Practices of herbal management of malaria among trading mothers in Shai Osudoku District, Accra.

BACKGROUND: Malaria is one of the leading causes of morbidity in the world. It is a significant health concern in most developing countries, including Ghana. Even though there are several orthodox medications used for decades in treating malaria effectively, a substantial number of individuals in developing countries are resorting to the use of herbs in the treatment of malaria. The study aim at exploring the practices of herbal management of malaria among trading mothers in Shai Osudoku District, Accra. METHODS: A qualitative approach with an exploratory, descriptive design was adopted in analyzing the research problem. Purposive sampling technique was used to select twenty (20) participants to partake in a face-face interview, guided by a semi-structured interview guide. The data were transcribed verbatim and analysed by adopting content analysis. RESULTS: Two significant themes and seven subthemes were generated following the analysis of this study. The main themes were; preferences for herbal malaria treatment and the practices and effectiveness of herbal medicine used for malaria treatment. It was worth noting that the women's cultural beliefs did not influence their preference for herbal malaria treatment. The main challenge associated with the herbal malaria treatment was inappropriate dosage specification. CONCLUSION: This study discovered that several factors influenced participants' preferences for malaria treatment. Participants further listed some traditional ways of treating malaria which implies that there is herbal malaria practice. However, literature in this area is inadequate, and most herbs lack specifications for use. It is therefore recommended that future research focus on scientific herbal malaria treatment. Also, regulating bodies should ensure that quality herbal drugs are sold for consumption.

Predictors of anaemia among adolescent schoolchildren of Ghana.

Anaemia is a public health problem in Ghana. We sought to identify factors associated with haemoglobin concentration (Hb) and anaemia among school-attending adolescents. We analysed data from 2948 adolescent girls and 609 boys (10-19 years) selected from 115 schools from regions of Ghana as a secondary analysis of baseline surveys conducted at two time-points. We measured Hb, malaria from capillary blood, anthropometry and used a modified food frequency questionnaire to assess diet. Multivariable linear and Poisson regression models were used to identify predictors of Hb and anaemia. The prevalence of anaemia, malaria and geophagy were 24, 25, and 24 %, respectively, among girls and 13, 27 and 6 %, respectively, among boys. Girls engaging in geophagy had a 53 % higher adjusted prevalence of anaemia and 0⋅39 g/dl lower Hb. There were similar results among those who tested positive for malaria (+52 % anaemia; -0⋅42 g/dl Hb). Among girls, lower anaemia prevalence and higher Hb were associated with consumption of foods rich in haeme iron (-22 %; +0⋅18 g/dl), consumption of iron-fortified cereal/beverages consumed with citrus (-50 %; +0⋅37 g/dl) and being overweight (-22 %; +0⋅22 g/dl). Age was positively associated with anaemia among girls, but negatively associated among boys. Boys who tested positive for malaria had 0⋅31 g/dl lower Hb. Boys who were overweight or had obesity and consumed flour products were also more likely to be anaemic (119 and 56 %, respectively). Factors associated with Hb and anaemia may inform anaemia reduction interventions among school-going adolescents and suggest the need to tailor them uniquely for boys and girls.

High Iron Stores in the Low Malaria Season Increase Malaria Risk in the High Transmission Season in a Prospective Cohort of Rural Zambian Children.

Background: Higher iron stores, defined by serum ferritin (SF) concentration, may increase malaria risk.Objective: We evaluated the association between SF assessed during low malaria season and the risk of malaria during high malaria season, controlling for inflammation.Methods: Data for this prospective study were collected from children aged 4-8 y (n = 745) participating in a biofortified maize efficacy trial in rural Zambia. All malaria cases were treated at baseline (September 2012). We used baseline SF and malaria status indicated by positive microscopy at endline (March 2013) to define exposure and outcome, respectively. Iron status was defined as deficient (corrected or uncorrected SF <12 or <15 µg/L, depending on age <5 or ≥5 y, respectively), moderate (<75 µg/L, excluding deficient), or high (≥75 µg/L). We used a modified Poisson regression to model the risk of malaria in the high transmission seasons (endline) as a function of iron status assessed in the low malaria seasons (baseline).Results: We observed an age-dependent, positive dose-response association between ferritin in the low malaria season and malaria incidence during the high malaria season in younger children. In children aged <6 y (but not older children), we observed a relative increase in malaria risk in the moderate iron status [incidence rate ratio (IRR) with SF: 1.56; 95% CI: 0.64, 3.86; IRR with inflammation-corrected SF: 1.92; 95% CI: 0.75, 4.93] and high iron status (IRR with SF: 2.66; 95% CI: 1.10, 6.43; or IRR with corrected SF: 2.93; 95% CI: 1.17, 7.33) categories compared with the deficient iron status category. The relative increase in malaria risk for children with high iron status was statistically significant only among those with a concurrently normal serum soluble transferrin receptor concentration (<8.3 mg/L; IRR: 1.97; 95% CI: 1.20, 7.37).Conclusions: Iron adequacy in 4- to 8-y-old children in rural Zambia was associated with increased malaria risk. Our findings underscore the need to integrate iron interventions with malaria control programs. This trial was registered at clinicaltrials.gov as NCT01695148.

