***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This paper reports the results of a cross-sectional study of the association between nutritional , environmental and socio-demographic factors , and malaria occurrence among 445 children under 5 years of age in a Sudanese rural community . The overall frequency of malaria as defined by a history of clinical illness during the previous 2 months was 27 % . Malaria occurrence was positively associated with the degree of malnutrition as assessed by weight-for-age . The age-adjusted odds ratio for mild malnutrition and history of malaria was 1.2 ( 95 % confidence interval ( CI ) : 0.7 - 2.0 ) and for moderate malnutrition and malaria was 2.1 ( 95 % CI : 1.1 - 4.0 ) . Malaria was less frequent among children 0 - 11 months of age relative to older children ( OR = 0.4 ; 95 % CI:0.2 - 0.7 ) , and was inversely associated with ownership of a refrigerator ( OR = 0.5 ; 95 % CI:0.36 - 0.94 ) , an indicator of socio-economic status . Indicators of crowding were the best predictors of the risk of malaria . Less malaria was observed in households with three or more rooms ( OR = 0.6 ; 95 % CI:0.37 - 0.98 ) and more malaria was observed in households with more than five people ( OR = 2.5 ; 95 % CI:1.4 - 4.5 ) . Malaria was slightly , but not significantly , more frequent among boys and was associated with anaemia , which was probably an outcome of malaria in the past . These data suggest that undernutrition may increase the risk of malaria , and draw attention to the importance of socio-economic and environmental factors in relation to this disease . These relationships deserve further examination in prospect i ve follow-up studies that are better able to evaluate the temporal relations of malnutrition and malaria OBJECTIVE Our study in Port Harcourt children with asymptomatic malaria aim ed at assessing the baseline anthropometric indices of nutritional status , and whether their nutritional status ( especially under nutrition ) offers any advantage for living in malaria endemic areas . DESIGN Cross-sectional study was used . SETTING Rumueme Community in Port Harcourt , Nigeria . SUBJECTS Apparently healthy children aged 1 - 8 years of both sexes ( Boys = 117 , Girls = 123 ; Ratio 1:1.05 ) , 240 children from r and omly selected households within the study community participated in the study . RESULTS Of the 240 children , 66 ( 27.5 % ) were infected with malaria ( P falciparum ) . Children below 5 years had a higher parasitaemic rate ( 36.36 % ) than those in 5 - 8 years group ( 21.27 % ) . Our baseline data showed that 17.5 % were underweight ( WFA Z < -2 ) , 3.75 % were stunted ( HFA Z < -2 ) and 22.5 % were wasting ( WFH Z < -2 ) . Children who are underweight were found to be at higher risk of acquiring malaria infection than the well nourished children ( RR = 1.02 , chi2 = 0.320 , p < 0.02 , 95 % CI 0.34 - 2.37 ) . Under nutrition was more prominent in the children below 5 years than the older children ( RR = 3.625 , chi2 = 10.36 , p < 0.006 , 95 % CI 1.81 - 5.43 ) . The haemoglobin value of parasitized children ( 10.8 + /- 1.9 g/dl ) was significantly lower than the non-parasitized group ( 11.3 + /- 1.7 g/dl , ) ( p < 0.01 ) . CONCLUSION We concluded that the presence of under nutrition places children ( especially below 5 years of age ) at higher risk of malaria related morbidity . Children in malaria endemic areas need adequate nutrition to withst and the negative impact of malaria Background Malaria is preventable and treatable when recommended interventions are properly implemented . Thus , diagnosis and treatment focus on symptomatic individuals while asymptomatic Plasmodium infection ( PI ) plays a role in the sustainability of the transmission and may also have an impact on the morbidity of the disease in terms of anaemia , nutritional status and even cognitive development of children . The objective of this study was to assess PI prevalence and its relationship with known morbidity factors in a vulnerable but asymptomatic stratum of the population . Methods A simple r and om sample , household survey in asymptomatic children under the age of five was conducted from April to September 2012 in two health areas of the health zone of Mont Ngafula 1 , Kinshasa , Democratic Republic of Congo . Results The PI prevalence were 30.9 % ( 95 % CI : 26.5 - 35.9 ) and 14.3 % ( 95 % CI : 10.5 - 18.1 ) in Cité Pumbu and Kindele health areas , respectively , ( OR : 2.7 ; p < 0.001 ) . All were Plasmodium falciparum infected and 4 % were co-infected with Plasmodium malariae . In Cité Pumbu and Kindele , the prevalence of anaemia ( haemoglobin < 11 g/dL ) was 61.6 % ( 95 % CI : 56.6 - 66.5 ) and 39.3 % ( 95 % CI : 34.0 - 44.6 ) , respectively , ( OR : 2.5 ; p < 0.001 ) . The health area of Cité Pumbu had 32 % ( 95 % CI : 27.5 - 37.0 ) of chronic malnutrition ( HAZ score ≤ −2SD ) compared to 5.1 % ( 95 % CI : 2.8 - 7.6 ) in Kindele . PI was predictor factor for anaemia ( aOR : 3.5 , p = 0.01 ) and within infected children , there was an inverse relationship between parasite density and haemoglobin level ( β = −5 * 10−5 , p < 0.001 ) . Age older than 12 months ( aOR : 3.8 , p = 0.01 ) , presence of anaemia ( aOR : 3.4 , p = 0.001 ) , chronic malnutrition ( aOR : 1.8 , p = 0.01 ) , having a single parent/guardian ( aOR : 1.6 , p = 0.04 ) , and the non-use of insecticide-treated nets ( aOR : 1.7 , p = 0.04 ) were all predictors for PI in the overall population . Conclusion PI in asymptomatic children was correlated with anaemia and chronic malnutrition and was thus a harmful condition in the study population . Malaria control initiatives should not only focus on treatment of symptomatic infections but also take into consideration asymptomatic but infected