Assessment of the performance of malaria rapid diagnostic test in acutely malnourished children under five years of age in Nanoro - Burkina Faso

The interaction of malaria with malnutrition is complex. In areas where malnutrition among children is prevalent, management of malaria is not standardized. In Burkina Faso, malaria treatment is prescribed after positive malaria rapid diagnostic test (RDT) or thick blood smears confirmation regardless of the nutritional status of the child. The study aims to assess the performance of malaria RDT in acute malnourished children under five years of age. A descriptive cross-sectional study was carried out from June 1st to August 31th 2014 in the health district of Nanoro in Burkina Faso. The study involved the children less than 5 years of age who were admitted for acute malnutrition and tested for malaria using RDT. The diagnostic values were then assessed for their agreement with the gold standard of the World Health Organization (thick blood smears) using Cohen-Kappa coefficient. In total, RDT and thick blood smear results were obtained from 131 children (aged 1-59 months). RDT was positive in 87 tested children (66.4%), while the thick smear indicated that only 47 were infected by malaria (35.9%) and Cohen kappa coefficient was 0.44. The sensitivity, specificity, positive predictive value and negative predictive value of RDT for malaria compared to microscopy were respectively 100% (95% CI: 92.5 - 100), 52.4% (95% CI: 51.1 - 52.9), 54% (95% CI: 43 - 64.8), 100% (95% CI: 92.5 - 100). Their timeliness was 8 min (± 3.47 min). Using malaria RDT in acutely malnourished children results in high number of false positive

Concentrations sériques en rétinol et en caroténoïdes comme biomarqueurs de la consommation d'aliments riches en vitamine A et en provitamine A chez les enfants de 36 à 59 mois dans un milieu rural a endémie palustre du Burkina Faso

Contexte : Malgré deux décennies de promotion de consommation des aliments riches en vitamine A (VA) à l’échelle nationale, la carence en cette vitamine, demeure un problème nutritionnel majeur chez les enfants de moins de cinq ans au Burkina Faso. L’objectif de cette étude était d'évaluer l'association entre la consommation d’aliments riches en VA et en pro-VA et les concentrations sériques en rétinol et en caroténoïdes chez des enfants de 36 à 59 mois vivant en milieu rural à endémie palustre au Burkina Faso. Matériel et méthodes : Deux enquêtes transversales étaient conduites en saison sèche et pluvieuse dans l’aire sanitaire du Centre de Santé et de Promotion Sociale de Sourkoudougou et portaient sur 115 enfants âgés de 36 à 59 mois. Dans cette étude, la consommation d'aliments riches en VA, était directement évaluée par le rappel de 24 heures et indirectement par les concentrations sériques de caroténoïdes et de rétinol. L'association a été évaluée par une régression linéaire multiple. Résultats : Le taux moyen de rétinol sérique était de 0,83 ± 0,25 µmol/l et 27,19 % des enfants avaient un taux de rétinol sérique < 0,7 µmol/L. La moyenne de la concentration sérique totale des caroténoïdes était de 1,167 ± 0,54 µmol/L. 73% des enfants consommaient des aliments riches en VA de source végétale et 17% consommaient des aliments riches en VA de source animale. La régression linéaire multiple n'a pas trouvé d'association entre l'apport alimentaire en VA et les concentrations sériques de rétinol et de caroténoïdes (p=0.7882). Conclusion : Dans l’étude, il n'y a pas eu d'association entre l'apport alimentaire riche en VA (pro VA) et les concentrations sériques de rétinol et de caroténoïdes en milieu a endémie palustre. Néanmoins, les consommations des fruits/légumes et les sources animales étaient sub-optimales

Vitamin A deficiency among rural primary school children : a still neglected group for vitamin A supplementation strategies

Background: Vitamin A deficiency (VAD) is still a public health problem across the globe and also in Burkina Faso, especially for under-five-years-old children. Since less information is available about the prevalence of VAD among the primary school children, this study aimed to study this area. Methods: A randomised double-blind placebo-controlled trial was conducted to assess the effect of high dose of vitamin A (VA) and daily zinc versus high dose of VA and daily zinc placebo (6 days per week) during four months among the primary school children. Of the total number of 200 school children, 100 were allocated to two random groups. Participants’ gender, age, weight, and height were measured, a blood smear was performed for malaria diagnosis, stool samples were collected for intestine parasites’ assessment, and blood samples were collected for haemoglobin and serum retinol measurement. Results: Baseline data of 183 school children were analysed and the findings showed that 20.6% of the school children were underweight (23.2% in girls vs. 16.5% in boys; P = 0.043). Anemia affected 36.2%, 39% had Plasmodium Falciparum, and 37.6% had intestine parasites. Furthermore, VAD prevalence was 46.1% (51.0% in boys vs. 41.2% in girls; P = 0,072). Conclusion: Among primary school children in the Western part of Burkina Faso, VAD is not only higher than other regions of the country, but also twice the critical level and defined as a severe public health problem by WHO. This result calls for action among the primary school children and recalls the importance of taking strategies against VAD among under-five-year-old children

