Abstract
BackgroundA recent trial in Burkina Faso and Mali showed that combining seasonal RTS,S/AS01E malaria vaccination with seasonal malaria chemoprevention (SMC) substantially reduced the incidence of uncomplicated and severe malaria in young children compared to either intervention alone. Given the possible negative effect of malaria on nutrition, the study investigated whether these children also experienced lower prevalence of acute and chronic malnutrition.MethodsIn Burkina Faso and Mali 5920 children were randomized to receive either SMC alone, RTS,S/AS01E alone, or SMC combined with RTS,S/AS01E for three malaria transmission seasons (2017–2019). After each transmission season, anthropometric measurements were collected from all study children at a cross-sectional survey and used to derive nutritional status indicators, including the binary variables wasted and stunted (weight-for-height and height-for-age z-scores below − 2, respectively). Binary and continuous outcomes between treatment groups were compared by Poisson and linear regression.ResultsIn 2017, compared to SMC alone, the combined intervention reduced the prevalence of wasting by approximately 12% [prevalence ratio (PR) = 0.88 (95% CI 0.75, 1.03)], and approximately 21% in 2018 [PR = 0.79 (95% CI 0.62, 1.01)]. Point estimates were similar for comparisons with RTS,S/AS01E, but there was stronger evidence of a difference. There was at least a 30% reduction in the point estimates for the prevalence of severe wasting in the combined group compared to the other two groups in 2017 and 2018. There was no difference in the prevalence of moderate or severe wasting between the groups in 2019. The prevalence of stunting, low-MUAC-for-age or being underweight did not differ between groups for any of the three years. The prevalence of severe stunting was higher in the combined group compared to both other groups in 2018, and compared to RTS,S/AS01E alone in 2017; this observation does not have an obvious explanation and may be a chance finding. Overall, malnutrition was very common in this cohort, but declined over the study as the children became older.ConclusionsDespite a high burden of malnutrition and malaria in the study populations, and a major reduction in the incidence of malaria in children receiving both interventions, this had only a modest impact on nutritional status. Therefore, other interventions are needed to reduce the high burden of malnutrition in these areas.Trial registration: https://www.clinicaltrials.gov/ct2/show/NCT03143218, registered 8th May 2017.
Highlights
A recent trial in Burkina Faso and Mali showed that combining seasonal RTS,S/AS01E malaria vaccina‐ tion with seasonal malaria chemoprevention (SMC) substantially reduced the incidence of uncomplicated and severe malaria in young children compared to either intervention alone
Study population A total of 5920 children were enrolled in the study, of whom 1716 (87.3%), 1734 (87.2%) and 1740 (88.5%) children in the SMC alone, RTS,S/AS01E alone or combined groups respectively, had completed their follow-up in March 2020 (Fig. 2)
Changes in nutritional status over time by country Across the three trial groups, the prevalence of malnutrition was generally higher in Burkina Faso than in Mali, but decreased in both countries over the study period (Fig. 3)
Summary
A recent trial in Burkina Faso and Mali showed that combining seasonal RTS,S/AS01E malaria vaccina‐ tion with seasonal malaria chemoprevention (SMC) substantially reduced the incidence of uncomplicated and severe malaria in young children compared to either intervention alone. The malaria burden remains high in sub-Saharan Africa, with an estimated 228 million cases and 602,000 deaths in 2020 [1]. Six of the 10 countries prioritized by the World Health Organization (WHO) ‘High Burden–High Impact’ initiative are in the Sahelian or subSahelian regions of Africa, where malaria transmission is very seasonal and still very high [2]. SMC is estimated to reduce the incidence of clinical malaria in the 28 days following administration by around 70% when effectively deployed [3]. Malaria remains the most frequent cause of death and hospital admissions in young children in many countries where SMC is being implemented, despite high coverage with SMC and insecticide-treated bed nets and good access to effective diagnosis and treatment. Improved use of existing control tools and novel approaches are urgently needed if malaria is to be brought fully under control in these countries
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