饮食干预对马拉维农村 6-18 个月大儿童无症状疟疾患病率的影响。

Effect of dietary intervention on the prevalence of asymptomatic malaria among 6-18-month-old children in rural Malawi.

机构信息

Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33014, Tampere, Finland.

Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen.

出版信息

Malar J. 2023 Sep 11;22(1):266. doi: 10.1186/s12936-023-04701-4.

DOI:10.1186/s12936-023-04701-4

PMID:37697296

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10496296/

Abstract

BACKGROUND

The complex interaction between malaria and undernutrition leads to increased mortality and morbidity rate among young children in malaria-endemic regions. Results from previous interventions suggest that improving nutritional status of young children may reduce the burden of malaria. This study tested a hypothesis that provision of lipid-based nutrient supplements (LNS) or corn-soy blend (CSB) supplementation to 6-18-month-old children in Malawi would reduce the prevalence of asymptomatic malaria among them.

METHODS

A total of 840 6-month-old children were enrolled in a randomized trial. The participants received 12-month supplementation with three different daily dietary supplementations: CSB, soy-LNS, or milk-LNS, and one control group without supplementation. The prevalence rate of asymptomatic Plasmodium falciparum was determined by real-time PCR from the participant's dried blood spots (DBS) collected at the baseline and every 3 months. The global null hypothesis was tested using modified Poisson regression to estimate the prevalence ratio (PR) between the control group and three intervention groups at all ages combined. All the models were adjusted for malaria at baseline, season of DBS sample collection, site of enrolment, and household asset Z-score.

RESULTS

All children combined, the prevalence of P. falciparum was 14.1% at enrollment, 8.7% at 9 months, 11.2% at 12 months, 13.0% at 15 months and 22.4% at 18 months of age. Among all samples that were taken after enrolment, the prevalence was 12.1% in control group, 12.2% in milk-LNS, 14.0% in soy-LNS, and 17.2% in CSB group. Compared to children in the control group the prevalence ratio of positive malaria tests was 1.19 (95% CI 0.81-1.74; P = 0.372) in the milk-LNS group, 1.32 (95% CI 0.88-1.96; P = 0.177) in the soy-LNS group and 1.72 (95% CI 1.19-2.49; P = 0.004) in the CSB group.

CONCLUSION

The study findings do not support a hypothesis that LNS or CSB supplementation would reduce the prevalence of asymptomatic malaria among Malawian children. In contrast, there was a signal of a possible increase in malaria prevalence among children supplemented with CSB.

摘要

背景

疟疾和营养不良之间的复杂相互作用导致疟疾流行地区的幼儿死亡率和发病率上升。以往干预措施的结果表明，改善幼儿的营养状况可能会降低疟疾负担。本研究检验了一个假设，即向马拉维 6-18 个月大的儿童提供脂基营养补充剂 (LNS) 或玉米-大豆混合物 (CSB) 补充剂，是否会降低他们无症状疟疾的流行率。

方法

共有 840 名 6 个月大的儿童参加了一项随机试验。参与者接受了为期 12 个月的三种不同的每日膳食补充：CSB、大豆-LNS 或牛奶-LNS，以及一个不补充的对照组。通过从参与者的干血斑 (DBS) 中采集的实时 PCR 确定无症状间日疟原虫的流行率，该 DBS 是在基线和每 3 个月收集一次。使用修正泊松回归来检验全球零假设，以估计对照组和三个干预组在所有年龄组的流行率比（PR）。所有模型均根据基线疟疾、DBS 样本采集季节、入组地点和家庭资产 Z 分数进行调整。

结果

所有儿童中，疟疾的流行率为 14.1%，在 9 个月时为 8.7%，12 个月时为 11.2%，15 个月时为 13.0%，18 个月时为 22.4%。在所有入组后采集的样本中，对照组的流行率为 12.1%，牛奶-LNS 组为 12.2%，大豆-LNS 组为 14.0%，CSB 组为 17.2%。与对照组儿童相比，牛奶-LNS 组阳性疟疾检测的流行率比为 1.19（95%CI 0.81-1.74；P=0.372），大豆-LNS 组为 1.32（95%CI 0.88-1.96；P=0.177），CSB 组为 1.72（95%CI 1.19-2.49；P=0.004）。