Major reduction of malaria morbidity with combined vitamin A and zinc supplementation in young children in Burkina Faso: a randomized double blind trial

BACKGROUND: Vitamin A and zinc are crucial for normal immune function, and may play a synergistic role for reducing the risk of infection including malaria caused by Plasmodium falciparum. METHODS: A randomized, double-blind, placebo-controlled trial of a single dose of 200 000 IU of vitamin A with daily zinc supplementation was done in children of Sourkoudougou village, Burkina Faso. Children aged from 6 to 72 months were randomized to receive a single dose of 200 000 IU of vitamin A plus 10 mg elemental zinc, six days a week (n = 74) or placebo (n = 74) for a period of six months. Cross-sectional surveys were conducted at the beginning and the end of the study, and children were evaluated daily for fever. Microscopic examination of blood smear was done in the case of fever (temperature > or =37.5 degrees C) for malaria parasite detection. RESULTS: At the end of the study we observed a significant decrease in the prevalence malaria in the supplemented group (34%) compared to the placebo group (3.5%) (p < 0.001). Malaria episodes were lower in the supplemented group (p = 0.029), with a 30.2% reduction of malaria cases (p = 0.025). Time to first malaria episode was longer in the supplemented group (p = 0.015). The supplemented group also had 22% fewer fever episodes than the placebo group (p = 0.030). CONCLUSION: These results suggest that combined vitamin A plus zinc supplementation reduces the risk of fever and clinical malaria episodes among children, and thus may play a key role in malaria control strategies for children in Africa

The positive impact of red palm oil in school meals on vitamin A status: study in Burkina Faso

BACKGROUND: Vitamin A (VA) deficiency is widespread in sub-Saharan Africa and school-age children are a vulnerable group. In Burkina Faso, the production and consumption of red palm oil (RPO) is being promoted as a food supplement for VA. The objective of the study was to assess the impact on serum retinol of adding RPO to school lunch in two test zones of Burkina Faso. METHODS: Over one school year, 15 ml RPO was added to individual meals 3 times a week in selected primary schools in two sites. Serum retinol was measured with HPLC at baseline and exactly 12 months later to take account of seasonality. A simple pre-post test design was used in the Kaya area (north-central Burkina), where 239 pupils from 15 intervention schools were randomly selected for the evaluation. In Bogandé (eastern Burkina), 24 schools were randomised for the controlled intervention trial: 8 negative controls (G1) with only the regular school lunch; 8 positive controls (G2) where the pupils received a single VA capsule (60 mg) at the end of the school year; and 8 schools with RPO through the school year (G3). A random sample of 128 pupils in each school group took part in the evaluation. RESULTS: In Kaya, serum retinol went from 0.77 ± 0.37 μmol/L at baseline to 1.07 ± 0.40 μmol/L one year later (p < 0.001). The rate of low serum retinol (<0.7 μmol/L) declined from 47.2% to 13.1%. In Bogandé, serum retinol increased significantly (p < 0.001) only in the capsule and RPO groups, going from 0.77 ± 0.28 to 0.98 ± 0.33 μmol/L in the former, and from 0.82 ± 0.3 to 0.98 ± 0.33 μmol/L in the latter. The rate of low serum retinol went from 46.1 to 17.1% in the VA capsule group and from 40.4% to 14.9% in the RPO group. VA-deficient children benefited the most from the capsule or RPO. Female sex, age and height-for-age were positively associated with the response to VA capsules or RPO. CONCLUSION: RPO given regularly in small amounts appears highly effective in the reduction of VA deficiency. RPO deserves more attention as a food supplement for VA and as a potential source of rural income in Sahelian countries

Effet de la double supplémentation en vitamine A et en zinc sur le statut nutritionnel et les réserves hépatiques en vitamine A chez les enfants de 6 à 59 mois de Sourkoudougou

Nous avons évalué l’effet de la double supplémentation en vitamine A et en zinc sur le tatut nutritionnel des enfants à Sourkoudougou (district sanitaire de Dandé). Cent enfants âgés de 6 à 59 mois ont été inclus (mai – novembre 2009) dans le cadre d’un essai randomisé contrôlé en double aveugle testant l’effet de la supplémentation (6 mois après) en vitamine A plus zinc (VAZ) (n = 50) versus vitamine A plus placebo (VA) (n = 50) sur leur statut nutritionnel. Nous avons comparé les statuts en vitamine A, en zinc, et les paramètres anthropométriques, inter-groupes et intra-groupes, en utilisant des tests statistiques descriptifs pour échantillons indépendants et appariés. Après la supplémentation, 85,4 % (41/48) du groupe VA et 88,9 % (40/45) du groupe VAZ, avaient des réserves hépatiques en vitamine A insuffisantes, 6 mois après la prise de vitamine A (p = 0,760), tandis que 64,8 % (31/48) et 59,1 % (26/44) respectivement, avaient une carence en zinc (p = 0,580). L’étude a montré une baisse significative de l’insuffisance pondérale (p = 0,011) et du retard de croissance (p = 0,008) dans les groupes VA et VAZ. L’étude n’a pas pu montrer une amélioration du statut des enfants en vitamine A et en zinc bien qu’un gain de taille ait été enregistré dans le groupe zinc.Mots-clés : supplémentation, vitamine A, zinc, statut nutritionnel

