Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.

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  • March 21, 2019
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  • Cates, Jordan
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Malnutrition and malaria infection commonly co-exist, afflicting pregnant women in resource-poor settings and increasing the risk of a low birthweight (LBW) infant. By 2025, WHO targets a reduction in the incidence LBW by 30%. Previously, four studies indicated that the effect of malaria infection on the risk of LBW may depend upon maternal nutritional status. We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using data from 14,633 pregnancies from 13 studies conducted in Africa and the Western Pacific. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random effects model. Using parametric g-formula, we estimated population-attributable effects and generalized intervention effects for differences in the incidence of LBW expected under hypothetical malaria and malnutrition interventions. The adjusted risk ratio (aRR) for delivering a baby with LBW was 1.14 (95% CI: 0.91, 1.42) among women with malaria infection at antenatal enrollment, 1.32 (95% CI: 1.08, 1.62) among women with malaria infection at delivery, and 1.60 (95% CI: 1.36, 1.87) among women with low mid-upper arm circumference at enrolment (MUAC <23cm). The joint aRR for women with both malaria infection and low MUAC at enrollment was 2.13 (95% CI: 1.21, 3.73; N=8,152). There was no evidence of synergism between malaria infection and MUAC on the multiplicative (p=0.5) or additive scale (p=0.9). We estimated that, compared to the current patterns of IPTp use in the study population, increasing every woman’s dosage of IPTp to at least three doses would result in a relative decrease in the incidence of LBW of 34% (95% CI: 25%, 43%). The intervention effects for malaria at delivery, low MUAC in early pregnancy, and bed nets were all modest. Pregnant women with malnutrition and malaria infection are at increased risk of LBW, but malaria and malnutrition do not act synergistically. Scale up of IPTp, alone or in tandem with other antenatal interventions, could help achieve the WHO’s Global Nutrition Target of a 30% reduction in LBW by 2025.
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  • In Copyright
Advisor
  • Meshnick, Steven R.
  • Bauserman, Melissa
  • Westreich, Daniel
  • Cole, Stephen
  • Adair, Linda
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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