Nutritional status, intestinal parasite infection and allergy among school children in Northwest Ethiopia Ascaris co-infection does not alter malaria-induced anaemia in a cohort of Nigerian preschool children Malaria and Under-Nutrition: A Community Based Study Among Under-Five Children at Risk of Malaria, South-West Ethiopia Parasitic infections, anaemia and nutritional status: a study of their interrelationships and the effect of prophylaxis and treatment on workers in Kwale District, Kenya. Spatial clustering and risk factors of malaria infections in Ratanakiri Province, Cambodia The effect of iron therapy on malarial infection in Papua New Guinean schoolchildren. Relationships of Schistosoma hematobium, hookworm and malarial infections and metrifonate treatment to hemoglobin level in Kenyan school children. Prevalence of chloroquine resistance alleles among Plasmodium falciparum parasites in countries affected by malaria disease since change of treatment policy: a systematic review protocol Effect of supplementary vitamins and iron on malaria indices in rural Gambian children. Multiple parasite infections and their relationship to self-reported morbidity in a community of rural Côte d'Ivoire. Distinct clinical and immunologic profiles in severe malarial anemia and cerebral malaria in Zambia. Competitive facilitation of drug-resistant Plasmodium falciparum malaria parasites in pregnant women who receive preventive treatment Increasing rates of malarial fever with deteriorating immune status in HIV-1-infected Ugandan adults Childhood asymptomatic malaria and nutritional status among Port Harcourt children. Iron supplementation improves appetite and growth in anemic Kenyan primary school children. Comparative feasibility of implementing rapid diagnostic test and microscopy for parasitological diagnosis of malaria in Uganda Urinary tract pathology attributed to Schistosoma haematobium: does parasite genetics play a role? A quantitative analysis of transmission efficiency versus intensity for malaria The impact of lipid-based nutrient supplementation on anti-malarial antibodies in pregnant women in a randomized controlled trial K13 mutations and pfmdr1 copy number variation in Plasmodium falciparum malaria in Myanmar Animal source foods improve dietary quality, micronutrient status, growth and cognitive function in Kenyan school children: background, study design and baseline findings. The relationship between Plasmodium infection, anaemia and nutritional status in asymptomatic children aged under five years living in stable transmission zones in Kinshasa, Democratic Republic of Congo Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission II. Descriptive epidemiology of malaria infection and disease among children.
Background Parasitic infections have been shown to have deleterious effects on host nutritional status . In addition , although helmintic infection can modulate the host inflammatory response directed against the parasite , a causal association between helminths and allergy remains uncertain . The present study was therefore design ed to evaluate the relationship between nutritional status , parasite infection and prevalence of allergy among school children . Methods A cross sectional study was performed involving school children in two elementary schools in Gondar , Ethiopia . Nutritional status of these children was determined using anthropometric parameters ( weight-for-age , height-for-age and BMI -for-age ) . Epi-Info software was used to calculate z-scores . Stool sample s were examined using st and ard parasitological procedures . The serum IgE levels were quantified by total IgE ELISA kit following the manufacturer ’s instruction . Result A total of 405 children ( with mean age of 12.09.1 ± 2.54 years ) completed a self-administered allergy question naire and provided stool sample s for analysis . Overall prevalence of underweight , stunting and thinness/wasting was 15.1 % , 25.2 % , 8.9 % , respectively . Of the total , 22.7 % were found to be positive for intestinal parasites . The most prevalent intestinal parasite detected was Ascaris lumbricoides ( 31/405 , 7.6 % ) . There was no statistically significant association between prevalence of malnutrition and the prevalence of parasitic infections . Median total serum IgE level was 344 IU/ml ( IQR 117–2076 , n = 80 ) and 610 IU/ml ( 143–1833 , n = 20 ) , respectively , in children without and with intestinal parasite infection ( Z = −0.198 , P > 0.8 ) . The prevalence of self reported allergy among the subset was 8 % . IgE concentration was not associated either with the presence of parasitic infection or history of allergy . Conclusion The prevalence of malnutrition , intestinal parasitism and allergy was not negligible in this population . In addition , there was no significant association between the prevalence of allergy and their nutritional status , and parasite infection . Further research prospect i ve observational and intervention studies are required to address the question of causality between nutritional factors , parasites , and allergy Background Co-infection with malaria and intestinal parasites such as Ascaris lumbricoides is common . Malaria parasites induce a pro-inflammatory immune response that contributes to the pathogenic sequelae , such as malarial anaemia , that occur in malaria infection . Ascaris is known to create an anti-inflammatory immune environment which could , in theory , counteract the anti-malarial inflammatory immune response , minimizing the severity of malarial anaemia . This study examined whether Ascaris co-infection can minimize the severity of malarial anaemia . Methods Data from a r and omized controlled trial on the effect of antihelminthic treatment in Nigerian preschool-aged ( 6–59 months ) children conducted in 2006–2007 were analysed to examine the effect of malaria and Ascaris co-infection on anaemia severity .  Children were enrolled and tested for malaria , helminths and anaemia at baseline , four , and eight months . Six hundred and ninety subjects were analysed in this study . Generalized linear mixed models were used to assess the relationship between infection status and Ascaris and Plasmodium parasite intensity on severity of anaemia , defined as a haemoglobin less than 11 g/dL. Results Malaria prevalence ranged from 35 - 78 % over the course of this study . Of the malaria-infected children , 55 % were co-infected with Ascaris at baseline , 60 % were co-infected four months later and 48 % were co-infected eight months later , underlining the persistent prevalence of malaria-nematode co-infections in this population . Over the course of the study the percentage of anaemic subjects in the population ranged between 84 % at baseline and 77 % at the eight-month time point . The odds of being anaemic were four to five times higher in children infected with malaria compared to those without malaria . Ascaris infection alone did not increase the odds of being anaemic , indicating that malaria was the main cause of anaemia in this population . There was no significant difference in the severity of anaemia between children singly infected with malaria and co-infected with malaria and Ascaris . Conclusion In this cohort of Nigerian preschool children , malaria infection was the major contributor to anaemia status . Ascaris co-infection neither exacerbated nor ameliorated the severity of malarial anaemia Background The interaction between malaria and under-nutrition is not well eluci date d in Ethiopia . The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia . Methods This cross-sectional study was undertaken during March – February , 2009 as part of the baseline assessment of a cluster r and omized trial around Gilgel Gibe Hydroelectric dam , south-west Ethiopia . A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia . The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics ( NCHS ) . Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer ( HemoCue Hb 301 , Sweden ) . Results Significant proportion ( 40.4 % ) of under-five children were stunted ( height-for-age<−2SD ) . The prevalence of under-weight was 34.2 % . One third and one tenth of the children had anemia and malaria parasite respectively . Older children were more likely to have under-nutrition . There was no association between malaria and under-nutrition . Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite , [ OR = 1.5 , ( 95 % CI : 1.1–2.0 ) ] . Conclusion In this study , there is no association between malaria and under-nutrition . Children who have malaria are more likely to be anaemic . Malaria prevention and control program should consider nutrition interventions particularly anemia A study was conducted between January and August 1979 on 150 male roadworkers in Kwale District in the coastal lowl and s of Kenya . At the baseline examination 59 % had hookworm ( mean of 227 epg + /- 541 ) , 38 % had infections of Schistosoma haematobium ( mean 52 + /- 82 ova per 10 ml urine ) , 23 % had a blood film positive for malarial parasites , 47 % had anaemia ( Hb below 13g/dl ) , and 31 % had a percentage weight for height below 80 % of a reference value for healthy men . It was found that anaemia was significantly associated with hookworm infections and egg counts . Three interventions were evaluated . These consisted of providing pyrantel pamoate for hookworm to all men , treating the S. haematobium infections with metrifonate , and giving weekly chloroquine prophylaxis for suppression of malaria to one group of men . A final examination conducted 16 weeks later showed a significant improvement in haemoglobin levels in anaemic men treated for hookworm and in those receiving chloroquine compared with those receiving placebos . Multiple regression analyses revealed that both hookworm and S. haematobium egg counts were associated with anaemia at the baseline examinations , that factors related to the treatment of hookworm and prophylaxis for suppression of malaria were related to haemoglobin increases in anaemic men , and that successful treatment of urinary schistosomiasis was associated with weight gain . The feasibility of the interventions was good and the costs moderately low Background Malaria incidence worldwide has steadily declined over the past decades . Consequently , increasingly more countries will proceed from control to elimination . The malaria distribution in low incidence setting s appears patchy , and local transmission hotspots are a continuous source of infection . In this study , species-specific clusters and associated risk factors were identified based on malaria prevalence data collected in the north-east of Cambodia . In addition , Plasmodium falciparum genetic diversity , population structure and gene flows were studied . Method In 2012 , blood sample s from 5793 r and omly selected individuals living in 117 villages were collected from Ratanakiri province , Cambodia .  