Serum carotenoids reveal poor fruit and vegetable intake among schoolchildren in Burkina Faso

The health benefits of fruits and vegetables are well-documented. Those rich in provitamin A carotenoids are good sources of vitamin A. This cross-sectional study indirectly assessed fruit and vegetable intakes using serum carotenoids in 193 schoolchildren aged 7 to 12 years in the Western part of Burkina Faso. The mean total serum carotenoid concentration was 0.23 +/- 0.29 mu mol/L, which included alpha- and beta-carotene, lutein, and beta-cryptoxanthin, and determined with serum retinol concentrations in a single analysis with high performance liquid chromatography. Serum retinol concentration was 0.80 +/- 0.35 mu mol/L with 46% of children (n = 88) having low values <0.7 mu mol/L. Total serum carotene (the sum of alpha- and beta-carotene) concentration was 0.13 +/- 0.24 mu mol/L, well below the reference range of 0.9-3.7 mu mol carotene/L used to assess habitual intake of fruits and vegetables. Individual carotenoid concentrations were determined for beta-carotene (0.01 +/- 0.05 mu mol/L), beta-carotene (0.17 +/- 0.24 mu mol/L), beta-cryptoxanthin (0.07 +/- 0.06 mu mol/L), and lutein (0.06 +/- 0.05 mu mol/L). These results confirm the previously measured high prevalence of low serum vitamin A concentrations and adds information about low serum carotenoids among schoolchildren suggesting that they have low intakes of provitamin A-rich fruits and vegetables

The association between inflammation and infection status and vitamin A status of children 36 – 59 months of in a malaria-endemic rural area in Burkina Faso

Background and objectives: Infections and micronutrient deficiencies are widespread health issues in Africa. Vitamin A (VA) deficiency remains an endemic public health concern, with its health consequences mostly affecting infants, young children and pregnant and lactating women. In Burkina Faso, VA deficiency is especially prevalent during the rainy season. The aim of this study was to assess the association between common infections and inflammatory status and VA status in children living in a malaria endemic rural area in Burkina Faso, and the effect of season on this association. Material and methodology: Two community-based cross- sectional studies were conducted in a malaria endemic area of Burkina Faso and have included 115 children of 36 - 59 months of age. The 13C-retinol isotope dilution test (RID) determined VA total body store (TBS) and total liver reserve (TLR). Malaria infection was assessed using rapid diagnosis test and malaria smear, intestinal parasites were assessed by stool microscopic examination, and inflammation indicators, C reactive proteins (CRP) and Alpha-1-acid glycoprotein (AGP) were assessed in venous blood by ELISA. The association between VA status and infection status was tested by a multiple linear regression. Results: No VA deficiency (1.0 mol/g liver). Elevated CRP and AGP were respectively detected in 9% and 26% children. Malaria was diagnosed in 10 % of the children. Significant but weak association was found between CRP concentration and VA status (β=0.055, p=0.009). There was no association between malaria status, AGP and exposition to digestive parasites with VA status. The association between CRP and VA status has a seasonal pattern (β= 0.591, p= 0.001). Conclusion: In this area of Burkina Faso where infections are common none of the children had VA deficiency. An association was found between acute inflammatory markers and VA status, which was stronger during the rainy season

Consommation des vitamines A préformées et provitamines A chez les enfants de 36 – 59 mois en milieu rural au Burkina Faso

