The causal effect of malaria on stunting - a Mendelian randomization and matching approach
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The causal effect of malaria on stunting - a Mendelian randomization and matching approach. / Kang, Hyunseung; Kreuels, Benno; Adjei, Ohene; Krumkamp, Ralf; May, Jürgen; Small, Dylan S.
in: INT J EPIDEMIOL, Jahrgang 42, Nr. 5, 01.10.2013, S. 1390-8.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - The causal effect of malaria on stunting - a Mendelian randomization and matching approach
AU - Kang, Hyunseung
AU - Kreuels, Benno
AU - Adjei, Ohene
AU - Krumkamp, Ralf
AU - May, Jürgen
AU - Small, Dylan S
PY - 2013/10/1
Y1 - 2013/10/1
N2 - 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.
AB - 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.
U2 - 10.1093/ije/dyt116
DO - 10.1093/ije/dyt116
M3 - SCORING: Journal article
C2 - 23925429
VL - 42
SP - 1390
EP - 1398
JO - INT J EPIDEMIOL
JF - INT J EPIDEMIOL
SN - 0300-5771
IS - 5
ER -
