Summary Objectives To ascertain whether malaria parasitaemia in children is associated with HIV status. To examine the effect of vitamin A supplementation on malaria parasitaemia in children. Methods We studied the cross-sectional associations between HIV status and malaria parasitaemia among 546 children 6–60 months of age who participated in a double-blind, randomized clinical trial of vitamin A supplementation. Prevalence ratios and 95% confidence intervals (CI) were estimated for the presence of malaria parasites at baseline by HIV status in uni- and multivariate models that adjusted for sociodemographic and environmental variables. Among children with malaria, correlates of high parasite loads were identified. Next, we examined the effect of vitamin A supplementation on the risk of malaria parasitaemia and high parasite density at 4–8 months of the first dose in a subset of children. Results The prevalence of malaria parasitaemia was 11.4% among HIV-infected children, compared with 27.6% among uninfected. After adjusting for season, anaemia, use of bednets, maternal education and indicators of socioeconomic status, we found some evidence for lower prevalence of parasitaemia among HIV positive compared with HIV-negative children (prevalence ratio = 0.56; 95% CI = 0.29, 1.09; P = 0.09). Other important correlates of malaria parasitaemia at baseline included low level of maternal education, poor quality of water supply, and the presence of animals at home. Vitamin A supplementation did not have a significant effect on malaria parasitaemia at 4–8 months of follow-up, overall or within levels of potential effect modifiers. Conclusion HIV infection appears to be negatively correlated with malaria parasitaemia in this group of children. Investing in women's education is likely to decrease the prevalence of malaria parasitaemia in children. Vitamin A supplementation does not seem to have an effect on malaria parasitaemia in this population; possible benefits against clinical episodes and severe malaria deserve further examination.
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA 2:
Department of Pediatrics and Child Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania