Assessment of a Combined Strategy of SMC + Nutrients Supplementation to Tackle Malaria and Malnutrition (SMC-NUT)

Study Description

Malaria and malnutrition represent major public health concerns worldwide especially in Sub-Sahara Africa. Despite implementation of Seasonal Malaria Chemoprophylaxis (SMC), an intervention aimed at reducing malaria prevalence among children aged 6- 59 months, the burden of malaria and associated mortality among children below age 5 years remains high in Burkina Faso. This raises the question of what hiding factors may negatively affect the responsiveness of SMC intervention. Malnutrition, in particular micronutrient deficiency, is one of these potential factors that can negatively affect the effectiveness of SMC. Treating micronutrient deficiencies is known to reduce the prevalence of malaria mortality in highly prevalent malaria zone such as rural settings. Therefore, the hypothesis that a combined strategy of SMC together with a daily oral nutrients supplement (Vitamin A-Zinc OR fortified peanut butter-like paste-Plumpy'Nut®) will enhance the immune response and decrease the incidence of malaria in this population and at the same time reduce the burden of malnutrition among children under SMC coverage was postulated.

Prior to the SMC implementation by the National Malaria Control Program (NMCP), children under SMC coverage will be identified through the Health and Demographic Surveillance System (HDSS). Children will be randomly assigned to one of the three groups (a) SMC alone, (b) SMC + Vitamin A-Zinc, or (c) SMC+Plumpy'Nut®. After each SMC monthly distribution, children will be visited at home to confirm drug administration and follow-up for one year. Anthropometric indicators will be recorded at each visit. Blood samples will be collected for thick and thin film and hemoglobin measurement and spotted onto filter paper for further PCR analyses.

This project will serve as a pilot of an integrated strategy in order to mutualize resources for best impact. By relying on existing strategies, the policy implementation of this joint intervention will be scalable at country and regional levels.

Study Arms

  • Active Comparator: SMC alone Children under SMC Coverage, receiving AQSP alone with no supplementation
  • Experimental: SMC+ Plumpy'Nut® Children under SMC Coverage, receiving AQSP plus Plumpy'Nut® supplementation
  • Experimental: SMC+ Vitamin A-Zinc Children under SMC Coverage, receiving AQSP plus Vitamin A-Zinc supplementation

Primary Outcomes

  • The relative risk of the incidence of clinical malaria [ Time Frame: One year ]
  • The mid-upper arm circumference gain [ Time Frame: One year ]
  • Weight gain [ Time Frame: One year ]
  • Prevalence of anemia [ Time Frame: one year ]

Study Interventions

  • Standard Lipid-Based Nutrient Supplements (LNS)
  • Micronutrient powders (MNP)

Research Gaps

  • Effectiveness

    How well do different food compositions and interventions prevent or treat undernutrition, when implemented "on the ground"?

Study Population