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Free Content Impact of malaria control on childhood anaemia in Africa – a quantitative review

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Abstract:

Summary 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.

Keywords: Africa; anaemia; chemoprophylaxis; children; insecticide residual spraying; insecticide-treated mosquito nets; intermittent preventive therapy; malaria/prevention and control

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2004.01317.x

Affiliations: 1: World Health Organization, Roll Back Malaria, Geneva, Switzerland 2: Ifakara Health Research and Development Centre, Ifakara, Tanzania, and London School of Hygiene & Tropical Medicine, London, UK 3: World Health Organization, Stop TB, Geneva, Switzerland 4: KEMRI Wellcome Trust Collaborative Programme, Nairobi, Kenya, and Centre for Tropical Medicine, University of Oxford, Oxford, UK

Publication date: October 1, 2004

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