Malariometric data of each participant were simultaneously accumulated using a st and ard question naire . A two-step PCR allowed for species-specific detection of malaria parasites , and SNP-genotyping of P. falciparum was performed . SaTScan was used to determine species-specific areas of elevated risk to infection , and univariate and multivariate risk analyses were carried out . Result PCR diagnosis found 368 positive individuals ( 6.4 % ) for malaria parasites , of which 22 % contained mixed species infections . The occurrence of these co-infections was more frequent than expected . Specific areas with elevated risk of infection were detected for all Plasmodium species . The clusters for Falciparum , Vivax and Ovale malaria appeared in the north of the province along the main river , while the cluster for Malariae malaria was situated elsewhere . The relative risk to be a malaria parasite carrier within clusters along the river was twice that outside the area . The main risk factor associated with three out of four malaria species was overnight stay in the plot hut , a human behaviour associated with indigenous farming . Haplotypes did not show clear geographical population structure , but pairwise Fst value comparison indicated higher parasite flow along the river . Discussion Spatial aggregation of malaria parasite carriers , and the identification of malaria species-specific risk factors provide key insights in malaria epidemiology in low transmission setting s , which can guide targeted supplementary interventions . Consequently , future malaria programmes in the province should implement additional specific policies targeting households staying overnight at their farms outside the village , in addition to migrants and forest workers The effect of iron therapy on malarial infection was investigated in Papua New Guinea , where malaria is endemic . Prepubescent schoolchildren with hemoglobin levels of 8 - 12 g/dl were r and omly assigned to receive either 200 mg ferrous sulfate or a placebo twice daily for 16 weeks . Iron status and malarial infection were assessed at baseline , after 6 and 16 weeks of therapy , and 8 weeks after therapy was discontinued . Iron status was significantly improved by the treatment . The treatment did not significantly affect parasite rate , parasite density , or levels of anti-malarial IgG. No changes in spleen size were observed in either group . Furthermore , there was no significant difference between the groups in reported episodes of suspected malaria during the therapy . These results suggest that , in malaria endemic areas , oral treatment for iron deficiency can be carried out in semi-immune or immune schoolchildren without adverse consequences Relationships between hemoglobin level and S. hematobium , hookworm , and malarial infection before and six months after metrifonate treatment were studied in Kenyan primary school children in an area where anemia , S. hematobium and hookworm are common ( prevalences 61 % , 46 % , and 95 % , respectively ) and malaria is holoendemic . The mean hemoglobin level in children from one school , both with and without S. hematobium infection ( n = 250 ) , was significantly lower in children with higher S. hematobium egg counts , heavier hookworm infections , positive Plasmodium slides , and larger spleens . All children with light-moderate S. hematobium infection ( 1 - 500 eggs/10 ml adj ) in four schools were examined ( Exam 1 ) , allocated at r and om to either placebo ( MIP , n = 198 ) or metrifonate treatment ( MIT , n = 202 ) groups , treated , and examined again six months later ( Exam 2 ) . Hemoglobin levels rose significantly in both groups between exams , but the rise in the MIT group was 30 % higher than in the MIP group ( 1.3 vs. 1.0 g/dl , P less than 0.014 ) . The increase in hemoglobin level in the MIT group was significantly and positively correlated with decreases between exams in S. hematobium and hookworm egg counts and with higher malarial parasite counts at Exam 1 ( Pearson r 's 0.21 , 0.20 , 0.20 , respectively , P less than 0.01 ) . A stepwise multiple regression equation using hemoglobin rise between exams as the dependent variable showed that decreases in S. hematobium and hookworm egg counts were equally important determinants of hemoglobin rise and that malarial parasite count was almost as important as the changes in intensities of the helminth infections . These results show that treatment for S. hematobium with metrifonate can increase hemoglobin levels in children in an area where S. hematobium and anemia are common . They also emphasize the importance of measuring multiple parasitic infections and using multivariate statistical techniques such as multiple regression analysis in order to define the relationships between parasitic infections and morbidity Background Malaria remains one of the leading causes of morbidity and mortality in most low- and middle-income countries . Chloroquine is a previously cheap and effective antimalarial agent whose loss to resistance result ed in more than doubling of malaria-related mortality in malaria-endemic countries . Recently , chloroquine sensitivity is re-emerging among Plasmodium falciparum parasites which gives hope