We studied the aetiology of malnutrition in a cohort of 1511 children < 10 years old in Espiritu Santo, Vanuatu. Malnutrition was categorized using standard anthropometric criteria as: underweight [weight-for-age (WA) Z score < -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 < 5 years [OR (95% CI) 1.8 (1.2-2.9), p = 0.01] and having suffered one or more episodes of clinical P. vivax malaria in the 6 months preceding nutritional assessment [OR 2.4 (1.3-4.4), p = 0.006]. The incidence of P. vivax infection was significantly higher during the 6 months preceding assessment in underweight vs. non-underweight children [incidence rate ratio (IRR) 2.6 (1.5-4.4), p < or = 0.0001). These groups had similar incidences of clinical 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 acute malnutrition; P. falciparum was not. Wasting neither predisposed to nor protected against malaria of either species. Although P. vivax malaria is generally regarded as benign, it may produce considerable global mortality through malnutrition.
PIP: The etiology of malnutrition was investigated in a cohort of all 1511 children under 10 years of age living in 13 villages in the island of Espiritu Santo, Vanuatu, where malaria is endemic. 18% of children under 5 years were underweight, 5% were wasted, and 20% were stunted. The mean weight-for-age Z score for the 1114 children resident in hyperendemic villages was significantly lower (-0.99) than that of the 397 children living in the mesoendemic area (-0.77). According to multiple logistic regression analysis, the only factors significantly associated with wasting in the hyperendemic area were age under 5 years (odds ratio (OR), 1.8; 95% confidence interval (CI), 1.2-2.9) and 1 or more episodes of clinical Plasmodium vivax malaria in the 6 months preceding nutritional assessment (OR, 2.4; 95% CI, 1.3-4.4). Only male sex and low birth weight were significantly associated with stunting. The incidence of P. vivax infection in the 6 months preceding the survey was significantly higher in underweight compared to non-underweight children (relative risk (RR), 2.6; 95% CI, 1.5-4.4). The incidence of P. falciparum malaria was not significantly different between groups, suggesting that this is not a major cause of malnutrition on the island. Wasting neither predisposed to nor protected against malaria of either species. Although P. vivax malaria is generally regarded as benign, it may produce substantial global mortality through malnutrition.