Peer-reviewed article

Prenatal and child malaria and child growth: evidence from a Ghanaian pregnancy cohort.

Sowole O, Kaali S, Li M, Mujtaba M, Wylie BJ et al. · 4 Jun 2026

Abstract

Introduction Additional investigation is needed to better understand the associations between prenatal and early child malaria and early childhood growth outcomes. Methods We leveraged the Ghana Randomized Air Pollution and Health Study which enrolled 1414 pregnant women from Kintampo, Ghana, and followed the mother-child dyads through the child's first year of life. We defined prenatal malaria exposure by histopathological examination of placenta tissue. We defined early child malaria exposure by active health surveillance over the child's first year of life and malaria rapid diagnostic testing when clinically indicated. We employed latent class growth analyses to construct growth trajectories for each anthropometric measure (weight and height and corresponding WHO z-scores, mid-upper arm circumference and head circumference (HC)), which we measured at birth, 3, 6, 9 and 12 months of age. We then used unadjusted and adjusted ordinal and multinomial regression to identify associations between prenatal and early child malaria growth trajectories, considered separately. Results Of the 1306 live births, 1144 children had prenatal and early child malaria exposure and growth data and were included in the analysis; 250 (21.9%) had prenatal malaria exposure, and 525 (45.9%) had early child malaria infection. Children with prenatal malaria as compared to those without had higher risk for poorer length growth (OR=1.46, 95% CI 1.08 to 1.98; multivariable OR=1.46, 95% CI 1.05 to 2.02), poorer length-for-age z-scores (OR=1.43, 95% CI 1.09 to 1.88; multivariable OR=1.53 95% CI 1.14 to 2.05) and smaller HC (OR=1.56, 95% CI 1.16 to 2.09; multivariable OR=1.43, 95% CI 1.04 to 1.98). Children with early childhood malaria as compared to those without had higher risk for poorer length-for-age z-score (OR=1.13, 95% CI 1.03 to 1.24; multivariable OR=1.12, 95% CI 1.01 to 1.24). Children with prenatal malaria as compared to without showed a trend for persistent stunting (multivariable OR=1.63, 95% CI 0.98 to 2.71). Conclusion Malaria beginning in pregnancy was associated with poorer growth outcomes. Public health preventative strategies beginning in pregnancy may reduce malaria incidence and improve early childhood growth.