for malaria control and treatment efforts globally . The aim of the current review is to establish the prevalence of chloroquine resistance alleles among P. falciparum parasites in malaria-endemic areas after change in malaria treatment policy . Methods / design The articles will be obtained from search of MEDLINE via PubMed , SCOPUS , and EMBASE data bases . The Mesh terms will be used in article search . Boolean operators ( “ AND , ” “ OR ” ) will be used in article search . The article search will be done independently by two librarians . The PRISMA -P statement will be used to guide the conduct and reporting of the systematic review . STREGA guideline will be used in developing data abstract ion form for the review . Data abstract ion will be done by two independent review ers , Kappa statistic will be calculated , and any discrepancies resolved by discussion . Data analysis will be done using STATA ver 13.0 . The level of heterogeneity in the articles will be established by using the I2-statistic . Publication bias will be assessed using funnel plot . R and om effects analysis will be used . Discussion The review seeks to establish the extent of chloroquine resistance reversal in malaria-endemic countries . The evidence generated from this review will help guide policy makers on the potential re-emerging role of chloroquine in malaria treatment . Systematic review registration The systematic review protocol has been registered in PROSPERO with registration number CRD42018083957 The effect of a combined supplement of iron , thiamine , riboflavin and vitamin C on  malarial incidence in 5 to 14-year-old children was tested in a malnourished rural community in a region of The Gambia noted for high prevalence of malaria during the rainy season . 190 children , divided into 2 matched groups , received either the supplement or a matching placebo for 3 months . No significant difference in malarial incidence was observed between the 2 groups , despite a major improvement in biochemical indices of nutrient status in the supplemented group , especially for riboflavin and vitamin C. Severity of episodes was also similar between groups , but in subjects who developed parasitaemias there was a trend towards higher parasite counts in those receiving the active supplement . Nutritional interventions in malarious areas may have adverse effects on malaria , and the increase in parasitaemia was compatible with the hypothesis that a small but significant reduction in defences had occurred . However , the absence of increases in the incidence of proven malaria cases and their severity must also be taken into account , in order to make a balanced assessment of the possible increase in risk . Further investigations are needed to measure the risk in benefit rates , and to consider the effects of individual nutrients in isolation BACKGROUND Concomitant parasitic infections are common in the developing world , yet most studies focus on a single parasite in a narrow age group . We investigated the extent of polyparasitism and parasite associations , and related these findings to self-reported morbidity . METHODS Inhabitants of 75 r and omly selected households from a single village in western Côte d'Ivoire provided multiple faecal specimens and a  single finger prick blood sample . The Kato-Katz technique and a formol-ether concentration method were employed to screen faecal sample s for Schistosoma mansoni , soil-transmitted helminths and intestinal protozoa . Giemsa-stained blood smears were analysed for malaria parasites . A question naire was administered for collection of demographic information and self-reported morbidity indicators . RESULTS Complete parasitological data were obtained for 500/561 ( 89.1 % ) participants , similarly distributed among sex , with an age range from 5 days to 91 years . The prevalences of Plasmodium falciparum , hookworms , Entamoeba histolytica/E. dispar , and S. mansoni were 76.4 % , 45.0 % , 42.2 % , and 39.8 % , respectively . Three-quarters of the population harboured three or more parasites concurrently . Multivariate analysis revealed significant associations between several pairs of parasites . Some parasitic infections and the total number of parasites were significantly associated with self-reported morbidity indicators . CONCLUSIONS Our data confirm that polyparasitism is very common in rural Côte d'Ivoire and that people have clear perceptions about the morbidity caused by some of these parasitic infections . Our findings can be used for the design and implementation of sound intervention strategies to mitigate morbidity and co-morbidity BACKGROUND The mechanisms of severe malarial anemia and cerebral malaria , which are extreme manifestations of Plasmodium falciparum malaria , are not fully understood . METHODS Children aged < 6 years from southern Zambia presenting to the hospital with severe malarial anemia ( n = 72 ) , cerebral malaria ( n = 28 ) , or uncomplicated malaria ( n = 66 ) were studied prospect ively . Children with overlapping severe anemia and cerebral malaria were excluded . RESULTS Low interleukin 10 concentrations had the strongest association with severe anemia ( st and ard β = .61 ; P < .001 ) followed by high tumor necrosis factor α and sFas concentrations , low weight-for-age z scores , presence of stool parasites , and splenomegaly ( st and ard β = .15-.25 ; P ≤ .031 ) ; most of these factors were also associated with lower reticulocytes . Greater parasitemia was associated with higher interleukin 10 and tumor necrosis factor α concentrations , whereas sulfadoxizole/pyrimethamine therapy and lower weight-for-age z scores were associated with lower interleukin 10 levels . Thrombocytopenia and elevated tissue plasminogen activator inhibitor 1 levels had the strongest associations with cerebral malaria ( st and ard β = .37 or .36 ; P < .0001 ) , followed by exposure to traditional herbal medicine and hemoglobinuria ( st and ard β = .21-.31 ; P ≤ .006 ) . CONCLUSIONS Predictors of severe malarial anemia ( altered immune responses , poor nutrition , intestinal parasites , and impaired erythropoiesis ) differed from those of cerebral malaria ( thrombocytopenia , herbal medicine , and intravascular hemolysis ) . Improved preventive and therapeutic measures may need to consider these differences Intermittent preventive treatment in pregnancy ( IPTp ) is used to prevent Plasmodium falciparum malaria . However , parasites resistant to the IPTp drug sulfadoxine-pyrimethamine ( SP ) have emerged worldwide , and infections with mixed resistant and susceptible parasites are exacerbated by pyrimethamine in mice . In a prospect i ve delivery cohort in Muheza , Tanzania , we examined the effects of SP IPTp on parasite resistance alleles , parasite diversity , level of parasitemia , and inflammation in the placenta .  IPTp use was associated with an increased fraction of parasites carrying the resistance allele at DHPS codon 581 , an increase in the level of parasitemia , and more intense placental inflammation . The lowest mean level of parasite diversity and highest mean level of parasitemia occurred in women after recent IPTp use . These findings support a model of parasite release and facilitation , whereby the most highly resistant parasites out-compete less fit parasite population s and overgrow under drug pressure . Use of partially effective anti-malarial agents for IPTp may exacerbate  malaria infections in the setting of widespread drug resistance Background Falciparum malaria and HIV-1 infection are two of the most important health problems facing sub-Saharan Africa . No convincing evidence of an association between symptomatic malaria and HIV-1 infection has been found . Objective To investigate the effect of HIV-associated immunosuppression on malarial fever rates . Design An observational cohort study in HIV-specific , primary healthcare clinics in Entebbe , Ug and a , on 1371 HIV-1-infected adults participating in a r and omized trial of 23-valent pneumococcal vaccine .  Methods Cohort members underwent routine 6 monthly surveillance and had open clinic access when sick . Episodes of fever were assessed according to st and ardized protocol s. Rates of malaria are described according to HIV immune status determined by CD4 T cell counts . Results Incidence rates of Plasmodium falciparum malarial fever showed a marked inverse relationship with CD4 T cell count ; 140 , 93 and 57 cases per 1000 pyo for CD4 T cell groups < 200 , 200–499 and > 500 respectively , P < 0.001 . Malarial fever definitions incorporating parasite density criteria ( derived from asymptomatic surveillance ) to correct for chance findings of fever and P. falciparum parasitaemia , did not affect the association of incidence rates with immunosuppression . Conclusion These data support an interaction between symptomatic P. falciparum and HIV . Emphasis on mosquito avoidance measures should be an important component of education and counselling of HIV/AIDS patients in malaria-endemic areas , and suggests an additional HIV-related public health problem in Africa OBJECTIVE Our study in Port Harcourt children with asymptomatic malaria aim ed at assessing the baseline anthropometric indices of nutritional status , and whether their nutritional status ( especially under nutrition ) offers any advantage for living in malaria endemic areas . DESIGN Cross-sectional study was used . SETTING Rumueme Community in Port Harcourt , Nigeria . SUBJECTS Apparently healthy children aged 1 - 8 years of both sexes ( Boys = 117 , Girls = 123 ; Ratio 1:1.05 ) , 240 children from r and omly selected households within the study community participated in the study . RESULTS Of the 240 children , 66 ( 27.5 % ) were infected with malaria ( P falciparum ) . Children below 5 years had a higher parasitaemic rate ( 36.36 % ) than those in 5 - 8 years group ( 21.27 % ) . Our baseline data showed that 17.5 % were underweight ( WFA Z < -2 ) , 3.75 % were stunted ( HFA Z < -2 ) and 22.5 % were wasting ( WFH Z < -2 ) . Children who are underweight were found to be at higher risk of acquiring malaria infection than the well nourished children ( RR = 1.02 , chi2 = 0.320 , p < 0.02 , 95 % CI 0.34 - 2.37 ) . Under nutrition was more prominent in the children below 5 years than the older children ( RR = 3.625 , chi2 = 10.36 , p < 0.006 , 95 % CI 1.81 - 5.43 ) . The haemoglobin value of parasitized children ( 10.8 + /- 1.9 g/dl ) was significantly lower than the non-parasitized group ( 11.3 + /- 1.7 g/dl , ) ( p < 0.01 ) . CONCLUSION We concluded that the presence of under nutrition places children ( especially below 5 years of age ) at higher risk of malaria related morbidity . Children in malaria endemic areas need adequate nutrition to withst and the negative impact of malaria A r and omized , double-blind , placebo-controlled iron supplementation trial was conducted in Kenya to examine the effect of iron supplements on appetite and growth in 87 primary school children .  