CRUN

AWI-Gen

Title Description
Project Title

03 Red EDCTP ok                                                EU flag yellow low ok

“This project is part of the EDCTP2 programme supported by the European Union”

 

Assessment of a combined strategy of seasonal malaria chemoprevention + nutrients and Vitamin A-Zinc supplementation to tackle malaria and malnutrition in Burkina Faso (SMC-NUT)

   

Identity of the Site Study Coordinator

Dr Paul SONDO

   
Summary

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, we hypothesised 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.
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 six months. Anthropometric indicators will be recorded at each visit. Blood samples will be collected for thick and thin film and haemoglobin measurement and spotted onto filter paper for further PCR analyses.
The primary outcome measure will be the incidence of malaria in each group. Secondary outcome measures include mid-upper arm circumference gain, and weight gain from baseline measurements, coverage and compliance to SMC, and prevalence molecular markers of antimalarial resistance Pfcrt, Pfmdr1, Pfdhfr and Pfdhps.
This project will serve as a pilot of an integrated strategy in order to mutualise resources for best impact. By relying on existing strategies, the policy implementation of this joint intervention will be scalable at country and regional levels. The project will allow return of the lead applicant to his home institute and allow translation of skills gained during his clinical research and development fellowship into practice. The project will also offer training opportunities to young scientists, reinforcing the capacity of the Clinical Research Unit of Nanoro.

   
Field of application Malaria, Malnutrition
   
Objectives

Aim 1: To assess the feasibility of combining two different strategies lead by different programmes (malaria and nutrition) which affect the same target population (children under five years). SMC is a larger community-based intervention at a national level lead by the NMCP. National Nutrition Program is trying to scale up the Community Management of Acute Malnutrition (CMAM). This project will serve as a pilot of integrated strategy in order to mutualise resources for best impact. By relying on existing strategies, the policy implementation of this joint intervention will be scalable at country and regional levels.
Aim 2: To boost the impact of SMC intervention in terms of reducing malaria morbidity, mortality and reduce the burden of malnutrition and anaemia in children under five years through supplementation with micronutrients and Vitamin A-Zinc.
Aim 3: To assess the impact of this combined strategy on the circulating parasite population. Sustainability of   SMC efficacy rely on the the sensitivity of the circulating parasite population to Amodiaquine and Sulfadoxine Pyrimethamine. Drug pressure, especially in wide scale community-based intervention such as SMC and intermittent Preventive Treatment (IPT) could lead to a selection of less sensitive mutant strains that could compromise the effectiveness of the intervention in a long-term period. Therefore, the project aims to assess the impact of SMC and the combined strategy on the circulating parasite population.

   
Start Date 10/01/2019
   
Probable End Date 04/30/2022
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