Increased Risk of Malaria During the First Year of Life in Small-for-Gestational-Age Infants: A Longitudinal Study in Benin: J Infect Dis

Background: According to the DOHaD paradigm, the foetal period is one of the most vulnerable periods that may have profound effects on health later in life. Few studies have assessed the effect of small-birth-weight-for-gestational age (SGA), a proxy for foetal growth impairment, on the risk of malaria during infancy in Africa. Methods: We used data from a cohort of 398 mother-child pairs, followed from early pregnancy to age one in Benin. Infant's malaria was actively and passively screened using thick blood smear. A logistic mixed regression model was performed to assess the effect of SGA on the risk of both malaria infection and clinical malaria from birth to age one, after stratifying on the infant's age. Results: After adjustment for potential confounding factors, as well as the infant's level of exposure to mosquitoes, SGA was associated with a 2-times higher risk of both malaria infection (aOR= 2.16, 95%CI: 1.04-4.51, p=0.039) and clinical malaria (aOR= 2.33, 95%CI: 1.09-4.98, p=0.030) after 6 months of age. Conclusion: Our results suggest a higher risk of malaria during the second semester of life in SGA infants. They argue for a better follow-up of these infants after birth as currently done for preterm babies.