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 using standard anthropometrie 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</it> = 0.01] and having suffered one or more episodes of clinical P. vivax</it> malaria in the 6 months preceding nutritional assessment [OR 2.4 (1.3–4.4), p = 0.006]. The incidence of P. vivax</it> 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</it>≤0.0001). These groups had similar incidences of clinical P. falciparum</it> infection during the same period [IRR 1.1 (0.57–2.1) p</it> = 0.8] and of either species during the 6 months following assessment [IRR P. vivax</it> 1.3 (0.9–2.0) p = 0.2; IRR P. falciparum</it> 1.3 (0.9–1.9) p</it> = 0.2]. In these children, P. vivax</it> malaria was a major predictor of acute malnutrition; P. faldparum</it> was not. Wasting neither predisposed to nor protected against malaria of either species. Although P. vivax</it> malaria is generally regarded as benign, it may produce considerable global mortality through malnutrition.