Journal Article

The causal effect of malaria on stunting: a Mendelian randomization and matching approach

Hyunseung Kang, Benno Kreuels, Ohene Adjei, Ralf Krumkamp, Jürgen May and Dylan S Small

in International Journal of Epidemiology

Published on behalf of International Epidemiological Association

Volume 42, issue 5, pages 1390-1398
Published in print October 2013 | ISSN: 0300-5771
Published online August 2013 | e-ISSN: 1464-3685 | DOI:
The causal effect of malaria on stunting: a Mendelian randomization and matching approach

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Background Previous studies on the association of malaria and stunted growth delivered inconsistent results. These conflicting results may be due to different levels of confounding and to considerable difficulties in elucidating a causal relationship. Randomized experiments are impractical and previous observational studies have not fully controlled for potential confounding including nutritional deficiencies, breastfeeding habits, other infectious diseases and socioeconomic status.

Methods This study aims to estimate the causal effect between malaria episodes and stunted growth by applying a combination of Mendelian randomization, using the sickle cell trait, and matching. We demonstrate the method on a cohort of children in the Ashanti Region, Ghana.

Results We found that the risk of stunting increases by 0.32 (P-value: 0.004, 95% CI: 0.09, 1.0) for every malaria episode. The risk estimate based on Mendelian randomization substantially differs from the multiple regression estimate of 0.02 (P-value: 0.02, 95% CI: 0.003, 0.03). In addition, based on the sensitivity analysis, our results were reasonably insensitive to unmeasured confounders.

Conclusions The method applied in this study indicates a causal relationship between malaria and stunting in young children in an area of high endemicity and demonstrates the usefulness of the sickle cell trait as an instrument for the analysis of conditions that might be causally related to malaria.

Keywords: Malaria; stunting; children; Mendelian randomization; matching

Journal Article.  5002 words.  Illustrated.

Subjects: Public Health and Epidemiology

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