm, respectively) and fever (not associated with linear growth deficits). Despite the larger effect of P. vivax incident episodes on growth of a particular child, diarrhoeal disease had a larger cumulative impact on growth deficits as diarrhoeal incidence rates in this community are >10-fold higher than vivax malaria.

Conclusions: Disease control measures for vivax malaria and diarrhoeal disease have the potential to improve the growth of children in endemic areas.

Figure 1

This figure shows the mean and estimated 95% CI for predicted ponderal and linear velocity deficits due to one incident episode of diarrhoea, fever or vivax malaria, using the adjusted models presented in Tables 2 and 3. Declines which were associated with a P = 0.05 or less are denoted with an “asterisk”

Figure 2

This figure shows the percent difference in model-predicted weight gain between healthy children and children experiencing an average disease burden. For example, 36-month-olds have predicted 2-month ponderal velocity declines of 1.3, 3.5 and 6.7% due to vivax malaria, diarrhoea and fever, respectively, yielding a cumulative decrement of 11.5%

Figure 3

This figure shows the impact of disease burden on 6-month linear velocity at the population level. For example, 36-month-olds with an average disease burden have a predicted 6-month linear velocity decline of 0.26% (0.009 cm) and 1.67% (0.059 cm) due to vivax malaria and diarrhoea, respectively: a cumulative decline of 1.94%