The risk of malaria infection decreased with increasing age i.e. the prevalence of malaria is inversely related to age. As age increase, the prevalence of malaria decrease and the immunity (capability of defending against deficiency and infectious disease) increases. Such increased susceptibility of younger children to infections has attributed to their poorly developed immune systems (Thorarinsdottir et al., 2005; Kunihya et al., 2016; Ani, 2004).
According to the results of this research the correlation(r) between malaria and anemia was linear positive (as Plasmodium species prevalence increase, the prevalence of anemia increase and vice versa) (p = 0.000), an association of Plasmodium species and anemia was significant. Children of the households not using a bed net for sleeping were 2.38 times more susceptible to malaria compared to net users. Approximately, 92.11% of the respondents reported using a mosquito net for sleeping, and malaria prevalence was observed to be more than two times higher among households that did not use mosquito nets (23.11%) compared to net user households (8.05%). Hanging a mosquito net is extremely important for preventing malaria (69.76%) while only 1.24% reported that it is not important at all. However, the malaria prevalence was higher for children in those households (9.70%) who mention that the hanging net is extremely important, showing variation between knowledge and practice (Sultana et al., 2017).
A present study showed that 29.2% were with malaria infection and 26.2% malaria with mild anemia (47.6%), moderate anemia (42.1%) and severe anemia (29.4%) and the relationship between malaria infection and anemia was statistically significant (Kunihya et al., 2016).
The prevalence rate of malaria-related anemia were 27.0% (Ademowo, 1995); 24.3% (Kuadzi et al., 2011); among children in Ghana 30.0% (Okonko et al., 2012) in Ibadan; 31.6% (Olasunkanmi et al., 2013) in Abeokuta, Nigeria, and 36.4% (Okafor and Oko-ose, 2012). The total malaria prevalence in this study was 54% and the prevalence of any anemia was 38.46%; 70% of anemia was malaria-related with mild (54.28%), moderate (30%), and severe (15.71%) malaria-related anemia. This is consistent with the findings (Kunihya et al., 2016).
Malaria was significantly associated with anemia, and, increasing the hemoglobin level may be associated with a significant reduction of mosquito contact with the children using the malaria prevention strategy (Oladeinde et al., 2012). This is in line with the current study i.e. hemoglobin concentration and malaria contact with children had a linear relationship (like a contact of children with malaria parasite increase, anemia also increase due to reduction of hemoglobin concentration). This reduction of hemoglobin concentration was due to poor utilization habit of the insecticide-treated net by parents and maybe low knowledge, attitude and practice about malaria and anemia relationship, and in addition to low educational qualification.
Even though, malaria causes chronic anemia, impaired growth, and delayed development in young children, but not significantly associated with each other (Wierzba et al., 2001; Sakwe et al., 2019). This is not consistent with the current study.
Children whose parents/guardians attended tertiary education were less prone to anemic with malaria infection; with mild (5.2%), moderate (5.2%), and severe anemia (3.4%). This is due to conscious of child nutrition, prevention of mosquito bites by using any possible means of prevention, and/or they are well informed about malaria because they are enlightened (Kunihya et al., 2016). The same is true in this study because the prevalence of mild, moderate, and severe anemia was higher on those children who had uneducated or illiteracy parents than children whose guardians have primary educational qualification; the prevalence of mild, moderate, and severe anemia was higher on those children who have primary educational status than children whose guardians have secondary and tertiary education qualification. Because, the degree of understanding about transmission, cause, and effect as well as prevention of malaria and anemia decrease from children’s guardian who has tertiary education to illiteracy or uneducated parents.
Children whose mothers were aged less than 20 years or 30–39 years were 4.69 and 2.55 times more likely to develop anemia, as compared to those who were aged 40 years and above though results were not significant (Borbor et al., 2014). Mothers who were aged 20 years and above were less likely to have their children to be anemic compared to mothers less than 20 years. Nevertheless, children of mothers aged 40–49 years were 84% and less likely to be anemic compared to those less than 30 years. The reason for the findings in this study regarding age could probably be mothers aged 40 years, above are multiparous, and thus have experience in childcare and feeding practices compared to mothers less than 20 years (Kweku et al., 2012).
Regarding underweight, a study in Nigeria showed that underweight was significantly associated with malaria attacks in children (Jeremiah and Uko, 2007; Hamid Hassen, and Jemal Ali 2015). The relationship between malaria infection and nutritional status was a two-way association. Malnourished children were more likely to be infected by malaria parasites compared to well-nourished children. This is consistent with current result, i.e. those who have low nutritional status, have high prevalence of malaria, anemia and underweight, and vice versa. On the other hand, malaria positive children were more likely to become malnourished than those uninfected. This implies that on one hand, malaria may cause malnutrition, whereas, on the other hand, malnutrition may exacerbate the disease (Sakwe et al., 2019).
Similarly, a study in Sudan indicated that malaria was more often in malnourished than inadequately nourished children (Samani, Willett, and Ware, 1987). According to WHO’s Comparative Risk Assessment project, children who were moderate to severely underweight had an increased risk of acquiring clinical malaria than better-nourished children though the difference is not significant (Caulfield et al., 2004).
Both underweight and severe underweight (weight loss) were highly related to malaria and mostly occurred weight loss or underweight was due to malaria infection and it is to be a means of recording high prevalence of weight loss in children. This is because of the low nutritional status of children in which provided by their parents, a poor habit of attending children's growth based on children and mothers health card, and lack of knowledge about the relationship or cause and effect association of malaria, and weight loss.
The prevalence of underweight in both males and females was consistent with the observations of Sumbele et al.(2015) in the Mount Cameroon area, Wamani et al.(2007) in Tanzania that underweight was common among males than females in all age groups (Kamugisha et al., 2006).
Concerning malnutrition, the high prevalence was an indicator of poor feeding habits (low nutritional status of children), absence of attendance habit of health organization, low nutritional and education status, and lack of proper knowledge about nutrition and balanced diets.
Regarding underweight, confirmed malaria case was higher among underweight children than their counterparts (Hassen and Ali, 2015) and the current study finding is in line with a study in Nigeria which showed that underweight were significantly associated with malaria attack in children (Jeremiah and Uko, 2007).
Counseling and promotion of breastfeeding and adequate complementary food intake, and child growth monitoring are some of the more effective and affordable interventions for preventing low birth weight and improving child growth (ACC/SCN, 2001). Studies have found an increased risk of malaria among underweight children (Williams et al., 1997). Underweight was identified as a risk factor for malarial anemia in Gambian children (Man et al., 1998). This is also consistent with this study; children’s who have got food and breast feeding access also were less susceptible for either underweight or anemia or coexistence of both anemia and underweight
According to health professional suggestions on babies and mother heath card about baby’s growth conditions or status, lack of attending the wellbeing of their babies frequently was present. This is due to lack of education (because most of the guardians or parents were uneducated), and professional type (being farmer’s); indirectly either lack of knowledge or shortage of time to attend children’s wellbeing. The level of education of the caregiver was associated with the risk of being malnourished. Children of illiterate mothers were more likely to become malnourished compared to those that had basic education (Sakwe et al., 2019). Sex of child and level of education of caregiver (e.g. illiteracy and primary educational level), was significant in this study as risk factors for underweight.