Impact of malaria control on childhood anaemia in Africa - a quantitative review


Korenromp, EL; Armstrong-Schellenberg, JRM; Williams, BG; Nahlen, BL; Snow, RW; (2004) Impact of malaria control on childhood anaemia in Africa - a quantitative review. Tropical medicine & international health, 9 (10). pp. 1050-1065. ISSN 1360-2276 DOI: https://doi.org/10.1111/j.1365-3156.2004.01317.x

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Abstract

OBJECTIVE To review the impact of malaria control on haemoglobin (Hb) distributions and anaemia prevalences in children under 5 in malaria-endemic Africa. METHODS Literature review of community-based studies of insecticide-treated bednets, antimalarial chemoprophylaxis and insecticide residual spraying that reported the impact on childhood anaemia. Anaemia outcomes were standardized by conversion of packed cell volumes into Hb values assuming a fixed threefold difference, and by estimation of anaemia prevalences from mean Hb values by applying normal distributions. Determinants of impact were assessed in multivariate analysis. RESULTS Across 29 studies, malaria control increased Hb among children by, on average, 0.76 g/dl [95% confidence interval (CI): 0.61-0.91], from a mean baseline level of 10.5 g/dl, after a mean of 1-2 years of intervention. This response corresponded to a relative risk for Hb < 11 g/dl of 0.73 (95% CI: 0.64-0.81) and for Hb < 8 g/dl of 0.40 (95% CI: 0.25-0.55). The anaemia response was positively correlated with the impact on parasitaemia (P = 0.005, P = 0.008 and P = 0.01 for the three outcome measures), but no relationship with the type or duration of malaria intervention was apparent. Impact on the prevalence of Hb < 11 g/dl was larger in sites with a higher baseline parasite prevalence. Although no age pattern in impact was apparent across the studies, some individual trials found larger impacts on anaemia in children aged 6-35 months than in older children. CONCLUSION In malaria-endemic Africa, malaria control reduces childhood anaemia. Childhood anaemia may be a useful indicator of the burden of malaria and of the progress in malaria control.

Item Type: Article
Keywords: malaria/prevention and control, anaemia, Africa, children, insecticide-treated mosquito nets, insecticide residual spraying, chemoprophylaxis, intermittent preventive therapy, TREATED BED NETS, PLACEBO-CONTROLLED TRIAL, YOUNG NIGERIAN CHILDREN, GAMBIAN CHILDREN, WEST-AFRICA, INTERMITTENT TREATMENT, IMPREGNATED, BEDNETS, TANZANIAN CHILDREN, IRON-DEFICIENCY, RURAL-COMMUNITY, Africa, epidemiology, Anemia, epidemiology, parasitology, Animals, Child, Preschool, Endemic Diseases, Humans, Infant, Infant, Newborn, Insect Vectors, Malaria, complications, epidemiology, prevention & control, Mosquito Control, methods
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Malaria Centre
Centre for Maternal, Reproductive and Child Health (MARCH)
PubMed ID: 15482397
Web of Science ID: 224464400003
URI: http://researchonline.lshtm.ac.uk/id/eprint/6426

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