Malaria Parasitemia and Nutritional Status during the Low Transmission Season in the Presence of Azithromycin Distribution among Preschool Children in Niger.

Ahmed M Arzika,Kieran S O’Brien,Ramatou Maliki,Jeremy D Keenan,Ying Lin,Nameywa Boubacar,Ariana Austin,For The Mordor Study Group ,Elodie Lebas,Salissou Kane,Catherine E Oldenburg,Catherine A Cook,Thomas M Lietman

doi:10.4269/ajtmh.19-0547

Abstract

.The relationship between malaria and malnutrition is complicated, and existence of one may predispose or exacerbate the other. We evaluated the relationship between malaria parasitemia and nutritional status in children living in communities participating in a cluster-randomized trial of biannual azithromycin compared with placebo for prevention of childhood mortality. Data were collected during the low malaria transmission and low food insecurity season. Parasitemia was not associated with weight-for-height Z-score (24 months: P = 0.11 azithromycin communities, P = 0.75 placebo communities), weight-for-age Z-score (24 months: P = 0.83 azithromycin, P = 0.78 placebo), height-for-age Z-score (24 months: P = 0.30 azithromycin, P = 0.87 placebo), or mid-upper arm circumference (24 months: P = 0.12 azithromycin, P = 0.56 placebo). There was no statistically significant evidence of a difference in the relationship in communities receiving azithromycin or placebo. During the low transmission season, there was no evidence that malaria parasitemia and impaired nutritional status co-occur in children.

Highlights

In Niger, the high malaria transmission season overlaps with periods of high food insecurity and malnutrition.[1,2,3] Despite this seasonal overlap, the relationship between malaria and malnutrition at the individual level is complicated.[4]
Most baseline characteristics were similar between children with malaria parasitemia and those without (Table 1), children with malaria parasitemia had lower hemoglobin levels (9.35 gender Age (months) Hemoglobin (g/dL) versus 9.9 g/dL, P = 0.0006) and lower Weight-forheight Z-scores (WHZ) and height-for-age Zscores (HAZ) scores, these were not statistically significant (Table 2)
In models adjusted for age, gender, and study arm, there was no association between malaria parasitemia and WHZ, HAZ, weight-for-age Z-scores (WAZ), or mid-upper arm circumference (MUAC) at months 0, 12, or 24 in either placebo or azithromycin communities (Table 2)

Summary

Introduction

In Niger, the high malaria transmission season overlaps with periods of high food insecurity and malnutrition.[1,2,3] Despite this seasonal overlap, the relationship between malaria and malnutrition at the individual level is complicated.[4]. Given the complexity of any potential relationship, it is possible that the relationship may differ in different geographic or seasonal settings or in the presence of interventions that affect one or both conditions

Methods

Results

Conclusion