Safety and benefits of antenatal oral iron supplementation in low-income countries: a review.

The World Health Organization recommends universal iron supplementation of 30-60 mg/day in pregnancy but coverage is low in most countries. Its efficacy is uncertain, however, and there has been a vigorous debate in the last decade about its safety, particularly in areas with a high burden of malaria and other infectious diseases. We reviewed the evidence on the safety and efficacy of antenatal iron supplementation in low-income countries. We found no evidence that daily supplementation at a dose of 60 mg leads to increased maternal Plasmodium infection risk. On the other hand, recent meta-analyses found that antenatal iron supplementation provides benefits for maternal health (severe anaemia at postpartum, blood transfusion). For neonates, there was a reduced prematurity risk, and only a small or no effect on birth weight. A recent trial showed, however, that benefits of antenatal iron supplementation on maternal and neonatal health vary by maternal iron status, with substantial benefits in iron-deficient women. The benefits of universal iron supplementation are likely to vary with the prevalence of iron deficiency. As a consequence, the balance between benefits and risks is probably more favourable in low-income countries than in high-income countries despite the higher exposure to infectious pathogens.

Fevered Decisions: Race, Ethics, and Clinical Vulnerability in the Malarial Treatment of Neurosyphilis, 1922-1953.

Physicians deliberately inoculated marginalized patients with malaria, using them as reservoirs to facilitate malarial fever therapy for syphilitic patients. The history presents ethical questions in an evolving historical context.

[Cost-effectiveness analysis (CEA) regarding vitamin A in children aged less than 5 years-old in Colombia]. / Análisis de costo efectividad de la vitamina A en niños menores de 5 años en Colombia.

OBJECTIVE: Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). MATERIALS AND METHODS: A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. RESULTS: Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. CONCLUSION: Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).

The effect of three-monthly albendazole treatment on malarial parasitemia and allergy: a household-based cluster-randomized, double-blind, placebo-controlled trial.

BACKGROUND: Helminth infections are proposed to have immunomodulatory activities affecting health outcomes either detrimentally or beneficially. We evaluated the effects of albendazole treatment, every three months for 21 months, on STH, malarial parasitemia and allergy. METHODS AND FINDINGS: A household-based cluster-randomized, double-blind, placebo-controlled trial was conducted in an area in Indonesia endemic for STH. Using computer-aided block randomization, 481 households (2022 subjects) and 473 households (1982 subjects) were assigned to receive placebo and albendazole, respectively, every three months. The treatment code was concealed from trial investigators and participants. Malarial parasitemia and malaria-like symptoms were assessed in participants older than four years of age while skin prick test (SPT) to allergens as well as reported symptoms of allergy in children aged 5-15 years. The general impact of treatment on STH prevalence and body mass index (BMI) was evaluated. Primary outcomes were prevalence of malarial parasitemia and SPT to any allergen. Analysis was by intention to treat. At 9 and 21 months post-treatment 80.8% and 80.1% of the study subjects were retained, respectively. The intensive treatment regiment resulted in a reduction in the prevalence of STH by 48% in albendazole and 9% in placebo group. Albendazole treatment led to a transient increase in malarial parasitemia at 6 months post treatment (OR 4.16(1.35-12.80)) and no statistically significant increase in SPT reactivity (OR 1.18(0.74-1.86) at 9 months or 1.37 (0.93-2.01) 21 months). No effect of anthelminthic treatment was found on BMI, reported malaria-like- and allergy symptoms. No adverse effects were reported. CONCLUSIONS: The study indicates that intensive community treatment of 3 monthly albendazole administration for 21 months over two years leads to a reduction in STH. This degree of reduction appears safe without any increased risk of malaria or allergies. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN83830814.

Análisis de costo efectividad de la vitamina A en niños menores de 5 años en Colombia / Cost-effectiveness analysis (CEA) regarding vitamin A in children aged less than 5 years-old in Colombia

Objetivo evaluar la costo-efectividad relativa del uso de vitamina a en los niños menores de 5 años en la disminución de eventos de diarrea, malaria y la mortalidad, bajo la perspectiva del sistema de salud colombiano (SGSSS). Materiales y Métodos se construyó unárbol de decisión con muertes evitadas como desenlace. Las probabilidades se extrajeron de la literatura y los costos de fuentes oficiales. El umbral de costo-efectividad fue tres veces el producto interno bruto (PIB) per cápita colombiano de 2012. Se realizaron análisis de sensibilidad determinísticos, probabilísticos y curva de aceptabilidad. Resultados En una cohorte de cien mil niños, la administración de vitamina a, frente no hacerlo, representaría un ahorro en costos de atención médica de $ 340.306.917, debido a que reduce el número de eventos de diarrea (4.268) y de malaria (76), así como los casos en los que se requiere hospitalización. En todos los análisis de sensibilidad se obtuvo un ahorro para el sistema. Conclusión Dentro del sistema de salud colombiano, la suplementación con vitamina a para niños menores de 5 años, comparado con no hacerlo, es la estrategia menos costosa y más efectiva (dominante).

Objective Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). Materials and Methods A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. Results Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. Conclusion Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).

[Knowledge, attitude, and practice of traditional healers on the topic of malaria in the city of Abidjan]. / Connaissances, attitudes et pratiques des tradipraticiens de la sante de la ville d'Abidjan sur le paludisme.

INTRODUCTION: An estimated 300 to 500 million clinical cases of malaria occur each year worldwide, 90% in Africa, mostly among young children. In Cote d'Ivoire, malaria is 46.03% of disease states and 62.44% of hospital admissions. In children under 5 years, it is 42.67% of the reasons for consultation and 59.68% of hospital admissions. In pregnant women, it represents 22.91% of disease states and 36.07% of hospital admissions. In Africa, traditional medicine is the first resort for the vast majority of people, because of its accessibility both geographically, economically and culturally. However, some modern practitioners show an attitude of distrust of traditional medicine and its players, calling them irrational. This work had set out to assess knowledge, attitudes and practices of traditional healers in the uncomplicated and complicated in the context of collaboration between traditional and modern medicine for the optimal management of critical cases. MATERIALS AND METHOD: The study focused on traditional healers practicing in the city of Abidjan. The study was conducted using individual interviews over a period of 30 days. The interviews were conducted in local languages, with the assistance, if necessary, translators. For data collection, we used a questionnaire containing four items: the socio-demographic characteristics of traditional healers, their knowledge on malaria, diagnostic practices and traditional therapies. RESULTS: Of the 60 healers and included in the study, only six were women (10%), a sex-ratio of a woman to 9 men. 66.7% of respondents traditional healers are herbalists and 25% of naturopaths.Only 8.3% were spiritualists. The etiology of malaria most commonly cited by the traditional healers were mosquito bites (16.7%), food (1.7%), solar (1.7%) and fatigue (1.7%) . 25% of traditional healers are associated with mosquitoes, sun and fatigue. Symptomatology most cited were fever (100%), dark urine (86%), the yellow or pale conjunctiva (80%), vomiting (71.7%), nausea (58.3%) and abdominal pain (48.3%). Traditional healers recognized three types of malaria: the white shape, form yellow / red and the black form. Traditional healers malarious patients surveyed were receiving both first (58.3%) than second-line (41.7%). 78.3% of them practiced an interview and physical examination of theirpatients before the diagnosis. In 13.3% of cases they were divinatory consultation. Medications used to treat malaria were herbal in 95% of cases. The main sign of healing was the lack of fever (58.3%). 90%of traditional healers interviewed referring cases of malaria black (severe malaria). This reference is made to modern health facilities (90.2%). 68.3% of respondents practiced traditional healers of malaria prophylaxis among pregnant women and children under 5 years. CONCLUSION: A description of clinical malaria by traditional practitioners in health is not very far from that of modern medicine. Nevertheless, the logics of our respondents are etiological more complex and linked to their cultural context. The management of cases is made from medicinal plants in treatment failure patients are usually referred to modern health facilities. The involvement of traditional healers in the detection and quick reference risk cases can contribute to reducing child mortality due to severe malaria.

Global and regional child mortality and burden of disease attributable to zinc deficiency.

BACKGROUND/OBJECTIVES: Zinc is an essential micronutrient and deficiency can lead to an increased risk for infectious diseases and growth retardation among children under 5 years of age. We aimed to estimate disease-specific and all-cause mortality attributable to zinc deficiency. SUBJECT/METHODS: We estimated the prevalence of zinc deficiency in Latin America, Africa and Asia, where based on zinc availability in the diet and childhood stunting rates, zinc deficiency is widespread. The relative risks of death among zinc-deficient children for diarrhea, malaria and pneumonia were estimated from randomized controlled trials. We used the comparative risk assessment methods to calculate deaths and burden of disease (measured in disability-adjusted life years, DALYs) from each of these three diseases attributable to zinc deficiency in these regions. RESULTS: Zinc deficiency was responsible for 453,207 deaths (4.4% of childhood deaths), and 1.2% of the burden of disease (3.8% among children between 6 months and 5 years) in these three regions in 2004. Of these deaths, 260,502 were in Africa, 182,546 in Asia and 10,159 in Latin America. Zinc deficiency accounted for 14.4% of diarrhea deaths, 10.4% of malaria deaths and 6.7% of pneumonia deaths among children between 6 months and 5 years of age. CONCLUSIONS: Zinc deficiency contributes to substantial morbidity and mortality, especially from diarrhea. Zinc supplementation provided as an adjunct treatment for diarrhea may be the best way to target children most at risk of deficiency.

Iron metabolism, malaria, and other infections: what is all the fuss about?

This article briefly describes how iron lies at the center of a host-pathogen battle for nutrients and why there are many theoretical reasons to suspect that administration of supplemental iron might predispose to infection. This is supported by in vitro and small animal studies, but meta-analysis of human epidemiological and intervention studies has found little evidence for most disease outcomes. Supplemental iron does appear to increase susceptibility to malaria as measured by a variety of malariometric indices. However, even in malarious areas, iron appears beneficial in iron-deficient subjects. The concerns about iron supplementation programs for children seem to be confined to Sub-Saharan Africa and to areas of high malaria endemicity, where it will be necessary to adopt a cautious approach to supplementation based either on screening out iron-replete children or combining iron administration with effective disease-control strategies.

Contribución al estudio histórico del paludismo / No disponible

Realizamos una revisión histórica del paludismo, enfermedad que supone un auténtico problema de Salud Pública, especialmente en países tropicales en vías de desarrollo, donde se registran 300 a 500 millones de casos y 2 a 3 millones de muertes por año. Se revisa la etiología, con distintas aportaciones realizadas a lo largo de la historia, hasta llegar a 1880, en que Laveran descubrió el parásito producto de la enfermedad. En España, todavía durante el siglo XX, la endemia palúdica fue importante, realizándose una lucha contra la enfermedad que permitió certificar su erradicación en 1964. Asimismo, realizamos una revisión histórica de la quinina, pilar fundamental en el tratamiento de la enfermedad (AU)

We present a historic revision of malaria. This condition is a real problem in public health, especially in undeveloped countries in tropical areas. In these countries between 300 and 500 million cases of malaria and from 2 to 3 million deaths are registered per year. We go over the ethiology of this condition as studied through the years concluding at the moment in which Laveran discovers the parasite producing malaria in 1880. Up to the XX century malaria was and important endemic entity in Spain. A persistent fight against malaria resulted in its eradication in 1964. Along with our study concerning malaria, we also present a historic revision of the appearance and development of quina, the fundamental pillar in the treatment of this pathologic entity (AU)

Traditional healers in Nigeria: perception of cause, treatment and referral practices for severe malaria.