Sustained-release ferrous sulfate ( 150 mg ) or placebo tablets were provided daily at school for 14 wk . Prior to tablet administration , baseline anthropometry , iron nutritional status ( hemoglobin and serum ferritin ) , parasitic infections and clinical indicators of morbidity were measured . A baseline appetite test was conducted twice on each child by quantitatively measuring the ad libitum consumption of a midmorning snack . In addition , each child was asked for a subjective assessment of his or her appetite . Follow-up exams and appetite tests were identical to those at baseline . Findings indicated that provision of iron supplements result ed in improved growth and improved appetite ( in terms of both energy intake of the snack and child report of appetite ) as compared with children receiving the placebo . The increased energy intake from the snack was 10 % of the daily estimated energy intake for children of this same age group living elsewhere in Kenya . Further research into the underlying physiological mechanisms may shed light on the relationship between iron nutritional status and appetite Background In Ug and a , parasite-based diagnosis is recommended for every patient suspected to have malaria before prescribing anti-malarials . However , the majority of patients are still treated presumptively especially in low-level health units . The feasibility of implementing parasite-based diagnosis for uncomplicated malaria in rural health centres ( HCs ) was investigated with a view to recommending measures for scaling up the policy . Methods Thirty HCs were r and omized to implement  parasite-based diagnosis based on rapid diagnostic tests [ RDTs ] ( n = 10 ) , blood microscopy ( n = 10 ) and presumptive diagnosis ( control arm ) ( n = 10 ) . Feasibility was assessed by comparing the proportion of patients who received parasite-based diagnosis ; with a positive malaria parasite-based diagnosis who received artemether-lumefantrine ( AL ) ; with a negative malaria parasite-based diagnosis who received AL ; and patient waiting time . Clinical trials.gov : NCT00565071 . Results 102 , 087 out patients were enrolled . Patients were more likely to be  tested in the RDT 44 , 565 ( 96.6 % ) than in microscopy arm 19 , 545 ( 60.9 % ) [ RR : 1.59 ] . RDTs reduced patient waiting time compared to microscopy and were more convenient to health workers and patients . Majority 23 , 804 ( 99.7 % ) in presumptive arm were prescribed AL . All ( 100 % ) of patients who tested positive for malaria in RDT and microscopy arms were prescribed anti-malarials . Parasitological-based diagnosis significantly reduced AL prescription in RDT arm [ RR : 0.62 ] and microscopy arm [ RR : 0.72 ] compared to presumptive treatment . Among patients not tested in the two intervention arms , 12 , 044 ( 96.1 % ) in microscopy and 965 ( 61.6 % ) in RDT arm were treated with AL [ RR : 1.56 ] . Overall 10 , 558 ( 29.4 % ) with negative results [ 5 , 110 ( 23.4 % ) in RDT and 5 , 448 ( 39.0 % ) in microscopy arms ] were prescribed AL . Conclusion It was more feasible to implement parasite-based diagnosis for malaria using RDT than with microscopy . A high proportion of patients with negative malaria results are still prescribed anti-malarials . There is need to increase access to parasite-based diagnosis where microscopy is used . In order to fully harness the benefits of parasitological confirmation of malaria , it is necessary to reduce the prescription of anti-malarials in negative patients Disease outcome in persons infected with Schistosoma haematobium varies dramatically , ranging from mild symptoms to severe damage of the kidneys and /or bladder . We used ultrasonography to characterize the extent of urinary tract pathology of infected children in Zimbabwe , and r and om genetic markers to examine the relationship between genetic diversity of S. haematobium and clinical outcome .  One hundred thirty-three parasite isolates from 12 students with mild lesions and 13 with severe lesions were compared . Using four r and omly amplified polymorphic DNA ( RAPD ) markers , we scored parasite allelic frequencies at 53 loci . Although parasite heterogeneity did not differ , allelic frequencies at eight loci differed significantly between the mild and severe groups . Parasite isolates were analyzed further using a modified cluster analysis that segregated the population into 13 clusters of associated genotypes . Three clusters were significantly over-represented in children with severe lesions . Our findings , although preliminary , suggest that parasite genetic associations may be important in clinical outcome The relationship between malaria transmission intensity and efficiency is important for malaria epidemiology , for the design of r and omized control trials that measure transmission or incidence as end points , and for measuring and modelling malaria transmission and control . Five kinds of studies published over the past century were assembled and reanalysed to quantify malaria transmission efficiency and describe its relation to transmission intensity , to underst and the causes of inefficient transmission and to identify functions suitable for modelling mosquito-borne disease transmission . In this study , we show that these studies trace a strongly nonlinear relationship between malaria transmission intensity and efficiency that is parsimoniously described by a model of heterogeneous biting . When many infectious bites are concentrated on a few people , infections and parasite population structure will be highly aggregated affecting the immunoepidemiology of malaria , the evolutionary ecology of parasite life history traits and the measurement and stratification of transmission for control using entomological and epidemiological data Background Malaria and undernutrition frequently coexist , especially in pregnant women and young children .  