Abstract:
Malaria and anaemia are important health problems among children globally. Iron deficiency anaemia may offer
protection against malaria infection and iron supplementation may increase the risk of malaria-related
hospitalization and mortality. The nature and mechanism of these relationships, however, remain largely unresolved,
resulting in concern and uncertainty around policies for non-selective iron supplementation in malaria endemic
areas. Use of geographical information systems (GIS) to investigate this disease-disease interaction could contribute
important new information for developing safe and effective anaemia and malaria interventions. To assess the
current state of knowledge we conducted a systematic review of peer-reviewed and grey literature. Our primary
objective was to qualitatively assess the application and utility of geographical concepts or spatial analyses in
paediatric global health research. The secondary objective was to identify geographical factors that may be
associated with anaemia and malaria prevalence or incidence among children 0–5 years of age living in low- and
middle-income countries. Evaluation tools for assessing the quality of geographical data could not be found in the
peer-reviewed or grey literature, and thus adapted versions of the STROBE (Strengthening The Reporting of
Observational Studies in Epidemiology) and GRADE (Grades of Recommendation, Assessment, Development and
Evaluation) methods were used to create reporting, and overall evidence quality scoring systems. Among the 20
included studies, we found that both malaria and anaemia were more prevalent in rural communities compared to
urban areas. Geographical factors associated with malaria prevalence included regional transmission stability, and
proximity to a mosquito breeding area. The prevalence of anaemia tended to vary inversely with greater or poorer
access to community services such as piped water. Techniques for investigating geographic relationships ranged
from simple descriptive mapping of spatial distribution patterns, to more complex statistical models that
incorporated environmental factors such as seasonal temperature and rain fall. Including GIS in paediatric global
health research may be an effective approach to explore relationships between childhood diseases and contribute
key evidence for safe implementation of anaemia control programs in malaria endemic areas. Further, GIS
presentation of ecological health data could provide an efficient means of translating this knowledge to lay
audiences