children Background Increased control has produced remarkable reductions of malaria in some parts of sub-Saharan Africa , including Rw and a. In the southern highl and s , near the district capital of Butare ( altitude , 1,768 m ) , a combined community- and facility-based survey on Plasmodium infection was conducted early in 2010 . Methods A total of 749 children below five years of age were examined including 545 r and omly selected from 24 villages , 103 attending the health centre in charge , and 101 at the referral district hospital . Clinical , parasitological , haematological , and socio-economic data were collected . Results Plasmodium falciparum infection ( mean multiplicity , 2.08 ) was identified by microscopy and PCR in 11.7 % and 16.7 % , respectively ; 5.5 % of the children had malaria . PCR-based P. falciparum prevalence ranged between 0 and 38.5 % in the villages , and was 21.4 % in the health centre , and 14.9 % in the hospital . Independent predictors of infection included increasing age , low mid-upper arm circumference , absence of several household assets , reported recent intake of artemether-lumefantrine , and chloroquine in plasma , measured by ELISA . Self-reported bed net use ( 58 % ) reduced infection only in univariate analysis . In the communities , most infections were seemingly asymptomatic but anaemia was observed in 82 % and 28 % of children with and without parasitaemia , respectively , the effect increasing with parasite density , and significant also for su bmi croscopic infections . Conclusions Plasmodium falciparum infection in the highl and s surrounding Butare , Rw and a , is seen in one out of six children under five years of age . The abundance of seemingly asymptomatic infections in the community forms a reservoir for transmission in this epidemic-prone area . Risk factors suggestive of low socio-economic status and insufficient effectiveness of self-reported bed net use refer to areas of improvable intervention BACKGROUND The relation between malnutrition and malaria is controversial . On the one h and , malaria may cause malnutrition , whereas on the other h and , malnutrition itself may modulate susceptibility to the disease . OBJECTIVE The objective was to investigate the association between Plasmodium falciparum malaria and malnutrition in a cohort of Kenyan children . DESIGN The study involved the longitudinal follow-up of children aged 0 - 95 [ corrected ] mo for clinical malaria episodes and anthropometric measurements through 4  cross-sectional surveys . We used Poisson regression analysis to investigate the association between malaria and nutritional status . RESULTS The crude incidence rate ratios ( IRRs ) for malaria during the 6-mo period before assessment in children defined as malnourished on the basis of low height-for-age or low weight-for-age z scores ( < -2 ) were 1.17 ( 95 % CI : 0.91 , 1.50 ; P=0.21 ) and 0.94 ( 0.71 , 1.25 ; P=0.67 ) , respectively , which suggests no association between malaria and the subsequent development of protein-energy malnutrition . However , we found that age acted as an effect modifier in the association between malaria episodes and malnutrition on prospect i ve follow-up . The IRR for malaria in children aged 0 - 2 y , who were subsequently characterized as underweight , was 1.65 ( 1.10 , 2.20 ; P=0.01 ) , and a significant overall relation between malaria and stunting was found on regression analysis after adjustment for the interaction with age ( IRR : 1.91 ; 1.01 , 3.58 ; P=0.04 ) . CONCLUSION Although children living on the coast of Kenya continue to experience clinical episodes of uncomplicated malaria throughout the first decade of life , the effect of malaria on nutritional status appears to be greatest during the first 2 y of life Background The interaction between malaria and under-nutrition is not well eluci date d in Ethiopia . The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia . Methods This cross-sectional study was undertaken during March – February , 2009 as part of the baseline assessment of a cluster r and omized trial around Gilgel Gibe Hydroelectric dam , south-west Ethiopia . A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia . The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics ( NCHS ) . Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer ( HemoCue Hb 301 , Sweden ) . Results Significant proportion ( 40.4 % ) of under-five children were stunted ( height-for-age<−2SD ) . The prevalence of under-weight was 34.2 % . One third and one tenth of the children had anemia and malaria parasite respectively . Older children were more likely to have under-nutrition . There was no association between malaria and under-nutrition . Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite , [ OR = 1.5 , ( 95 % CI : 1.1–2.0 ) ] . Conclusion In this study , there is no association between malaria and under-nutrition . Children who have malaria are more likely to be anaemic . Malaria prevention and control program should consider nutrition interventions particularly anemia In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach 
    Output:
    
Divergent results were reported on the effect of malnutrition on malaria risk .
While no consistent association between risk of malaria and acute malnutrition was found , chronic malnutrition was relatively consistently associated with severity of malaria such as high-density parasitemia and anaemia .
Furthermore , there is little information on the effect of malnutrition on therapeutic responses to artemisinin combination therapies ( ACTs ) and their pharmacokinetic properties in malnourished children in published literature .
Conclusions The evidence on the effect of malnutrition on malaria risk remains inconclusive .