Malaria infection and nutritional status: Results from a cohort survey of children from 6-59 months old in the Kivu province, Democratic Republic of the Congo

Background. - Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey. Methods. - A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at -3 and -2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. Results. - After adjustment for season, children with severe stunting (height for age Z score < -3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/mu L of blood as compared to those in with a better nutritional status (height for age Z score >= -2) (OR = 0.48, 95% CI: 0.25-0.91). Conclusion. - Severely stunted children are at a lower risk of high-level malaria parasitemia. (C) 2013 Elsevier Masson SAS. All rights reserved.