Table 2.
Relationship between chronic malnutrition (stunting) and risk of malarial infection (N = 23)
| Author, Year, Reference | HAZ cutoff | Malaria outcome | Risk estimate comparing children below and above HAZ cutoff | Risk |
|---|---|---|---|---|
| Akiyama 2016 [46] | ≤ − 2 | Asymptomatic malaria confirmed by PCR | OR = 3.34 (95% CI = 1.25–8.93) | Increased |
| Alexandre 2015 [47] | < − 2 | Fever and thick blood smear | HR = 0.31 (95% CI = 0.10–0.99), P = 0.049 | Decreased |
| Arinaitwe 2012 [48] | − 1 and −2 | Pf malaria, fever and a positive blood smear | IRR = 1.24 (95% CI 1.06–1.46), P = 0.008 | Increased |
| < − 2 | Pf malaria, fever and a positive blood smear | IRR = 1.24 (95% CI 1.03–1.48), P = 0.02 | Increased | |
| Ayana 2015 [49] | < − 2 | Malaria by RDT | HR = 2.50 (95% CI = 1.4–5.1) | Increased |
| Crookston 2010 [50] | ≥ − 2 and < − 1 | Asymptomatic malaria confirmed by PCR | OR = 2.23 (95% CI = 0.99–5.02) | No impact |
| ≥ − 3 and < − 2 | Asymptomatic malaria confirmed by PCR | OR = 0.56 (95% CI = 0.16–1.69) | No impact | |
| < − 3 | Asymptomatic malaria confirmed by PCR | OR = 1.02 (95% CI = 0.20–3.76) | No impact | |
| Custodio 2009 [30] | < − 2 | Pf malaria parasitemia prevalence | OR = 3.07 (95% CI = 1.40–6.73) | Increased |
| Deen 2002 [10] | < − 2 | Malaria episode (fever ≥37.5 °C or parasitemia > 5000/μL) | RR = 1.35 (95% CI = 1.08–1.69), P = 0.01 | Increased |
| Deribew 2010 [51] | < − 2 | Pf malaria (any parasitemia) | AOR = 0.9 (95% CI = 0.7–1.2), P = 0.85 | No impact |
| Fillol 2009 [27] | < − 2 | Clinical malaria (fever ≥37.5 °C plus parasitemia ≥ 3000/μL) | “Non-significant association” reported | No impact |
| < − 2 | High density parasitemia (geometric mean ≥ 300/μL) | AOR = 2.42 (95% CI = 1.12–5.24), P = 0.03 | Increased | |
| Friedman 2005 [26] | < − 2 | Concurrent malaria (any parasitemia) | AOR = 1.98, P < 0.0001 | Increased |
| < − 2 | High density parasitemia (any species, > 1500–7000/μL) | AOR = 1.84, P < 0.0001 | Increased | |
| < − 2 | Clinical malaria (fever plus high density parasitemia) | AOR = 1.77, P = 0.06 | Increased | |
| < −2 | Severe anaemia (Haemoglobin < 7 g/dL) | AOR = 2.65, P < 0.0001* | – | |
| Genton 1998 [14] | < − 2 | Pf malaria (fever plus any parasitemia) | Adj. Rate ratio = 1.13 (95% CI = 0.98–1.29), P = 0.09 | No impact |
| < −2 | Pf malaria (fever plus parasitemia ≥ 5 × 109/L) | Adj. Rate ratio = 1.19 (95% CI = 1.01–1.40), P = 0.03 | Increased | |
| < −2 | Pf malaria (fever plus parasitemia ≥ 10 × 109/L) | Adj. Rate ratio = 1.18 (95% CI = 0.98–1.41), P = 0.08 | No impact | |
| Kateera 2015 [54] | < − 2 | Pf malaria (any parasitemia) | “Non-significant association” reported | No impact |
| Maketa 2015 [55] | ≤ − 2 | Asymptomatic malaria by blood smear | AOR = 1.8, P = 0.01 | Increased |
| Mamiro 2005 [56] | < − 2 | Malaria by blood smear | AOR = 1.9 (95% CI = 1.1–3.2), P = 0.02 | Increased |
| Mitangala 2013 [21] | < − 2 | Pf malaria parasitemia (≥ 5000/μL) | AOR = 0.72 (95% CI = 0.37–1.40) | No impact |
| < −3 | Pf malaria parasitemia (≥ 5000/μL) | AOR = 0.48 (95% CI = 0.25–0.91) | Decreased | |
| Muller 2003 [18] | ≤ − 2 | Pf malaria (fever plus parasitemia ≥ 1/μL) | RR = 1.0 (95% CI = 0.9–1.1), P = 0.87 | No impact |
| ≤ − 2 | Pf malaria (fever plus parasitemia ≥ 5000/μL) | RR = 1.0 (95% CI = 0.9–1.2), P = 0.59 | No impact | |
| ≤ − 2 | Pf malaria (fever plus parasitemia ≥ 100,000/μL) | RR = 0.8 (95% CI = 0.5–1.4), P = 0.44 | No impact | |
| Nyakeriga 2004 [6] | < − 2 | Pf malaria (fever plus any parasitemia) | Adj. IRR = 1.89 (95% CI = 1.01–3.53), P = 0.05 | Increased |
| < − 2 | Pf malaria (fever plus any para < 1 year, > 2500/μL > 1 year) | Adj. IRR = 1.93 (95% CI = 0.9–4.16), P = 0.09 | Increased | |
| Snow 1991 [17] | < − 2 | Clinical malaria (fever plus any parasitemia) | “Non-significant association” reported | No impact |
| < −2 | Asymptomatic malaria parasitemia | “Non-significant association” reported | No impact | |
| Sumbele 2015 [57] | < − 2 | Clinical malaria parasitemia | Stunted vs. Non-stunted: 16.9% vs. 7.5%, P = 0.01 | Increased |
| < −2 | Asymptomatic malaria parasitemia | Stunted vs. Non-stunted: 26.0% vs. 26.2%, P = 0.91 | No impact | |
| Tonglet 1999 [32] | < − 2 | Clinical malaria without lab confirmation in < 9 m | AOR = 1.16 (95% CI = 0.54–1.77) | Increased |
| < −2 | Clinical malaria without lab confirmation in ≥ 9 m | AOR = 0.71 (95% CI = 0.28–1.14) | No impact | |
| Uscategui Penuela 2009 [58] | < − 2 | Malaria infection | OR = 1.94 (95% CI = 1.07–3.50), P = 0.023 | Increased |
| Verhoef 2002 [13] | < −2 | Laboratory confirmed malaria | OR = 0.87 (95% CI = 0.69–1.09), P = 0.23 | No impact |
| Verret 2011 [22] | ≥ − 1 and < 0 | Pf malaria risk of recurrent parasitemia | HR = 2.35 (95% CI = 0.85–6.48), P = 0.099 | No impact |
| ≥ −2 and < − 1 | Pf malaria risk of recurrent parasitemia | HR = 2.89 (95% CI = 1.06–7.89), P = 0.039 | Increased | |
| < − 2 | Pf malaria risk of recurrent parasitemia | HR = 3.18 (95% CI = 1.18–8.56), P = 0.022 | Increased |
Pf Plasmodium falciparum, HAZ height-for-age Z-scores, CI confidence interval, OR odds ratio, HR hazard ratio, RR risk ratio, IRR incidence rate ratio, AOR adjusted odds ratio
*Limited to anaemia