Abstract
BackgroundIn sub-Saharan Africa, preschool children represent the population most vulnerable to malaria and malnutrition. It is widely recognized that malnutrition compromises the immune function, resulting in higher risk of infection. However, very few studies have investigated the relationship between malaria, malnutrition and specific immunity. In the present study, the anti-Plasmodium falciparum IgG antibody (Ab) response was evaluated in children according to the type of malnutrition.MethodsAnthropometric assessment and blood sample collection were carried out during a cross-sectional survey including rural Senegalese preschool children. This cross-sectional survey was conducted in July 2003 at the onset of the rainy season. Malnutrition was defined as stunting (height-for-age <-2 z-scores) or wasting (weight-for-height <-2 z-scores). The analysis was performed on all malnourished children in July (n = 161, either stunted, n = 142 or wasted, n = 19), pair-matched to well-nourished controls. The IgG Ab response to P. falciparum whole extracts (schizont antigens) was assessed by ELISA in sera of the included children.ResultsBoth the prevalence of anti-malarial immune responders and specific IgG Ab levels were significantly lower in malnourished children than in controls. Depending on the type of malnutrition, wasted children and stunted children presented a lower specific IgG Ab response than their respective controls, but this difference was significant only in stunted children (P = 0.026). This down-regulation of the specific Ab response seemed to be explained by severely stunted children (HAZ ≤ -2.5) compared to their controls (P = 0.03), while no significant difference was observed in mildly stunted children (-2.5 < HAZ <-2.0). The influence of child malnutrition on the specific anti-P. falciparum Ab response appeared to be independent of the intensity of infection.ConclusionChild malnutrition, and particularly stunting, may down-regulate the anti-P. falciparum Ab response, both in terms of prevalence of immune responders and specific IgG Ab levels. This study provides further evidence for the influence of malnutrition on the specific anti-malarial immune response and points to the importance of taking into account child malnutrition in malaria epidemiological studies and vaccine trials.
Highlights
In sub-Saharan Africa, preschool children represent the population most vulnerable to malaria and malnutrition
This study provides further evidence for the influence of malnutrition on the specific anti-malarial immune response and points to the importance of taking into account child malnutrition in malaria epidemiological studies and vaccine trials
The intensity of infection could be a confounder in the association between malnutrition and anti-P. falciparum Ab response, i.e. IgG Ab levels could be correlated to parasitaemia
Summary
In sub-Saharan Africa, preschool children represent the population most vulnerable to malaria and malnutrition. Several older studies based on hospital admissions for severe malaria showed lower risk of malaria infection among undernourished children [1012]. Results of recent community-based studies are conflicting: two studies showed that stunting increased the risk of malaria morbidity among rural children in Gambia [13,14], whereas a trial in Papua New Guinea indicated that stunting protected children from P. falciparum malaria [15]. Some studies showed a trend to lower malariarelated morbidity among wasted children [13,18,21] These studies point to the importance of taking into account the kind of child malnutrition (stunting/ wasting) in the relationship between malaria and malnutrition
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