August 10, 2017

A new international study, co-led by UNC Gillings School of Global Public Health researchers, has analyzed the associations between malaria, malnutrition and birth outcomes in women in Africa and the western Pacific between 1996 and 2015.

During that period, more than one in three pregnant women suffered from malaria and/or undernutrition, emphasizing the importance of joint approaches to decrease maternal malaria and improve nutrition to minimize adverse pregnancy outcomes. Fortunately, there is no evidence of a synergistic interaction between the diseases.

Dr. Jordan Cates

Dr. Jordan Cates

Dr. Steve Meshnick

Dr. Steve Meshnick

Dr. Daniel Westreich

Dr. Daniel Westreich

Jordan E. Cates, PhD, recent alumna in epidemiology at the Gillings School, conducted the research as part of her doctoral thesis. Steven Meshnick, MD, PhD, professor and associate chair of epidemiology, and Daniel Westreich, PhD, associate professor of epidemiology, are co-last authors of the study, along with Stephen Rogerson, PhD, professor of medicine at University of Melbourne (Australia). The study was published Aug. 8 in PLOS Medicine.

Four previous studies had indicated that the effect of malaria infection during pregnancy on the risk of low birthweight could depend upon the mother’s nutritional status.

In the current study, the authors examined a large, diverse population to investigate the relationship further. Examining data from 14,633 pregnancies described in 13 studies, they found the adjusted risk of delivering a low birthweight infant was 8.8 percent among women with malaria infection, compared with 7.7 percent among uninfected women.

The risk of delivering a low-birthweight infant among women with both malaria infection and undernourishment was 17.8 percent, compared to 8.4 percent among uninfected women with who were malnourished.

The analysis could find no evidence of an increased risk resulting from a woman’s being both undernourished and infected with malaria.

Meshnick noted that more than 125 million pregnant women are at risk for contracting malaria each year, and maternal undernutrition could be responsible for as many as 800,000 newborn deaths annually.

“Our findings didn’t support cautious hopes raised by four previous studies that nutritional supplementation might lessen malaria’s devastating effects on foetal development,” Cates said, “but they do indicate that both problems need to be tackled at the same time.”

Other Gillings School co-authors of the study are Melissa Bauserman, PhD, adjunct clinical assistant professor of nutrition; Linda Adair, PhD, professor of nutrition; and Stephen R. Cole, PhD, professor of epidemiology.

Additional co-authors are from the U.K., Australia, France, Burkina Faso, Ghana, the U.S., Kenya, Malawi, Finland, Denmark and Tanzania. Meshnick is also professor of microbiology and immunology in the UNC School of Medicine.


Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or

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