A large percentage of child deaths related to malaria are
attributable to undernutrition and deficiencies of vitamin
A, zinc, iron and folate, according to a new report by
researchers with the Johns Hopkins
Bloomberg School of Public
Health. Their review of recent data from malaria
endemic regions showed that improving child nutrition could
prevent more malaria-related illnesses and deaths than
previously thought. Their paper appears in the August
supplement to the American Journal of Tropical Medicine
"While undernutrition's role in exacerbating diarrheal
disease and respiratory infections is well-known,
scientific evidence has been mixed regarding its role in
malaria infection," says lead author Laura E. Caulfield, an
associate professor with the Bloomberg School's
Human Nutrition. "Despite the fact that people have
thought that undernutrition prevents malaria, the bulk of
evidence suggests that undernutrition contributes
significantly to the malaria burden."
Nearly 550,000 annual malaria deaths are attributable
to underweight in children less than 5 years of age,
according to global burden of disease data published
earlier this year. The investigators looked at malaria
morbidity and mortality risk due to underweight and
specific micronutrient deficiencies in countries including
The Gambia, Vanuatu, Ghana, Guinea-Bissau and Senegal.
While underweight children had only a slightly increased
risk of a clinical malaria attack, the data on mortality
risk in underweight children were dramatic. Mildly
malnourished children were two times more likely to die
from malaria than children who are not undernourished,
while moderately malnourished children were four times more
likely to die. Severely malnourished children were nine
times more likely to die. While the risk of malaria
mortality increases with the severity of undernutrition,
most child deaths occur in only mildly to moderately
undernourished children because of the high prevalence of
children of this nutritional status in many countries.
Widespread zinc and vitamin A deficiencies in
malaria-endemic regions contribute to growth faltering and
compromise a child's ability to fight infection. Zinc
improves growth and enhances the body's ability to respond
to infection, and vitamin A plays an essential role in the
immune response and is believed to be necessary for host
resistance to malaria. Researchers stress that strategies
to reduce the global malaria burden must include integrated
nutrition programs that address growth faltering and
improve the micronutrient status of young children.
"We still need more research to better understand the
complex relationship between nutrition and malarial
infection," Caulfield says, "but the existing and emerging
evidence strongly suggests that well-nourished children are
better able to fight and survive malaria infection."
The study was written by Caulfield, Stephanie A.
Richard and Robert E. Black.