Malaria remains one of the main causes of mortality among young children in sub-Saharan Africa. In Nigeria traditional healers play an important role in health care delivery and the majority of the population depend on them for most of their ailments. The aim of this study was to investigate the perceptions of traditional healers regarding causes, symptoms, treatment of uncomplicated malaria and referral practices for severe malaria with a view to developing appropriate intervention strategies aimed at improving referral practices for severe malaria. A qualitative study was carried out in Ugwogo-Nike, a rural community in south-east Nigeria, which included in-depth interviews with 23 traditional healers. The traditional healers believed that the treatment of severe malaria, especially convulsions, with herbal remedies was very effective. Some traditional healers were familiar with the signs and symptoms of malaria, but malaria was perceived as an environmentally related disease caused by heat from the scorching sun. The majority of traditional healers believed that convulsions are inherited from parents, while a minority attributed them to evil spirits. Most (16/23) will not refer cases to a health facility because they believe in the efficacy of their herbal remedies. The few that did refer did so after several stages of traditional treatment, which resulted in long delays of about two weeks before appropriate treatment was received. The fact that traditional healers are important providers of treatment for severe malaria, especially convulsions, underlines the need to enlist their support in efforts to improve referral practices for severe malaria.

Zinc and infection: a review.

Dietary zinc deficiency is widespread in developing countries and is often aggravated by intercurrent acute and chronic infections. Recent studies have demonstrated that zinc supplementation can significantly reduce the morbidity and mortality of apparently well-nourished children and shorten the time to recovery from acute infectious diseases. This review summarises current knowledge of the role of zinc in childhood diarrhoea, acute respiratory infections and malaria, and its potential role in diseases associated with impaired cellular immunity, namely tuberculosis, lepromatous leprosy and leishmaniasis, and explores avenues for future research.

Beliefs and traditional treatment of malaria in Kishe settlement area, southwest Ethiopia.

Kishe settlement area southwest Ethiopia, is endemic for malaria, and malaria-related morbidity and mortality are important public health problems. Malaria beliefs and practices are often related to culture, and can influence the effectiveness of control strategies. This study assessed attitude and practices relative to causation, treatment, prevention and control of malaria, and documented traditional malaria treatment practices and remedies, in order to provide baseline data for control program planning and further investigation. A cross-sectional study was conducted in December 1997 by interviewing 254 randomly selected study subjects 85 indigenous and 169 settlers. Eighty three percent of 254 respondents attributed the cause of malaria infection to dirt and rubbish. Ranking of vector control measures was poor, with 77% prioritizing cleaning dirt and rubbish, while only 36% mentioned drainage of swampy areas. Ninety eight percent accepted Dichlorodiphenyltrichlroethane (DDT) house spraying. The prevalence of clinical malaria attacks was 77% and communities had good knowledge about malaria morbidity and mortality. Forty three percent had used traditional medicine for malaria, for reasons including greater accessibility (82%), low cost (48%), lack of awareness about modern medicine (25%) and belief that traditional medicine is better (7%). Most are well informed about malaria morbidity and mortality, understood about the use of DDT spraying and have good treatment seeking behavior but practice of prevention and concept about causation prevention, and control of malaria is poor. It is wise to put emphasis on health education particularly on preventive aspects. Malaria control technicians and environmental health technicians, who closely interact with the community could be used for this purpose. The common traditional treatments for malaria could be further investigated for their effects on malaria parasites and/or symptomatic relief of clinical illness.

Effect of iron supplementation on incidence of infectious illness in children: systematic review.

OBJECTIVE: To evaluate the effect of iron supplementation on the incidence of infections in children. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: 28 randomised controlled trials (six unpublished and 22 published) on 7892 children. INTERVENTIONS: Oral or parenteral iron supplementation or fortified formula milk or cereals. OUTCOMES: Incidence of all recorded infectious illnesses, and individual illnesses, including respiratory tract infection, diarrhoea, malaria, other infections, and prevalence of positive smear results for malaria. RESULTS: The pooled estimate (random effects model) of the incidence rate ratio (iron v placebo) was 1.02 (95% confidence interval 0.96 to 1.08, P=0.54; P<0.0001 for heterogeneity). The incidence rate difference (iron minus placebo) for all recorded illnesses was 0.06 episodes/child year (-0.06 to 0.18, P=0.34; P<0.0001 for heterogeneity). However, there was an increase in the risk of developing diarrhoea (incidence rate ratio 1.11, 1.01 to 1.23, P=0.04), but this would not have an overall important on public health (incidence rate difference 0.05 episodes/child year, -0.03 to 0.13; P=0.21). The occurrence of other illnesses and positive results on malaria smears (adjusted for positive smears at baseline) were not significantly affected by iron administration. On meta-regression, the statistical heterogeneity could not be explained by the variables studied. CONCLUSION: Iron supplementation has no apparent harmful effect on the overall incidence of infectious illnesses in children, though it slightly increases the risk of developing diarrhoea.

