Impact of vitamin A with zinc supplementation on malaria morbidity in Ghana

Nutrition Journal

Sherry A Tanumihardjo³  Thabisile Moleah²  Latifa Alhassan¹  Kofi Tchum¹  Kwame Adjei¹  Martha Ali¹  Lawrence Gyabaa Febir¹  Emmanuel Mahama¹  Sam Newton¹  Seth Owusu-Agyei¹ 

[1] Kintampo Health Research Centre (KHRC), Ghana Health Service, P.O.Box 200Kintampo, Brong-Ahafo Region, Ghana;International Atomic Energy Agency, P O Box 100, A-1400, Vienna, Austria;Department of Nutritional Sciences, University of Wisconsin, Madison, USA

关键词: MRDR;    Morbidity;    Malaria;    Zinc;    Vitamin A;   

Others  :  805649
DOI  :  10.1186/1475-2891-12-131

 received in 2013-05-24, accepted in 2013-09-16,  发布年份 2013

【 摘 要 】

Background

Malaria is a leading cause of morbidity and mortality among young children and is estimated to cause at least 1 million deaths each year especially among pregnant women and young children under the age of five years. Vitamin A supplementation is known to reduce morbidity and mortality in young children. Zinc is required for growth and immunity and we sought to replicate the study by Zeba et al. which showed 30% lower cases of clinical malaria in children on a combination of zinc and a large dose of vitamin A compared with children on vitamin A alone based on the hypothesis that combined vitamin A and zinc reduced symptomatic malaria compared to vitamin A alone.

Objectives

The primary objective was to determine the effect of vitamin A alone vs. vitamin A and zinc supplements on the incidence of clinical malaria and other anthropometric indices. It also sought to assess the effects on the incidence of anaemia, diarrhoea and pneumonia.

Methods

The study was community-based and 200 children between the ages of 6–24 months were randomised to receive either vitamin A (100,000 IU for infants less than 12 months & 200,000 IU for children greater than 12 months and 10 mg daily zinc in the intervention group or vitamin A and zinc placebo for 6 months in the control group.

Results

The number of children who were diagnosed with uncomplicated malaria in the intervention group was 27% significantly lower compared with the children in the control group (p = 0.03). There were, however, no effects on severe malaria, pneumonia, anaemia and diarrhea.

Conclusions

Our study confirms a significant role of vitamin A and zinc in reducing malaria morbidity.

