EFFECTS OF MATERNAL VITAMIN SUPPLEMENTS ON MALARIA IN CHILDREN BORN TO HIV-INFECTED WOMEN

EDUARDO VILLAMOR Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Tropical Medicine, University of Munich, Germany; Department of Pediatrics and Child Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Search for other papers by EDUARDO VILLAMOR in
Current site
Google Scholar
PubMed
Close
,
GERNARD MSAMANGA Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Tropical Medicine, University of Munich, Germany; Department of Pediatrics and Child Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Search for other papers by GERNARD MSAMANGA in
Current site
Google Scholar
PubMed
Close
,
ELMAR SAATHOFF Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Tropical Medicine, University of Munich, Germany; Department of Pediatrics and Child Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Search for other papers by ELMAR SAATHOFF in
Current site
Google Scholar
PubMed
Close
,
MAULIDI FATAKI Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Tropical Medicine, University of Munich, Germany; Department of Pediatrics and Child Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Search for other papers by MAULIDI FATAKI in
Current site
Google Scholar
PubMed
Close
,
KARIM MANJI Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Tropical Medicine, University of Munich, Germany; Department of Pediatrics and Child Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Search for other papers by KARIM MANJI in
Current site
Google Scholar
PubMed
Close
, and
WAFAIE W. FAWZI Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Tropical Medicine, University of Munich, Germany; Department of Pediatrics and Child Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Search for other papers by WAFAIE W. FAWZI in
Current site
Google Scholar
PubMed
Close
Restricted access

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 (N = 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%; P = 0.02), whereas VA/BC alone resulted in a nonsignificant 63% reduction (95% CI = −4% to 87%; P = 0.06). Multivitamins including VA/BC significantly reduced the incidence of high parasitemia by 43% (95% CI = 2–67%; P = 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.

Author Notes

Reprint requests: Eduardo Villamor, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, Telephone: +1 (617) 432-1238, Fax: +1 (617) 432-2435, E-mail: evillamo@hsph.harvard.edu.
  • 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.

    • PubMed
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    World Health Organization, 1991. Basic Laboratory Methods in Medical Parasitology. Geneva: World Health Organization.

    • PubMed
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 305 247 83
Full Text Views 385 11 6
PDF Downloads 87 12 4
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save