Treatment of malaria in Ethiopian folk medicine.

Key informant interviews of herbalists were conducted to document the traditional management of malaria in Ethiopia. The perceptions of the cause and symptoms of malaria, the use of plants, their preparation and administration were recorded. Interviews were performed in rural Butajira and Addis Ababa (the main city). The result showed that 33 (75%) of the interviewed healers treat malaria using herbal drugs. Sixteen plants were reported to have been used of which eight were used as a single remedy and the rest as composite remedies with other plants. The ethnopharmacological data generated in this study on antimalarial plants is useful for further evaluations of the traditional claims of antimalarial plants in Ethiopia.

[Malaria in children: links between nutrition and immunity]. / Malaria en niños: relaciones entre nutrición e inmunidad.

OBJECTIVE: To explore some relationships among immunity, nutrition, and malaria in a group of children from a population with a high endemic incidence of malaria. METHODS: This pilot descriptive prospective cross-sectional study was carried out in 1998 in the municipality of El Bagre, Antioquia, Colombia. Both boys and girls were studied in two groups: one group of 51 children had malaria and another group of 49 did not have malaria. The children with malaria had symptoms or signs of malaria and a positive thick blood film. The comparison group of 49 children without malaria (no signs or symptoms of malaria and a negative thick blood film) were chosen at random at government schools or children's centers. For the study the following indices were calculated: weight-for-age, height-for-age, and weight-for-height. Also measured were the blood-serum concentrations of: albumin, prealbumin, apolipoprotein A1 (apoA1), transferrin, zinc, vitamin A, immunoglobulins G and M, interleukin-10 (IL-10), tumor necrosis factor-alpha, interferon-gamma, and lymphocyte populations. RESULTS: Of the children studied, 69% presented some risk of malnutrition, and 63% had some risk of chronic malnutrition. With regard to the immunity and biochemical variables, the children with malaria had less apoA1 and albumin and more IL-10 than did the children without malaria. All the biochemical variables showed lower averages in the group with malaria, risk of malnutrition, and immune or biochemical changes, while all the immunity variables had higher averages in that same group of children. CONCLUSIONS: 1) The high frequency of chronic malnutrition found clearly indicates the need for food supplementation measures. 2) The low values of prealbumin found could be due to the frequent bacterial or viral infections reported. 3) The serious vitamin A deficiency found calls for a supplementation program. 4) An association was found between low apoA1 values and the presence of malaria, but which one follows from the other is not known. 5) No relationship was observed between the anthropometric indicators of risk of malnutrition and the possible biochemical markers of malnutrition. 6) We found high levels of IL-10 in the children with malaria; this is the first time that this has been reported for Plasmodium vivax.

Iron and its relation to immunity and infectious disease.

The continuing unresolved debate over the interaction of iron and infection indicates a need for quantitative review of clinical morbidity outcomes. Iron deficiency is associated with reversible abnormalities of immune function, but it is difficult to demonstrate the severity and relevance of these in observational studies. Iron treatment has been associated with acute exacerbations of infection, in particular, malaria. Oral iron has been associated with increased rates of clinical malaria (5 of 9 studies) and increased morbidity from other infectious disease (4 of 8 studies). In most instances, therapeutic doses of oral iron were used. No studies in malarial regions showed benefits. Knowledge of local prevalence of causes of anemia including iron deficiency, seasonal malarial endemicity, protective hemoglobinopathies and age-specific immunity is essential in planning interventions. A balance must be struck in dose of oral iron and the timing of intervention with respect to age and malaria transmission. Antimalarial intervention is important. No studies of oral iron supplementation clearly show deleterious effects in nonmalarious areas. Milk fortification reduced morbidity due to respiratory disease in two very early studies in nonmalarious regions, but this was not confirmed in three later fortification studies, and better morbidity rates could be achieved by breast-feeding alone. One study in a nonmalarious area of Indonesia showed reduced infectious outcome after oral iron supplementation of anemic schoolchildren. No systematic studies report oral iron supplementation and infectious morbidity in breast-fed infants in nonmalarious regions.