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Jordan
Cates
Author
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
Spring 2017
2017
Epidemiology
low birthweight, malaria, malnutrition, pregnancy
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Daniel
Westreich
Thesis advisor
Steven
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions
and Interventions.
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.
Spring 2017
2017
Epidemiology
low birthweight, malaria, malnutrition,
pregnancy
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting
institution
Epidemiology
Daniel
Westreich
Thesis advisor
Steven
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
Spring 2017
2017
Epidemiology
low birthweight, malaria, malnutrition, pregnancy
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Daniel
Westreich
Thesis advisor
Steven
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
2017-05
2017
Epidemiology
low birthweight, malaria, malnutrition, pregnancy
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Daniel
Westreich
Thesis advisor
Steven
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
2017
Epidemiology
low birthweight, malaria, malnutrition, pregnancy
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Daniel
Westreich
Thesis advisor
Steven
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
2017-05
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
2017
Epidemiology
low birthweight, malaria, malnutrition, pregnancy
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Daniel
Westreich
Thesis advisor
Steven
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
2017-05
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
2017
Epidemiology
low birthweight, malaria, malnutrition, pregnancy
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Daniel
Westreich
Thesis advisor
Steven
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
2017-05
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
2017
Epidemiology
low birthweight, malaria, malnutrition, pregnancy
eng
Doctor of Philosophy
Dissertation
Epidemiology
Daniel
Westreich
Thesis advisor
Steven R.
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
2017-05
University of North Carolina at Chapel Hill
Degree granting institution
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
2017
Epidemiology
low birthweight; malaria; malnutrition; pregnancy
eng
Doctor of Philosophy
Dissertation
Epidemiology
Daniel
Westreich
Thesis advisor
Steven R.
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
2017-05
University of North Carolina at Chapel Hill
Degree granting institution
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
2017
Epidemiology
low birthweight, malaria, malnutrition, pregnancy
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Daniel
Westreich
Thesis advisor
Steven R.
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
2017-05
Jordan
Cates
Creator
Department of Epidemiology
Gillings School of Global Public Health
Malaria and Malnutrition during Pregnancy: An Investigation of Interactions and Interventions.
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.
2017
Epidemiology
low birthweight; malaria; malnutrition; pregnancy
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Daniel
Westreich
Thesis advisor
Steven R.
Meshnick
Thesis advisor
Linda
Adair
Thesis advisor
Stephen
Cole
Thesis advisor
Melissa
Bauserman
Thesis advisor
text
2017-05
Cates_unc_0153D_16912.pdf
uuid:ac8c682b-b0ee-4b88-8f94-0f9e0d4742f9
2017-04-14T16:44:18Z
proquest
2019-07-06T00:00:00
application/pdf
3909625
yes