Nutrient supplementation of these vulnerable groups might reduce their susceptibility to malaria by improving immunity . Methods Antibody immunity to antigens expressed by a placental-binding parasite isolate , a non-placental binding parasite isolate , merozoites and schizonts at enrolment ( before 20 gestation weeks ) and at 36 gestation weeks were measured in 1,009 Malawian pregnant women receiving a daily lipid-based nutrient supplement , multiple micronutrients or iron and folic acid , who were participants in a r and omized clinical trial assessing the effects of nutrient supplementation on pregnancy outcomes and child development ( registration ID : NCT01239693 ) . Results Antibodies to placental-binding isolates significantly increased while antibodies to most merozoite antigens declined over pregnancy . Overall , after adjustment for covariates , the type of supplementation did not influence antibody levels at 36 gestation weeks or the rate of change in antibody levels from enrolment to 36 weeks . A negative association between maternal body mass index and opsonizing antibodies to placental-binding antigens ( coefficient ( 95 % CI ) -1.04 ( −1.84 , −0.24 ) , was observed . Similarly , women with higher socioeconomic status had significantly lower IgG and opsonizing antibodies to placental-binding antigens . Neither of these associations was significantly influenced by the supplementation type . Conclusions In the current cohort nutrient supplementation did not affect anti-malarial antibody responses , but poor and undernourished mothers should be a priority group in future trials Background Artemisinin-based combination therapy has been first-line treatment for falciparum malaria in Myanmar since 2005 . The wide extent of artemisinin resistance in the Greater Mekong sub-region and the presence of mefloquine resistance at the Myanmar-Thail and border raise concerns over resistance patterns in Myanmar . The availability of molecular markers for resistance to both drugs enables assessment even in remote malaria-endemic areas . Methods A total of 250 dried blood spot sample s collected from patients with Plasmodium falciparum malarial infection in five malaria-endemic areas across Myanmar were analysed for kelch 13 sequence ( k13 ) and pfmdr1 copy number variation . K13 mutations in the region corresponding to amino acids 210–726 ( including the propeller region of the protein ) were detected by nested PCR amplification and sequencing , and pfmdr1 copy number variation by real-time PCR . In two sites , a sub-set of patients were prospect ively followed up for assessment of day-3 parasite clearance rates after a st and ard course of artemether-lumefantrine . Results K13 mutations and pfmdr1 amplification were successfully analysed in 206 and 218 sample s , respectively . Sixty-nine isolates ( 33.5 % ) had mutations within the k13 propeller region with 53 of these ( 76.8 % ) having mutations already known to be associated with artemisinin resistance . F446I ( 32 isolates ) and P574L ( 15 isolates ) were the most common examples . K13 mutation was less common in sites in western border regions ( 29 of 155 isolates ) compared to sample s from the east and north ( 40 of 51 isolates ; p < 0.0001 ) . The overall proportion of parasites with multiple pfmdr1 copies ( greater than 1.5 ) was 5.5 % . Seven sample s showed both k13 mutation and multiple copies of pfmdr1 . Only one of 36 patients followed up after artemether-lumefantrine treatment still had parasites at day 3 ; molecular analysis indicated wild-type k13 and single copy pfmdr1 . Conclusion The proportion of P. falciparum isolates with mutations in the propeller region of k13 indicates that artemisinin resistance extends across much of Myanmar . There is a low prevalence of parasites with multiple pfmdr1 copies across the country . The efficacy of artemisinin-based combination therapy containing mefloquine and lumefantrine is , therefore , expected to be high , although regular monitoring of efficacy will be important A previous longitudinal three-country study in Egypt , Kenya and Mexico found significant positive associations between intake of animal source foods ( ASF ) and growth , cognitive development and physical activity . To test for a causal relationship , a controlled school feeding intervention study was design ed to test the hypotheses that ASF would improve micronutrient status , growth and cognitive function in Kenyan primary school children . Twelve rural Kenyan schools with 554 children were r and omized to four feeding interventions using a local vegetable stew as the vehicle . The groups were design ated as Meat , Milk , Energy and