Project Title

Assessment of a combined strategy of seasonal malaria chemoprevention + nutrients and Vitamin A-Zinc supplementation to tackle malaria and malnutrition in Burkina Faso (SMC-NUT)

Project Objectives

Primary objective 1: to assess in a randomized trial whether Seasonal Malaria Chemoprophylaxis (SMC) + Vitamin A-Zinc or SMC+ Plumpy’DozTM is more effective and safe in reducing uncomplicated malaria incidence, severe malaria incidence and related mortality compared to the SMC alone. Primary objective 2: to investigate the impact of the combined strategy in reducing the burden of malnutrition through reduction of anaemia incidence, mid-upper arm circumference gain, and weight gain. All these parameters were measured throughout the scheduled home visits of the participants during then follow-up period Secondary objective 1: to assess the impact of each treatment arm on the circulation parasite population through monitoring the temporal trend of antimalarial resistance molecular markers pfcrt, pfmdr1, dhfr and dhps Secondary objective 2: to assess the coverage and compliance to SMC in the study area Secondary objective 3: to determine the overall risk of adverse events (AEs)

Results & Outcomes

Host Organisation

EDCTP Project Call

Career Development Fellowship (CDF)

Study Design

Interventional

Project Summary

Malaria and malnutrition represent major public health concerns worldwide especially in Sub-Sahara Africa. Despite implementation of Seasonal Malaria Chemoprophylaxis (SMC), an intervention aimed at reducing malaria prevalence among children aged 6-59 months, the burden of malaria and associated mortality among children below age 5 years remains high in Burkina Faso. This raises the question of what hiding factors may negatively affect the responsiveness to SMC intervention. Malnutrition, in particular micronutrient deficiency, is one of these potential factors that can negatively affect the effectiveness of SMC. Treating micronutrient deficiencies is known to reduce the prevalence of malaria mortality in highly prevalent malaria zone, such as rural settings. Therefore, we hypothesised that a combined strategy of SMC together with a daily oral nutrients supplement (Vitamin A-Zinc OR fortified peanut butter-like paste-Plumpy’DozTM) will enhance the immune response and decrease the incidence of malaria in this population and at the same time reduce the burden of malnutrition among children under SMC coverage. A randomized clinical trial was carried out between July 2020 and June 2021 in the health district of Nanoro, Burkina Faso (NCT04238845). Children were randomly assigned to one of the three groups (a) SMC alone + Vitamin A, (b) SMC + Vitamin A+ Zinc, or (c) SMC+ Vitamin A + Plumpy’Doz. Micronutrient supplementation was carried out over three months during the SMC period between August and October 2020. After each SMC monthly distribution, children were visited at home to confirm drug administration. Anthropometric indicators were recorded at each visit. Blood samples was collected for thick and thin film and haemoglobin measurement and spotted onto filter paper for further PCR analyses. Included children were followed up for one year including six-month active surveillance (July 2020 to December 2020) and six-months passive surveillance (January 2021 to June 2021). A total of 1059 (353 per arm) children under SMC coverage were recruited within four villages of Health District of Nanoro: Soaw, Rakalo, Zoetgomde, and Kalwaka. Adding nutritional supplements to SMC reduced significantly all-cause morbidity in children. Furthermore, wasted children recovered much faster after nutrient supplementation. More specifically, Zinc + Vitamin A supplementation reduced the incidence of uncomplicated malaria by 17% while Plumpy'DozTM + Vitamin A supplementation reduced this incidence by 22.6%. Interestingly, Plumpy'DozTM supplementation reduced the incidence of severe malaria by 50%. During the period of high malaria transmission, many children under SMC coverage are also malnourished. Combining micronutrient supplementation into SMC significantly increases the impact of this intervention for reducing malaria burden in children under five years olds. The effect was greater with ready-to-use therapeutic foods such as PlympyDoz than with Zinc. Micronutrient supplementation would boost the immune system while improving the absorption of Amodiaquine-Sulfadoxine Pyrimethamine. By relying on an existing strategy (SMC), the scaling up of the intervention is easily achievable throughout the Sahelian zone. Beside answering this specific research question, the project highly contributed to building the capacity of the Clinical Research Unit of Nanoro. The fellow was promoted as Research Master while training opportunities were offered to young researchers. During the programme, two students were trained for Master's degrees, one in the field of molecular biology and one in nutrition.

Current Organisation

Centre National de la Recherche Scientifique et Technologique (CNRST) - Institut de Recherche en Science de la Santé (IRSS)

Current Job Title

Medical Parasitologist

Biography