A to Z of reducing malaria morbidity

Nutrition Journal has just published a study that shows micronutrient supplements – Vitamin A and Zinc – can produce a ‘major reduction’ in malaria morbidity in Burkina Faso. Previous work has been pointing to a positive role for Vitamin A on malaria, and zinc has shown positive effects on other health problems such as diarrhoeal diseases. The authors hypothesized a positive effect of the two micronutrients, and were not disappointed. There was a 30% reduction in malaria cases and a 22% reduction in fever episodes in the supplemented group compared to the placebo group.

The study covered a 6-month period, and the regimen consisted of Vitamin A once and zinc supplementation daily, 6 days a week for the 6 months. The authors acknowledge that comparison arms with zinc only and Vitamin A only would have been instructive in determining whether the results were additive or synergistic. We assume others will take up this challenge, but assuming that we want now to add this A-Z regimen to the toolkit of malaria prevention, what are the implications for a safe and feasible delivery mechanism?

Concerning safety, the BBC quoted Dr Ron Behrens, an expert in tropical diseases at the London School of Hygiene and Tropical Medicine. He addressed the issue of seasonality of micronutrient deficiencies as well as the need for caution to avoid excess dosing of these supplements. “Neither of these micro-nutrients is totally safe. They should be used like pharmaceuticals, and not seen as cure alls,” he said.

Vitamin A has already been incorporated into immunization campaigns. The authors think that, “Ultimately, the more affordable and sustainable solution would be the incorporation of vitamin A and zinc in food fortification for children.” Campaigns may not offer a long term or sustainable delivery mechanism, and food supplementation in resource poor settings, especially more remote rural areas is not likely feasible in the foreseeable future.

the-tdr-program-has-shown-that-vitamin-a.jpgEnabling the community to take charge of delivery of malaria interventions has been advocated here. This works for Vitamin A supplementation as seen in the graph to the left and continues to be the preferred approach to ensure people participate in their own health care. Hopefully the Global Fund and other donors will be willing to pay for this addition to the malaria prevention toolkit.

Finally, Bhutta et al. in the Lancet this month offer another ‘ultimate’ or long term solution by recommending that nutritional “interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women’s empowerment.”

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