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Table 4 Relationship between being underweight and risk of malarial infection (N = 19)

From: Complex interactions between malaria and malnutrition: a systematic literature review

Author, year, reference WAZ cutoff Malaria outcome Risk estimate comparing children below and above WAZ cutoff Risk
Akiyama 2016 [46] ≤ − 2 Asymptomatic malaria confirmed by PCR OR = 1.33 (95% CI = 0.53–3.30) No impact
Arinaitwe 2012 [48] − 1 and −2 Pf malaria, fever and a positive blood smear IRR = 1.09 (95% CI 0.95–1.25), P = 0.24 No impact
< − 2 Pf malaria, fever and a positive blood smear IRR = 1.12 (95% CI 0.86–1.46), P = 0.39 No impact
Ayana 2015 [49] < − 2 Malaria by RDT “Non-significant association” reported No impact
Custodio 2009 [30] < − 2 Pf malaria parasitemia prevalence “Non-significant association” reported No impact
Deen 2002 [10] < − 2 Malaria episode (fever ≥ 37.5 °C or parasitemia > 5000/μL) RR = 1.01 (95% CI = 0.82–1.26) No impact
Deribew 2010 [51] < − 2 Pf malaria (any parasitemia) AOR = 0.9 (95% CI = 0.7–1.2), P = 0.90 No impact
Ehrhardt 2006 [11] < − 2 Fever AOR = 1.59 (95% CI = 1.13–2.23), P = 0.008 Increased
< − 2 Clinical malaria (fever ≥ 37.5 °C plus any parasitemia) AOR = 1.67 (95% CI = 1.10–2.50), P = 0.009 Increased
< − 2 Anaemia (Haemoglobin < 11 g/dL) AOR = 1.68 (95% CI = 1.38–2.04), P < 0.0001φ .
El Samani 1987 [52] Weight-for-age 75–89% (mild) History of malaria in past 2 months AOR = 1.20 (95% CI = 0.70–2.00) No impact
Weight-for-age < 75% (moderate) History of malaria in past 2 months AOR = 2.10, (95% CI = 1.10–4.00) Increased
Fillol 2009 [27] < − 2 Clinical malaria (fever ≥ 37.5 °C plus parasitemia ≥ 3000/μL) “Non-significant association” reported No impact
< − 2 High density parasitemia (geometric mean ≥ 300/μL) AOR = 0.96 (95% CI = 0.35–2.66), P = 0.94 No impact
Jeremiah 2007 [53] < − 2 Malaria by blood smear RR = 1.02 (95% CI = 0.34–2.37), P < 0.02 Increased
Kateera 2015 [54] < − 2 Pf malaria (any parasitemia) “Non-significant association” reported No impact
Mitangala 2013 [21] < − 2 Pf malaria parasitemia (≥ 5000/μL) AOR = 0.85 (95% CI = 0.53–1.35), P = 0.49 No impact
Muller 2003 [18] ≤ − 2 Pf malaria (fever plus parasitemia ≥ 1/μL) RR = 1.0 (95% CI = 0.9–1.1), P = 0.98 No impact
≤ − 2 Pf malaria (fever plus parasitemia ≥ 5000/μL) RR = 1.0 (95% CI = 0.9–1.2), P = 0.68 No impact
≤ − 2 Pf malaria (fever plus parasitemia ≥ 100,000/μL) RR = 0.8 (95% CI = 0.5–1.4), P = 0.49 No impact
Nyakeriga 2004 [6] < − 2 Pf malaria (fever plus any parasitemia) IRR = 1.33 (95% CI = 0.64–2.70), P = 0.44 No impact
< − 2 Pf malaria (fever plus any para < 1 year, > 2500/μL > 1 year) IRR = 0.28 (95% CI = 0.51–3.17), P = 0.60 No impact
Snow 1991 [17] < − 2 Clinical malaria (fever plus any parasitemia) “Non-significant association” reported No impact
< − 2 Asymptomatic malaria parasitemia “Non-significant association” reported No impact
Sumbele 2015 [57] < − 2 Clinical malaria parasitemia Underweight vs. Non: 21.6% vs. 8.2%, P = 0.007 Increased
< − 2 Asymptomatic malaria parasitemia Underweight vs. Non: 21.6% vs. 27.5%, P = 0.44 No impact
Tonglet 1999 [32] < − 2 Clinical malaria without lab confirmation in < 9 m AOR = 1.31 (95% CI = 0.68–1.94) No impact
< − 2 Clinical malaria without lab confirmation in ≥ 9 m AOR = 0.68 (95% CI = 0.24–1.11) No impact
Verret 2011 [22] (≥ − 1 and < 0) Pf malaria risk of recurrent parasitemia HR = 0.65 (95% CI = 0.37–1.15), P = 0.137 No impact
(≥ − 2 and < − 1) Pf malaria risk of recurrent parasitemia HR = 0.86 (95% CI = 0.45–1.62), P = 0.636 No impact
< − 2 Pf malaria risk of recurrent parasitemia HR = 1.01 (95% CI = 0.54–1.89), P = 0.969 No impact
William 1997 [31] < − 2 Clinical malaria (fever plus parasitemia ≥ 1000/μL) IRR = 1.1 (95% CI = 0.57–2.1)*, P = 0.8 No impact
< − 2 Clinical malaria (fever plus parasitemia ≥ 1000/μL) IRR = 1.3 (95% CI = 0.9–1.9)**, P = 0.2 No impact
< − 2 P. vivax malaria IRR = 2.6 (95% CI = 1.5–4.4)*, P < 0.0001; Increased
< − 2 P. vivax malaria IRR = 1.3 (95% CI = 0.9–2.0)**, P = 0.2 No impact
  1. Pf Plasmodium falciparum, WAZ weight-for-age Z-scores, CI confidence interval, OR odds ratio, HR hazard ratio, RR risk ratio, IRR incidence rate ratio, AOR adjusted odds ratio
  2. φLimited to anaemia;*6 months preceding anthropometric assessment; **6 months following anthropometric assessment