Plasmodium vivax: a cause of malnutrition in young children

We studied the aetiology of malnutrition in a cohort of 1511 children <10 years old in Espiritu Santo, Vanuatu. Malnutrition was categorized usingstandard anthropometric criteria as: underweight [weight-for-age (WA) Zscore < -2], wasting [weight-for-height (WH) Z < -2], or stunting[height-for-age (HA) Z < -2]. On multiple logistic regression analysis,the only factors significantly associated with wasting were age < 5years [OR (95% CI) 1.8 (1.2-2.9), p = 0.01] and having suffered one or moreepisodes of clinical P. vivax malaria in the 6 months preceding nutritionalassessment [OR 2.4 (1.3-4.4), p = 0.006]. The incidence of P. vivaxinfection was significantly higher during the 6 months preceding assessmentin underweight vs. non-underweight children [incidence rate ratio (IRR) 2.6(1.5-4.4), p < or = 0.0001). These groups had similar incidences ofclinical P. falciparum infection during the same period [IRR 1.1 (0.57-2.1)p = 0.8] and of either species during the 6 months following assessment[IRR P. vivax 1.3 (0.9- 2.0) p = 0.2; IRR P. falciparum 1.3 (0.9-1.9) p =0.2]. In these children, P. vivax malaria was a major predictor of acutemalnutrition; P. falciparum was not. Wasting neither predisposed to norprotected against malaria of either species. Although P. vivax malaria isgenerally regarded as benign, it may produce considerable global mortalitythrough malnutrition.