Introduction : La carence en Vitamine A (VA) constitue un problème nutritionnel majeur au Burkina Faso. Une des interventions pour lutter contre, est la promotion de la consommation des aliments riches en VA. L’objectif de cette étude était de déterminer la consommation des VA préformées et des pro-VA ainsi que sa variabilité saisonnière en milieu rural. Matériel et méthodes : Deux enquêtes transversales communautaires (en saisons sèche et pluvieuse) ont été effectuées en milieu rural et ont inclus 115 enfants de 36 – 59 mois. Chez tous les participants, deux rappels alimentaires des 24 heures ont servi à collecter la consommation des VA préformées et des pro-VA. La quantification de la consommation des aliments a été effectuée à partir de la table de composition alimentaire de l’Afrique de l’Ouest et des repas standards. Le t-Test a été utilisé pour la comparaison par saison. Résultats : Le score de diversité alimentaire était de 4,11 (±1,11) groupes alimentaires. Les scores de consommation des pro-VA (caroténoïdes) et des VA préformées étaient respectivement de 1,07 (±0.48) et de 0,13 (±0,37). Les apports journaliers moyens de VA étaient de 672 (252- 1080) µg RE. Un tiers (n=38) des enfants avait un apport journalier bas (<300 µg RE/jour). Une consommation significativement élevée des α- carotènes (p=0,005) et de β- carotènes (p=0,03) a été observée pendant la saison pluvieuse. Conclusion : Les VA préformées et pro VA étaient insuffisamment consommées, avec une préférence pour celles d’origine végétale. Elles étaient plus consommées en saison pluvieuse qu’en saison sèche.Introduction: Vitamin A (VA) deficiency is a major nutritional concerned in Burkina Faso. One of the interventions to tackle it is promoting the consumption of VA rich foods. The study aimed to determine the consumption of preformed VA and pro-VA and its seasonal variability in rural areas. Material and methods: Two community-based cross-sectional surveys (dry and rainy seasons) were conducted in rural areas and included 115 children 36-59 months of age. In all participants, two 24-hour dietary recalls were used to collect consumption of preformed VA and pro-VA. Quantification of food consumption was performed using the West African food composition table and standard meals. The t-test was used for comparison by season. Results: The dietary diversity score was 4.11 (±1.11) food groups. The consumption scores of pro-VA (carotenoids) and preformed VA were 1.07 (±0.48) and 0.13 (±0.37) respectively. The average daily intake of VA was 672 (252- 1080) µg RE. One third (n=38) of the children had a low daily intake (<300 µg RE/day). Significantly high consumption of α-carotenes (p=0.005) and β-carotenes (p=0.03) was observed during the rainy season. Conclusion: Preformed VA and pro-VA were insufficiently consumed, with a preference for those of plant origin. They were consumed more in the rainy season than in the dry season

Dietary intake of preformed vitamin A and provitamin A carotenoids are not associated with serum retinol and carotenoid concentrations among children 36–59 months of age in rural Burkina Faso : a cross-sectional study

PurposeThis study aimed to assess the association between dietary intake of preformed vitamin A (VA) and pro-VA carotenoids and serum retinol and carotenoid concentrations among 36-59-month-old children in a rural area in Burkina Faso.MethodsTwo community-based cross-sectional studies were conducted in a rural area of Burkina Faso and included 115 children aged 36-59 months. Dietary intake of preformed VA and pro-VA was assessed directly by 24-h dietary recall. Serum retinol and carotenoid (& alpha;- and & beta;-carotene, and & beta;-cryptoxanthin) concentrations were measured. The associations between serum retinol and carotenoid concentrations and their respective dietary intake were assessed by multiple linear regression.ResultsGeometric mean [95% CI] adjusted serum retinol concentration in children was 0.86 [0.81; 0.92] & mu;mol/L. The prevalence of low adjusted serum retinol concentration (< 0.7 & mu;mol/L) was 26.8%. Geometric mean [95% CI] serum carotenoid concentrations were: & alpha;-carotene (0.03 [0.02; 0.03] & mu;mol/L), & beta;-carotene (0.14 [0.12; 0.16] & mu;mol/L), and & beta;-cryptoxanthin (0.17 [0.15; 0.21] & mu;mol/L). Dietary intakes of & alpha;- and & beta;-carotene and adjusted serum retinol and & alpha;-carotene concentrations were significantly higher during the rainy season. In multiple linear regressions, no associations were found between dietary intakes of preformed VA and pro-VA carotenoids and serum retinol and carotenoid concentrations in children aged 36-59 months in Burkina Faso. There was no effect of season on the associations between preformed VA and pro-VA carotenoids intake and serum retinol and carotenoid concentrations.ConclusionsThis study shows that dietary intakes of preformed VA and pro-VA carotenoids based on 24-h dietary recall method cannot be used as proxy of serum retinol and carotenoid concentrations in this population

Rétinol sérique versus techniques d’isotopes stables, dans l’évaluation du statut en vitamine A des enfants de 36 à 59 mois dans un milieu rural a endémie palustre du Burkina Faso

Introduction: Despite the existence of several diagnostic methods, the assessment of vitamin A (VA) status in children remains a challenge in localities where VA deficiency and infection coexist. The study aimed to assess the VA status in children 36-59 months of age living in rural malaria-endemic areas in Burkina Faso using stable isotope techniques compared to serum retinol, a technique commonly used in the diagnosis of VA deficiency. Material and methods: Two cross-sectional surveys were conducted during the dry and rainy seasons in the health area of the Sourkoudougou. They included 115 children of both sexes aged 36 to 59 months. VA status was assessed using serum retinol, liver reserves (LR) and total VA reserves (TLR). Results: The mean serum retinol concentration (standard deviation) was 0.83 (± 0.25) µmol/L and 27.19% of children had a serum retinol concentration 1.0 mol/L/g liver). Conclusion: This study shows, in this malaria-endemic locality, a difference in the prevalence of VA deficiency according to the test use