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

Journal article

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.

Authors: Korenromp, E; Armstrong-Schellenberg, JR; Williams, BG; Nahlen, B; Snow, R

• Publication status: Published
• Journal: Tropical medicine and international health : TM and IH
• Volume: 9
• Issue: 10
• Pages: 1050-1065
• Publication date: 2004-10-01
• DOI: 10.1111/j.1365-3156.2004.01317.x
• EISSN: 1365-3156
• ISSN: 1360-2276
• Language: English
• Keywords: Animals; Insect Vectors; Infant; Mosquito Control; Africa; Humans; Infant, Newborn; Child, Preschool; Malaria; Anemia; Endemic Diseases