The association between malnutrition and the incidence of malaria among young HIV-infected and -uninfected Ugandan children: a prospective study.
The association between malnutrition and the incidence of malaria among young HIV-infected and -uninfected Ugandan children: a prospective study.
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DOI：
10.1186/1475-2875-11-90
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发表时间：
2012-03-27
期刊：
影响因子：
3
通讯作者：
Dorsey G
中科院分区：
文献类型：
--
作者：
Arinaitwe E;Gasasira A;Verret W;Homsy J;Wanzira H;Kakuru A;Sandison TG;Young S;Tappero JW;Kamya MR;Dorsey G
在撒哈拉以南非洲，营养不良和疟疾仍然是幼儿发病和死亡的主要原因。关于营养不良是否与疟疾风险的增加或减少有关，有相互矛盾的数据。此外，关于艾滋病毒感染与营养不良和疟疾风险之间潜在相互作用的数据有限。从乌干达农村疟疾传播强度高的地区招募了100名未接触艾滋病毒的儿童、203名接触艾滋病毒的儿童（艾滋病毒感染母亲所生的艾滋病毒阴性儿童）和48名6周至1岁感染艾滋病毒的儿童，随访至他们2.5岁。在登记时为所有儿童提供了驱虫蚊帐，并为接触艾滋病毒的母乳喂养儿童和感染艾滋病毒的儿童开具了每日甲氧苄啶-磺胺甲恶唑预防处方。每月例行评估，包括测量身高和体重，在研究诊所进行。营养结果包括发育迟缓（低年龄身高）和体重不足（低年龄体重），分为轻度（随访期间平均z分数在-1和-2之间）和中度严重（随访期间平均z分数< -2）。当一名儿童出现发烧和血液涂片阳性时，就诊断出疟疾。采用负二项回归对疟疾发病率进行比较，控制潜在混杂因素，并以发病率比（IRR）表示相关测量。疟疾总发病率为3.64例/人/年。与非发育迟缓儿童相比，轻度发育迟缓（IRR = 1.24, 95% CI 1.06-1.46, p = 0.008）和中重度发育迟缓（IRR = 1.24, 95% CI 1.03-1.48, p = 0.02）与疟疾发病率相似地增加相关。轻度体重不足（IRR = 1.09, 95% CI 0.95-1.25, p = 0.24）和中度体重不足（IRR = 1.12, 95% CI 0.86-1.46, p = 0.39）与非体重不足儿童的疟疾发病率无显著差异相关。艾滋病毒感染和暴露于艾滋病毒的儿童接受TS治疗与营养不良和疟疾发病率之间没有显著的相互作用。发育迟缓表明长期营养不良，与生活在疟疾高传播强度地区的艾滋病毒感染和未感染幼儿群体中疟疾发病率增加有关。然而，考虑到观察性研究设计和无法理清营养不良与疟疾发病率之间的时间关系，在进行因果推论时应谨慎。ClinicalTrials.gov: NCT00527800。
In sub-Saharan Africa, malnutrition and malaria remain major causes of morbidity and mortality in young children. There are conflicting data as to whether malnutrition is associated with an increased or decreased risk of malaria. In addition, data are limited on the potential interaction between HIV infection and the association between malnutrition and the risk of malaria. A cohort of 100 HIV-unexposed, 203 HIV-exposed (HIV negative children born to HIV-infected mothers) and 48 HIV-infected children aged 6 weeks to 1 year were recruited from an area of high malaria transmission intensity in rural Uganda and followed until the age of 2.5 years. All children were provided with insecticide-treated bed nets at enrolment and daily trimethoprim-sulphamethoxazole prophylaxis (TS) was prescribed for HIV-exposed breastfeeding and HIV-infected children. Monthly routine assessments, including measurement of height and weight, were conducted at the study clinic. Nutritional outcomes including stunting (low height-for-age) and underweight (low weight-for-age), classified as mild (mean z-scores between -1 and -2 during follow-up) and moderate-severe (mean z-scores < -2 during follow-up) were considered. Malaria was diagnosed when a child presented with fever and a positive blood smear. The incidence of malaria was compared using negative binomial regression controlling for potential confounders with measures of association expressed as an incidence rate ratio (IRR). The overall incidence of malaria was 3.64 cases per person year. Mild stunting (IRR = 1.24, 95% CI 1.06-1.46, p = 0.008) and moderate-severe stunting (IRR = 1.24, 95% CI 1.03-1.48, p = 0.02) were associated with a similarly increased incidence of malaria compared to non-stunted children. Being mildly underweight (IRR = 1.09, 95% CI 0.95-1.25, p = 0.24) and moderate-severe underweight (IRR = 1.12, 95% CI 0.86-1.46, p = 0.39) were not associated with a significant difference in the incidence of malaria compared to children who were not underweight. There were no significant interactions between HIV-infected, HIV-exposed children taking TS and the associations between malnutrition and the incidence of malaria. Stunting, indicative of chronic malnutrition, was associated with an increased incidence of malaria among a cohort of HIV-infected and -uninfected young children living in an area of high malaria transmission intensity. However, caution should be made when making causal inferences given the observational study design and inability to disentangle the temporal relationship between malnutrition and the incidence of malaria. ClinicalTrials.gov: NCT00527800.
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