1921
Volume 76, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Vitamin deficiencies are frequent in children suffering from malaria. The effects of maternal multivitamin supplementation on the risk of malaria in children are unknown. We examined the impact of providing multivitamins or vitamin A/β-carotene supplements during pregnancy and lactation to HIV-infected women on their children’s risk of malaria up to 2 years of age, in a randomized, placebo-controlled trial. Tanzanian women ( = 829) received one of four daily oral regimens during pregnancy and after delivery: 1) vitamins B, C, and E (multivitamins); 2) vitamin A and β-carotene (VA/BC); 3) multivitamins including VA/BC; or 4) placebo. After 6 months of age, all children received 6-monthly oral vitamin A supplements irrespective of treatment arm. The incidence of childhood malaria was assessed through three-monthly blood smears and at monthly and interim clinic visits from birth to 24 months of age. Compared with placebo, multivitamins excluding VA/BC reduced the incidence of clinical malaria by 71% (95% CI = 11–91%; = 0.02), whereas VA/BC alone resulted in a nonsignificant 63% reduction (95% CI = −4% to 87%; = 0.06). Multivitamins including VA/BC significantly reduced the incidence of high parasitemia by 43% (95% CI = 2–67%; = 0.04). The effects did not vary according to the children’s HIV status. Supplementation of pregnant and lactating HIV-infected women with vitamins B, C, and E might be a useful, inexpensive intervention to decrease the burden of malaria in children born to HIV-infected women in sub-Saharan Africa.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2007.76.1066
2007-06-01
2017-11-18
Loading full text...

Full text loading...

/deliver/fulltext/14761645/76/6/0761066.html?itemId=/content/journals/10.4269/ajtmh.2007.76.1066&mimeType=html&fmt=ahah