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

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

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

Chronic exposure to mycotoxins is not associated with vitamin A status in children of 36 – 59 months old living in a malaria-endemic rural area in Burkina Faso

Background: Exposures to environmental contaminants in the food supply, especially mycotoxins may be linked to micronutrient deficiencies through their potential role in inducing inflammation and altering absorption. Children in Burkina Faso are chronically exposed to mycotoxins in the food chain. We aim at investigating the relationship between serum concentrations in Aflatoxins AFB1 and AFB2 and vitamin A (VA) status in Burkinabe children aged 36-59 mo. Methods: Two cohort surveys were conducted in western Burkina Faso on a total sample of 115 children aged 36-59 mo during the dry and the rainy seasons. Blood samples were collected to assess VA status (serum retinol concentrations using High-Performance Liquid Chromatography; total liver reserve [TLR] and total body stores [TBS] using the 13C-retinol isotope dilution method), inflammation indicators (alpha 1-acid glycoprotein, AGP and C-reactive protein, CRP) and AFB1 and AFB2 by Liquid Chromatography Mass Spectrometry. Multiple linear regression was used to assess the association of VA status with potential predictors such as aflatoxins, and demographic, anthropometric, dietary variables in STATA. Results: Mean serum retinol was 0.83±0.25 µmol/l. Median TLR and TBS was 0.75 mol/g liver (IQ25-IQ75: 0.52 - 1.08) and 430 mol (289.9 - 620.6), respectively. 28% had TLR >1.0 mol/g liver and none had VA deficiency. TLR was significantly associated with baseline weight-for-height z-score and serum β-carotene (p<0.05), while TBS was significantly associated with AGP. Neither AFB1 nor AFB2 was associated with VA status. Conclusion: No association was found between exposure to mycotoxins and VA status in children with no VA deficiency

Association between biomarkers of inflammation and total liver vitamin A reserves estimated by 13C-retinol isotope dilution among preschool children in 5 African countries

Background: Vitamin A (VA) assessment is important for targeting public health programs. Retinol isotope dilution (RID) is a sensitive method to estimate total body VA stores (TBSs) and total liver reserves (TLRs), but the impact of subclinical inflammation on RID is unclear. Objective: We determined the association between TBSs and TLRs, estimated by RID, and inflammation among preschool children without clinical infection in Burkina Faso, Cameroon, Ethiopia, South Africa, and Tanzania. Methods: Five studies (n = 532; 47.9 +/- 8.3 mo; 49.0% male) included 13C-RID and measurement of inflammation markers, CRP, and alpha 1-acid glycoprotein (AGP). Spearman correlations were used to evaluate TBSs and TLRs with inflammation biomarkers. Wilcoxon and Kruskal-Wallis tests were used to compare TBSs and TLRs by inflammation categories [normal vs. elevated CRP (>5 mg/L) or AGP (>1 g/L)] and inflammation stage [reference, incubation (elevated CRP), early convalescence (elevated CRP and AGP), and late convalescence (elevated AGP)]. Results: Complete data were available for 439 children. Median (Q1, Q3) TLRs ranged from 0.12 (0.07, 0.18) mu mol/g in Ethiopia to 1.10 (0.88, 1.38) mu mol/g in South Africa. Elevated CRP ranged from 4% in Burkina Faso to 42% in Cameroon, and elevated AGP from 20% in Tanzania to 58% in Cameroon. Pooled analysis (excluding Cameroon) showed a negative correlation between TBSs and AGP (rho = -0.131, P = 0.01). Children with elevated AGP had higher probability of having lower TBSs (probability = 0.61, P = 0.002). TBSs differed among infection stages (P = 0.020). Correlations between TLRs and CRP or AGP were not significant. Conclusions: No indication of systematic bias in RID-estimated TLRs was found due to subclinical inflammation among preschool children. The inverse relationship between TBSs and AGP may reflect decreased stores after infection or an effect of inflammation on isotope par-titioning. Further research should investigate potential confounding variables to improve TBS-estimate validity