Control , who received no feedings . Feeding was carried out on school days for seven terms during 21 mo . Preintervention baseline measures included nutritional status , home food intake , anthropometry , biochemical measures of micronutrient status , malaria , intestinal parasites , health status and cognitive and behavioral measures . The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in approximately 30 % of children and widespread inadequate intakes and /or biochemical evidence of micronutrient deficiencies , particularly of iron , zinc , vitamins A and B-12 , riboflavin and calcium . Little or no ASF were eaten and fat intake was low . Malaria was present in 31 % of children , and hookworm , amebiasis and giardia were widely prevalent . The outcomes measured were rates of change or increase during the intervention in cognitive function , growth , physical activity and behavior and micronutrient status . Hierarchical linear r and om effects modeling was used for analysis of outcomes Background Malaria is preventable and treatable when recommended interventions are properly implemented . Thus , diagnosis and treatment focus on symptomatic individuals while asymptomatic Plasmodium infection ( PI ) plays a role in the sustainability of the transmission and may also have an impact on the morbidity of the disease in terms of anaemia , nutritional status and even cognitive development of children . The objective of this study was to assess PI prevalence and its relationship with known morbidity factors in a vulnerable but asymptomatic stratum of the population . Methods A simple r and om sample , household survey in asymptomatic children under the age of five was conducted from April to September 2012 in two health areas of the health zone of Mont Ngafula 1 , Kinshasa , Democratic Republic of Congo . Results The PI prevalence were 30.9 % ( 95 % CI : 26.5 - 35.9 ) and 14.3 % ( 95 % CI : 10.5 - 18.1 ) in Cité Pumbu and Kindele health areas , respectively , ( OR : 2.7 ; p < 0.001 ) . All were Plasmodium falciparum infected and 4 % were co-infected with Plasmodium malariae . In Cité Pumbu and Kindele , the prevalence of anaemia ( haemoglobin < 11 g/dL ) was 61.6 % ( 95 % CI : 56.6 - 66.5 ) and 39.3 % ( 95 % CI : 34.0 - 44.6 ) , respectively , ( OR : 2.5 ; p < 0.001 ) . The health area of Cité Pumbu had 32 % ( 95 % CI : 27.5 - 37.0 ) of chronic malnutrition ( HAZ score ≤ −2SD ) compared to 5.1 % ( 95 % CI : 2.8 - 7.6 ) in Kindele . PI was predictor factor for anaemia ( aOR : 3.5 , p = 0.01 ) and within infected children , there was an inverse relationship between parasite density and haemoglobin level ( β = −5 * 10−5 , p < 0.001 ) . Age older than 12 months ( aOR : 3.8 , p = 0.01 ) , presence of anaemia ( aOR : 3.4 , p = 0.001 ) , chronic malnutrition ( aOR : 1.8 , p = 0.01 ) , having a single parent/guardian ( aOR : 1.6 , p = 0.04 ) , and the non-use of insecticide-treated nets ( aOR : 1.7 , p = 0.04 ) were all predictors for PI in the overall population . Conclusion PI in asymptomatic children was correlated with anaemia and chronic malnutrition and was thus a harmful condition in the study population . Malaria control initiatives should not only focus on treatment of symptomatic infections but also take into consideration asymptomatic but infected children A large-scale longitudinal cohort project was initiated in western Kenya in June 1992 . Between June 1992 and July 1994 , 1,848 children less than 15 years of age were monitored prospect ively for a mean of 236 days . During this period , 12,035 blood smears were examined for malaria and only 34 % were found to be negative . Parasite prevalence ( all species ) decreased with age ( from a high of 83 % among children 1 - 4 years old to 60 % among children 10 - 14 years old ) . Even more dramatic decreases were noted in the prevalence of high density falciparum infection ( from 37 % among children 12 - 23 months old to < 1 % among 10 - 14-year-old children ) and in clinical malaria ( 20 % to 0.3 % in the same age groups ) . Children < 1 year of age accounted for 55 % of all cases of anemia detected . Anemia was consistently associated with high density infection in children < 10 years of age ( 20 % to 210 % increased risk relative to aparasitemic children ) . These results demonstrate the relationship between high-density malaria infection and two clinical manifestations of malarial illness
Conclusions This systematic review found that most of the evidence associating malaria and malnutrition comes from P. falciparum endemic areas , with a significant heterogeneity in studies ’ design .
Apparently malnutrition has not a great impact on malaria morbidity , but could have a negative impact on malaria mortality and severity .
Most studies show no association between malaria and subsequent malnutrition in P. falciparum areas .
In Plasmodium vivax endemic areas , malaria was associated with malnutrition in children .
Background Multiple studies in various parts of the world have analysed the association of nutritional status on malaria using anthropometric measures , but results differ due to the heterogeneity of the study population , species of the parasite , and other factors involved in the host and parasite relationship .
The aim of this study was to perform a systematic review on the inter-relationship of nutritional status based on anthropometry and malarial infection .