Institut de Recherche en Sciences de La Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso.
Ministry of Health of Burkina Faso/Ouagadougou, Ouagadougou, Burkina Faso.
Malar J. 2023 Oct 18;22(1):315. doi: 10.1186/s12936-023-04745-6.
In rural African settings, most of the children under the coverage of Seasonal Malaria Chemoprevention (SMC) are also undernourished at the time of SMC delivery, justifying the need for packaging malarial and nutritional interventions. This study aimed at assessing the impact of SMC by coupling the intervention with nutrients supplementation for preventing malaria in children less than 5 years old in Burkina Faso.
A randomized trial was carried out between July 2020 and June 2021 in the health district of Nanoro, Burkina Faso. Children (n = 1059) under SMC coverage were randomly assigned to one of the three study arms SMC + Vitamin A (SMC-A, n = 353) or SMC + Vitamin A + Zinc (SMC-AZc, n = 353) or SMC + Vitamin A + PlumpyDoz(tm) (SMC-APd, n = 353)-a medium quantity-lipid-based nutrient supplement (MQ-LNS). Children were followed up for one year that included an active follow-up period of 6 months with scheduled monthly home visits followed by 6 months passive follow-up. At each visit, capillary blood sample was collected for malaria diagnosis by rapid diagnosis test (RDT).
Adding nutritional supplements to SMC had an effect on the incidence of malaria. A reduction of 23% (adjusted IRR = 0.77 (95%CI 0.61-0.97) in the odds of having uncomplicated malaria in SMC-APd arm but not with SMC-AZc arm adjusted IRR = 0.82 (95%CI 0.65-1.04) compare to control arm was observed. A reduction of 52%, adjusted IRR = 0.48 (95%CI 0.23-0.98) in the odds of having severe malaria was observed in SMC-APd arm compared to control arm. Besides the effect on malaria, this combined strategy had an effect on all-cause morbidity. More specifically, a reduction of morbidity odds of 24%, adjusted IRR = 0.76 (95%CI 0.60-0.94) in SMC-APd arm compared to control arm was observed. Unlike clinical episodes, no effect of nutrient supplementation on cross sectional asymptomatic infections was observed.
Adding nutritional supplements to SMC significantly increases the impact of this intervention for preventing children from malaria and other childhood infections.
NCT04238845.
在非洲农村地区，大多数接受季节性疟疾化学预防（SMC）的儿童在接受 SMC 时也存在营养不良，这证明需要将疟疾和营养干预措施结合起来。本研究旨在评估 SMC 的影响，方法是在布基纳法索纳罗多卫生区开展一项随机试验，将接受 SMC 覆盖的儿童（n=1059）随机分配至以下三个研究组之一：接受 SMC+维生素 A（SMC-A，n=353）、接受 SMC+维生素 A+锌（SMC-AZc，n=353）或 SMC+维生素 A+PlumpyDoz（SMC-APd，n=353）——一种中剂量脂质基础营养素补充剂（MQ-LNS）。儿童接受为期一年的随访，包括 6 个月的主动随访和 6 个月的被动随访。每次随访时，采集毛细血管血样进行疟疾诊断，采用快速诊断检测（RDT）。
在 SMC 中添加营养补充剂对疟疾的发病率有影响。与对照组相比，在 SMC-APd 组中，无并发症疟疾的发生几率降低了 23%（调整后的优势比[IRR]：0.77（95%CI 0.61-0.97），而在 SMC-AZc 组中则没有观察到这种影响（调整后的 IRR：0.82（95%CI 0.65-1.04）。与对照组相比，在 SMC-APd 组中，严重疟疾的发生几率降低了 52%，调整后的 IRR：0.48（95%CI 0.23-0.98）。除了对疟疾的影响外，这种联合策略还对所有病因的发病率有影响。更具体地说，与对照组相比，在 SMC-APd 组中，发病几率降低了 24%，调整后的 IRR：0.76（95%CI 0.60-0.94）。与临床发作不同，营养补充剂对横断面无症状感染没有影响。
在 SMC 中添加营养补充剂可显著提高该干预措施预防儿童疟疾和其他儿童感染的效果。
NCT04238845。
