Major reduction of malaria morbidity with combined vitamin A and zinc supplementation in young children in Burkina Faso: a randomized double blind trial
Nutrition Journal
Major reduction of malaria morbidity with combined vitamin A and zinc supplementation in young children in Burkina Faso: a randomized double blind trial
Augustin N Zeba 2
Hermann Sorgho 2
Nol Rouamba 2
Issiaka Zongo 2
Jeremie Rouamba 1
Robert T Guiguemd 1
Davidson H Hamer 0
Najat Mokhtar 3
Jean-Bosco Ouedraogo 2
0 Center for international health and development, Boston university school of public health , Boston , USA
1 Centre Muraz , Bobo-Dioulasso , Burkina Faso
2 Institut de recherche en sciences de la sante (IRSS) , Bobo Dioulasso , Burkina Faso
3 International atomic energy agency , Vienna , Austria
Background: Vitamin A and zinc are crucial for normal immune function, and may play a synergistic role for reducing the risk of infection including malaria caused by Plasmodium falciparum. Methods: A randomized, double-blind, placebo-controlled trial of a single dose of 200 000 IU of vitamin A with daily zinc supplementation was done in children of Sourkoudougou village, Burkina Faso. Children aged from 6 to 72 months were randomized to receive a single dose of 200 000 IU of vitamin A plus 10 mg elemental zinc, six days a week (n = 74) or placebo (n = 74) for a period of six months. Cross-sectional surveys were conducted at the beginning and the end of the study, and children were evaluated daily for fever. Microscopic examination of blood smear was done in the case of fever (temperature 37.5C) for malaria parasite detection. Results: At the end of the study we observed a significant decrease in the prevalence malaria in the supplemented group (34%) compared to the placebo group (3.5%) (p < 0.001). Malaria episodes were lower in the supplemented group (p = 0.029), with a 30.2% reduction of malaria cases (p = 0.025). Time to first malaria episode was longer in the supplemented group (p = 0.015). The supplemented group also had 22% fewer fever episodes than the placebo group (p = 0.030). Conclusion: These results suggest that combined vitamin A plus zinc supplementation reduces the risk of fever and clinical malaria episodes among children, and thus may play a key role in malaria control strategies for children in Africa.
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cause of morbidity and mortality among African children
[1]. Between 300 to 500 millions new cases of malaria,
primarily due to P. falciparum, are annually observed in
the world, with 90% in sub-saharan Africa, and these
account for an estimated one million children deaths [2].
Furthermore, resistance to drugs and insecticides used to
fight this disease has hampered malaria control efforts [3].
Children and adults living in malaria-endemic areas often
have a high prevalence of malnutrition and deficiencies of
micronutrients such as vitamin A and zinc; this situation
creates a complexity of interactions with serious health
consequences [4,5].
Vitamin A is essential for normal immune function [6],
suggesting that it could play a role in protection against
malaria. Zinc is essential for many biological functions
such as protein synthesis, growth and immunity [7].
Vitamin A metabolism requires normal zinc status, explaining
the frequent association of their deficiency [8]. Beneficial
protective effects of vitamin A or zinc on malaria-related
morbidity have been demonstrated in Papua New
Guinea, Peru and Zanzibari a [9-12]. Two randomized,
placebo-controlled trials conducted in Ghana (both
reported in a single publication) did not find an overall
significant effect of vitamin A on malaria parasitemia rates
or parasite densities although the studies showed a
reduction of 23% and 32% of probable malaria illness in
supplemented children [13]. However, the number of
children with probable malaria was so small that this
study lacked adequate power to demonstrate an effect of
vitamin A on slide-confirmed malaria morbidity. In
contrast to these studies that have suggested potential
protective effects of vitamin A or zinc supplementation, a
randomized, placebo-controlled trial in Burkina Faso of
zinc supplementation failed to show a protective impact
on malaria episodes [13].
Given the evidence of a positive effect of these two
micronutrients when used individually on malaria [13,14], we
hypothesized that, due to the potentially synergistic effect
of vitamin A and zinc on immune function, dual
supplementation with these two micronutrients would decrease
morbidity due to P. falciparum malaria. We therefore
performed a randomized, double-blind, placebo-controlled
trial to assess the efficacy of combined of vitamin A and
zinc supplementation on morbidity due to P. falciparum
among young children in a malaria-endemic area of
Burkina Faso.
Methods
Study site
The study was done in Sourkoudougou village in Dand
health district, which is located 25 km from Bobo
Dioulasso city, Burkina Faso. Malaria is holoendemic, with
transmission peaking during the rainy season
(May-October) and entomological inoculation rate of 697 infected
bites per person per year [15]. The village has a
gove (...truncated)