There is a very interesting study in MalariaWorld this week examining the link between malaria and malnutrition. ‘Malaria-malnutrition interaction: prevalence, risk factors, and the impact of intermittent preventive therapy for malaria on nutritional status of school-age children in Muheza, Tanga, Tanzania — A cross-sectional survey and a randomized controlled open-label trial’ by Hhera et al compared three groups of children over eight months.
Two groups of school age children were treated periodically (so-called intermittent preventative treatment, IPT) with ACT drugs (arteminin-based combination therapy), either dihydroartemisinin-piperaquine (DP) or Artesunate amodiaquine (ASAQ). The third group was a control group who only received so-called standard care drug (Artemether Lumefantrine) if they tested positive for malaria plasmodia.
The main outcome of the study was that during the intervention, change in mean weight, height, and BMI over time as estimated from age-treatment interaction was not significantly different in the DP and ASAQ treatment groups compared with the control group.
Malaria, malnutrition and poverty are connected. At baseline, the prevalence of malaria was 27%, 23% of children were underweight, 21% were stunted and 28% were either thin or severely thin. The odds of stunting were 78% higher among children who had malaria compared with those who did not have malaria. Children from low socioeconomic status (SES) had higher odds of being underweight compared with their high SES counterparts.
Digging deeper into the study found interesting nuggets of information. During trial, the average weight gains for the DP, ASAQ, and Standard Care treatment groups were 5.0 kg, 5.1 kg, and 5.2 kg, respectively. For the children’s height, the net gains were 6.0 cm, 6.1 cm, and 6.5 cm in the DP, ASAQ, and Standard Care treatment groups, respectively. It would seem that children who were not dosed with the IPT drugs grew more than those who were, even if not statistically significant. At visit 4 13.2% were stunted compared to 24.8% for DP group and 21.8% for ASAQ group. Control children were also less likely to be underweight or thin. They were more likely to test positive for malaria plasmodia. It makes one wonder how important this fact is.
The authors conclude that public health efforts should combine malaria control with nutrition programs, including community driven strategies to enhance sustainable nutrition education and access to adequate food at home and school. It is great to see some malaria researchers becoming aware of the importance of nutrition.