References

  1. Snow RW, Guerra CA, Noor AM, Myint HY, Hay SI, 2005. The global distribution of clinical episodes of Plasmodium falciparum malaria. Nature 434 : 214–217.
  2. World Health Organization, 2003. The World Health Report 2003: Shaping the Future. Geneva: World Health Organization.
  3. Snow RW, Korenromp EL, Gouws E, 2004. Pediatric mortality in Africa: Plasmodium falciparum malaria as a cause or risk? Am J Trop Med Hyg 71 : 16–24.
  4. Holding PA, Kitsao-Wekulo PK, 2004. Describing the burden of malaria on child development: what should we be measuring and how should we be measuring it? Am J Trop Med Hyg 71 : 71–79.
  5. Breman JG, Alilio MS, Mills A, 2004. Conquering the intolerable burden of malaria: what’s new, what’s needed: a summary. Am J Trop Med Hyg 71 : 1–15.
  6. Shankar AH, 2000. Nutritional modulation of malaria morbidity and mortality. J Infect Dis 182 (Suppl 1): S37–S53.
  7. Shankar AH, Genton B, Semba RD, Baisor M, Paino J, Tamja S, Adiguma T, Wu L, Rare L, Tielsch JM, Alpers MP, West KP, Jr, 1999. Effect of vitamin A supplementation on morbidity due to Plasmodium falciparum in young children in Papua New Guinea: a randomised trial. Lancet 354 : 203–209.
  8. Shankar AH, Genton B, Baisor M, Paino J, Tamja S, Adiguma T, Wu L, Rare L, Bannon D, Tielsch JM, West KP Jr, Alpers MP, 2000. The influence of zinc supplementation on morbidity due to Plasmodium falciparum: a randomized trial in preschool children in Papua New Guinea. Am J Trop Med Hyg 62 : 663–669.
  9. Sazawal S, Black RE, Ramsan M, Chwaya HM, Stoltzfus RJ, Dutta A, Dhingra U, Kabole I, Deb S, Othman MK, Kabole FM, 2006. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. Lancet 367 : 133–143.
  10. Krishna S, Taylor AM, Supanaranond W, Pukrittayakamee S, ter Kuile F, Tawfiq KM, Holloway PA, White NJ, 1999. Thiamine deficiency and malaria in adults from southeast Asia. Lancet 353 : 546–549.
  11. Murray MJ, Murray AB, Murray NJ, Murray MB, 1978. Diet and cerebral malaria: the effect of famine and refeeding. Am J Clin Nutr 31 : 57–61.
  12. Metzger A, Mukasa G, Shankar AH, Ndeezi G, Melikian G, Semba RD, 2001. Antioxidant status and acute malaria in children in Kampala, Uganda. Am J Trop Med Hyg 65 : 115–119.
  13. Fawzi WW, Msamanga GI, Spiegelman D, Wei R, Kapiga S, Villamor E, Mwakagile D, Mugusi F, Hertzmark E, Essex M, Hunter DJ, 2004. A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med 351 : 23–32.
  14. Villamor E, Saathoff E, Bosch RJ, Hertzmark E, Baylin A, Manji K, Msamanga G, Hunter DJ, Fawzi WW, 2005. Vitamin supplementation of HIV-infected women improves postnatal child growth. Am J Clin Nutr 81 : 880–888.
  15. World Health Organization, 1991. Basic Laboratory Methods in Medical Parasitology. Geneva: World Health Organization.
  16. Muller O, Becher H, van Zweeden AB, Ye Y, Diallo DA, Konate AT, Gbangou A, Kouyate B, Garenne M, 2001. Effect of zinc supplementation on malaria and other causes of morbidity in west African children: randomised double blind placebo controlled trial. BMJ 322 : 1567.
  17. D’Alessandro U, Olaleye BO, McGuire W, Langerock P, Bennett S, Aikins MK, Thomson MC, Cham MK, Cham BA, Greenwood BM, 1995. Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bed-net programme. Lancet 345 : 479–483.
  18. Fawzi WW, Msamanga GI, Spiegelman D, Urassa EJ, McGrath N, Mwakagile D, Antelman G, Mbise R, Herrera G, Kapiga S, Willett W, Hunter DJ, 1998. Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet 351 : 1477–1482.
  19. Fawzi WW, Msamanga GI, Hunter D, Renjifo B, Antelman G, Bang H, Manji K, Kapiga S, Mwakagile D, Essex M, Spiegelman D, 2002. Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality. AIDS 16 : 1935–1944.
  20. Bates CJ, Powers HJ, Lamb WH, Gelman W, Webb E, 1987. Effect of supplementary vitamins and iron on malaria indices in rural Gambian children. Trans R Soc Trop Med Hyg 81 : 286–291.
  21. Ekvall H, Premji Z, Bjorkman A, 2000. Micronutrient and iron supplementation and effective antimalarial treatment synergistically improve childhood anaemia. Trop Med Int Health 5 : 696–705.
  22. Baylin A, Villamor E, Rifai N, Msamanga G, Fawzi WW, 2005. Effect of vitamin supplementation to HIV-infected pregnant women on the micronutrient status of their infants. Eur J Clin Nutr 59 : 960–968.
  23. Fawzi WW, Msamanga GI, Wei R, Spiegelman D, Antelman G, Villamor E, Manji K, Hunter D, 2003. Effect of providing vitamin supplements to human immunodeficiency virus-infected, lactating mothers on the child’s morbidity and CD4+ cell counts. Clin Infect Dis 36 : 1053–1062.
  24. Stephens R, Langhorne J, 2006. Priming of CD4+ T cells and development of CD4+ T cell memory; lessons for malaria. Parasite Immunol 28 : 25–30.
  25. Akompong T, Ghori N, Haldar K, 2000. In vitro activity of riboflavin against the human malaria parasite Plasmodium falciparum. Antimicrob Agents Chemother 44 : 88–96.
  26. Marva E, Golenser J, Cohen A, Kitrossky N, Har-el R, Chevion M, 1992. The effects of ascorbate-induced free radicals on Plasmodium falciparum. Trop Med Parasitol 43 : 17–23.
  27. Serghides L, Kain KC, 2002. Mechanism of protection induced by vitamin A in falciparum malaria. Lancet 359 : 1404–1406.
  28. Willett WC, Stampfer MJ, Underwood BA, Taylor JO, Hennekens CH, 1983. Vitamins A, E, and carotene: effects of supplementation on their plasma levels. Am J Clin Nutr 38 : 559–566.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2007.76.1066
Loading
/content/journals/10.4269/ajtmh.2007.76.1066
Loading

Data & Media loading...

  • Received : 11 Dec 2006
  • Accepted : 13 Mar 2007

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error