【 授权许可】

   
2013 Owusu-Agyei et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Chuma JM, Thiede M, Molyneux CS: Rethinking the economic costs of malaria at the household level: Evidence from applying a new analytical framework in rural Kenya. Malar J 2006, 30:5-76.
• [2]Holding PA, Kitsao-Wekulo PK: Describing the burden of malaria on child development: what should We Be measuring and How should We Be measuring It? Am J Trop Med Hyg 2004, 71(Suppl 2):71-79.
• [3]Dewey KG, Peerson MJ, Heinig MJ, Noomsen LA, Lonnerdal B, Lopez De Roman G, De Kanashiro HC, Black RE, Brown KH: Growth patterns of breast fed infants in affluent (United States) and poor (Peru) communities: implications for timing of complementary feeding. Am J Clin Nutr 1992, 56:1012-1018.
• [4]Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin KH, Briend A, Dewey KG: Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects in infant iron status in Ghana. Am J Clin Nutr 2008, 87(4):929-938.
• [5]Nestel P, Briend A, de Benoist B, Decker E, Ferguson E, Fontaine O, Micardi A, Nalubola R: Complementary food supplements to achieve micronutrient adequacy for infants and young children. J Pediatr Gastroenterol Nutr 2003, 36(3):316-328.
• [6]Ghana Vast Study Team Vitamin A supplementation in Northern Ghana: Effects on clinic attendances, hospital admissions and child mortality. Lancet 1994, 344:228-231.
• [7]Barreto ML, Santos LMP, Assis AMO, Araujo MPN, Farenzena GG, Santos PAB, Fiaccone RL: Effect of vitamin A supplementation on diarrhoea and acute lower respiratory infections in young children in Brazil. Lancet 1994, 344:228-231.
• [8]Beaton GH, Martorell R, Aronson KJ, et al.: Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries. Geneva: ACC/SCN; 1993.
• [9]Sommer A, Davidson FR: Assessment and control of vitamin a deficiency: the Annecy accords. J Nutr 2002, 132(Suppl):S2845-S2850.
• [10]Semba RD: The role of vitamin A and related retinoids in immune function. Nutr Rev 1998, 56:S38-S48.
• [11]Veenemans J, Milligan P, Prentice AM, Schouten LR, Inja N, der Heijden V, De Boer LC, Jansen EJ, Koopmans AE, Enthoven WT, Kraaijenhagen RJ, Demir AY, Uges DRA, Mbugi EV, Savelkou HF, Verhoef H: Effect of supplementation with zinc and other micronutrients on malaria in Tanzanian children: a randomised trial. PloS Med 2011, 8(11):e1001125.
• [12]Brown K, Wehler S, Person J: The importance of zinc in humans nutrition and estimation of the global prevalence of zinc deficiency. Food Nutr Bull 2001, 22:113-125.
• [13]Keen CL: Gershwin ME Zinc deficiency and immune function. Annu Rev Nutr 1990, 10:415-431.
• [14]Zeba AN, Sorgho H, Rouamba N, Zongo I, Rouamba J, Guiguemde RT, Hamer DH, Mokhtar N, Ouedraogo JB: Major reduction of malaria morbidity with combined vitamin A and zinc supplementation in young children in Burkina Faso: a randomized double blind tria. Nut J 2008, 7:7. BioMed Central Full Text
• [15]WHO/CHD immunization linked Vitamin A Supplementation Study Group: Randomised trial to assess benefits and safety of vitamin A supplementation linked to immunization in early infancy. Lancet 1998, 352:1257-1263.
• [16]Newton S, Cousens S, Owusu Agyei S, Filteau S, Stanley C, Linsell L, Kirkwood B: Vitamin a supplementation does not affect Infants’ immune responses to polio and tetanus vaccines. J Nutr 2005, 135:2669-2673.
• [17]Owusu-Agyei S, Nettey OE, Zandoh C, Sulemana A, Adda R, Amenga-Etego S, Mbacke C: Demographic patterns and trends in Central Ghana: baseline indicators from the kintampo health and demographic surveillance system. Glob Health Action 2012, 5(0):1-11. doi: 10.3402/gha.v5i0.19033
• [18]Domellof M, Dewey KG, Lonnerdal B, Cohen RJ, Hernell O: The diagnostic criteria for iron deficiency in infants should be reevaluated. J Nutr 2002, 132:3680-3686.
• [19]Valentine AR, Tanumihardjo SA: Adjustments to the modified relative dose response MRDR) test for assessment of vitamin A status minimize the blood volume used in piglets. J Nutr 2004, 134:1186-1192.
• [20]Olson JA: Vitamin A. In Handbook of Vitamins. 3rd edition. Edited by Rucker RB, Suttie JW, McCormick DB, Machlin LJ. New York, NY: Marcel Dekker; 2001:1-50.
• [21]Tanumihardjo SA, Cheng JC, Permaesih D, Muherdiyantiningsih E, Rustan M, Muhilal Karyadi D, Olson JA: Refinement of the modified-relative-dose–response test as a method for assessing vitamin A status in a field setting: experience with Indonesian children. Am J Clin Nutr 1996, 64:966-971.
• [22]Smith JC, Butrimovitz GP, Purdy WC: Direct measurement of zinc in plasma by atomic absorption spectroscopy. Clin Chem 1979, 25:1487-1491.
• [23]Shankar A, Genton B, Semba R, Baisor M, Paino J, et al.: Effect of vitamin A supplementation on morbidity due to Plamodium falciparum in young children in Papua New Guinea: A randomized trial. Lancet 1999, 354:203-209.
• [24]Gibson RS, Heywood A, Yaman C, Sohlstrom A, Thompson LU, Heywood P: Growth in children from the Wosera sub district, Papua New Guinea in relation to energy and protein intakes and zinc status. Am J Clin Nutr 1991, 53:782-789.
• [25]Gibson RS, Huddle JM: Sub optimal zinc status in pregnant Malawian women: its association with low intakes of poorly available zinc, frequent reproductive cycling and malaria. Am J Clin Nutr 1998, 67:702-709.
• [26]Shankar AH, Genton B, Baisor M, Paino J, Tamja S, et al.: The influence of zinc supplementation on morbidity due to Plasmodium falciparum: a randomised trial in preschool children in Papua New Guinea. Am J Trop Med Hyg 2000, 62:663-669.
• [27]Bates C, Evans PH, Dardene M, Prentice A, Lunn PG, et al.: A trial of zinc supplementation in young rural Gambian children. Br J Nutr 1993, 69:243-255.
• [28]Muller O, Becher H, van Zweeden AB, Ye Y, Diallo DA: Effect of zinc supplementation on malaria and other causes of morbidity in West African children: randomised double blind placebo controlled trial. BMJ 2001, 322:1567.
• [29]Binka F, Ross D, Morris S: Vitamin A supplementation and childhood malaria in northern Ghana. Am J Clin Nutr 1995, 61:853-859.
• [30]Rahman MM, Tofail F, Wahed MA, Fuchs GJ, Baqui AH, Alvarez JO: Short term supplementation with zinc and vitamin A gas no significant effect on the growth of undernourished Bangladeshi children. AM J Clin Nutr 2002, 75:87-91.
• [31]Michaelson KF, Samuelson G, Graham TW, Lonnerdal B: Zinc intake, zinc status and growth in a longitudinal study of health Danish Infants. Acta Pediatr 1994, 83:1115-1121.
• [32]Krebs NF, Reidinger C, Robertson AD, Hambridge KM: Growth and intakes of energy and zinc in infants fed human milk. J Pediatr 1994, 124:32-39.
• [33]Samenpera L, Perheentupa J, Nanto V, Siimes MA: Low zinc intake during exclusive-breastfeeding does not impair growth. J Pediatr Gastroenterol Nutr 1994, 18:361-370.
• [34]World Health Organization: Zinc. In Trace Elements in Human Nutrition and Health. Geneva: WHO; 1996:72-104.
• [35]Brown KH, Peerson JM, Rivera J, Allen LH: Effect of supplemented zinc on the growth and serum zinc concentrations of prepubertal children: a meta analyses of randomized controlled trials. Am J Clin Nutr 2002, 75:1062-1071.
• [36]Bhutta ZA, Black R, Brown KH, et al.: Prevention of diarrhoea and pneumonia by zinc supplementation in children in developing countries: pooled analyses of randomized controlled trials. Zinc investigators collaborative group. J Pediatr 1999, 135:689-697.
• [37]Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS: Bellabio: child survival study. How many deaths can we prevent this year? Lancet 2003, 362:65-71.
• [38]The Zinc Investigators’ Collaborative Group: Prevention of diarrhoea and pneumonia by zinc supplementation in children in developing countries :pooled analysis of randomized controlled trialsZinc investigators’ collaborative group. J Pediatr 1999, 135:689-697.
• [39]Rahman MM, Vermund SH, Wahed MA, Fuchs GJ, Baqui AH, Alvarez JO: Simultaneous zinc and vitamin A supplements in Bangladeshi children: randomised double blind controlled trial. BMJ 2001, 323:314-318.
• [40]Gupta DN, Mondal SK, Ghosh S, Rajendran K, Sur D, Manna B: Impact of zinc supplementation on diarrhoeal morbidity in rural children of West Bengal, India. Acta Pediatr 2003, 92:531-536.
• [41]Lo NB, Aaron GL, Hess SY, Dossou NI, Guiro AT, Wade S, Brown KH: Plasma zinc concentration responds to zinc supplementation, but non zinc fortification, in young children in Senegal. Am J Clin Nutr 2011, 93:1348-1355.
• [42]Walker CF, Black RE: Zinc and the risk for infectious disease. Annu Rev Nut 2004, 24:255-275.