Malaria and other risk factors for malnutrition, and the impact of intermittent preventive therapy for malaria on nutritional status of school-age children in Tanzania. A cross-sectional survey and a randomized controlled open-label trial

Abstract

AbstractBackgroundWHO and the Lancet reported that malaria and malnutrition form a double health burden in low and middle-income countries. Despite the massive implementation of several malaria interventions, there is limited information on the impact of intermittent preventive therapy (IPTsc) for malaria on the nutritional status of school-age children.ObjectiveTo determine malnutrition risk factors and evaluate the impact of IPTsc for malaria on the nutritional status of school-age children in North-East Tanzania.MethodsWe analyzed secondary data from a cross-sectional baseline survey and a randomized controlled open-label trial. Study participants were randomized to three treatment groups and thereafter followed for 20 months. Data were analyzed using logistic regression and a linear mixed model.FindingsAt baseline, the prevalence of malaria was 27%. 23% of ≤10 years children were underweight, 21% were stunted, and 28% were either thin or severely thin. The odds of stunting were 78% higher (AOR=1.78, 95%CI=[1.36, 2.33], P<0.001) among children who had malaria compared to those who did not. Children from low socioeconomic status (SES) had higher odds of being underweight (AOR=1.50, 95%CI=[1.13,2.01], P=0.006) compared to their high SES counterparts. During the intervention, change in mean weight, height, and BMI over time as estimated from age-treatment interaction was not significantly different in the DP and ASAQ treatment groups compared to the control group. A unit change in age increased weight, height, and BMI by 2.2 units (p-value<0.001), 3.3 units (p-value<0.001), and 0.5 units (p-value<0.001). The height and weight in female children were higher compared to that of male children by 1 unit (p-value<0.001) and 0.8 unit (p-value<0.001), respectively.ConclusionThe burden of malaria and malnutrition in this study’s setting is remarkable. Instead of focusing only on malaria, public health agencies should reinforce nutritional programs by collaborating with local communities to ensure food availability in schools and provide sustainable nutritional education to the local community members.