A case-control study in MalariaWorld this week found association between malaria and undernutrition. ‘Associations between undernutrition and malaria infection: a case–control study from Rwanda’ by Uwimana et al found significant association between malaria and vitamin E and iron deficiency. There was a significant association in the occurrence of malaria with sub-optimal lipid consumption.
The case study with a total of 1025 participants in Western, Southern, Northern, Eastern provinces and Kigali of Rwanda, which are classified as malaria-endemic with stable transmission was carried out from November 2021 until December 2023. 658 were included in the analysis. Children under 3 years old were excluded due to underrepresentation. After analysis of reported dietary habits to detect under reporters and over reporters using the Goldberg index, 337 participants were excluded. 34% of the 658 tested positive for malaria.
The diet of the study population was predominantly composed of starchy foods, 56.7% of total intake. Fats contributed a moderate 16%, while vegetables and legumes made up 9.4% and 9.3%, respectively. Animal-source proteins were consumed at notably low levels: dairy products at 2.5%, and meat, poultry, fish, and eggs collectively at just 1.1%. 58.2% of participants reported caloric intake below 90% of the daily recommended intake.
There was an association between overall nutrition and malaria (measured with rapid diagnostic tests, RDT) but not statistically significant. Low intake of fats was associated with increased malaria. In general, the diet of the participants was sub-optimum with 58.2% consuming less than 90% of recommended calories, and low consumption of animal proteins.
There were some anomalies in the micronutrient consumption studies. In particular, the consumption of selenium was positively associated with malaria. Also, recall bias related to nutrition intake cannot be excluded and could lead to potential risk of error from participants in reporting their dietary habits.
The authors conclude that addressing micronutrient deficiencies may be a valuable strategy in malaria control efforts. Improving nutrition status, with an emphasis on food composition and a balanced diet, could further strengthen immunity for the control of infectious diseases including malaria. Therefore, integration or close collaboration between national programmes for nutrition and infectious diseases control are highly recommended.