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Anti-malarial drug resistance, malnutrition and socio-economic status

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To investigate the relationship between nutritional status and resistance to chloroquine treatment, we designed a nested case-control study prospective with respect to the outcome of Plasmodium falciparum-infected school children aged 5–14 years from Honiara, Solomon Islands. 38 chloroquine-resistant cases were compared with treatment-susceptible controls with respect to current nutritional status, behavioural characteristics, medical and demographic data. The overall prevalence of moderate malnutrition was 28%. The incidence rate of chloroquine resistance was 23%. Malnourished children were generally at higher risk for treatment failure than well-nourished ones (OR: 3.6; 95%CI: 1.6–8.4; P= 0.001). This effect was modified by socio-economic status. Stratified analysis by logistic regression resulted in an eightfold risk of resistance for malnourished children in the higher socio-economic category (OR:8.1; 95%CI: 2.4–27.9; P= 0.0001). In children from the lower socio-economic group, the effect of malnutrition was not significant (OR:1.5; 95%CI:0.4–5.6). Socio-economic differences may affect the immune status. The treatment response in children of lower socio-economic status, which are more exposed to malaria, may therefore be less affected by malnutrition.

Keywords: Plasmodium falciparum; malnutrition; resistance; socio-economic status

Document Type: Original Article


Affiliations: 1: Department of Infectious Diseases and Tropical Medicine, University of Munich, Germany, 2: Solomon Island Ministry of Health, 3: Army Malaria Research Unit, Ingleburn, NSW, Australia

Publication date: August 1, 1997


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