@article{Roberts2021-gg,

title = {Seasonal patterns of malaria, genital infection, nutritional and  iron status in non-pregnant and pregnant adolescents in Burkina  Faso: a secondary analysis of trial data},

author = {Stephen A Roberts and Loretta Brabin and Halidou Tinto and Sabine Gies and Salou Diallo and Bernard Brabin},

doi = {10.1186/s12889-021-11819-0},

issn = {1471-2458},

year  = {2021},

date = {2021-09-01},

urldate = {2021-09-01},

journal = {BMC Public Health},

volume = {21},

number = {1},

pages = {1764},

publisher = {Springer Science and Business Media LLC},

abstract = {BACKGROUND: Adolescents are considered at high risk of developing iron deficiency. Studies in children indicate that the prevalence of iron deficiency increased with  malaria transmission, suggesting malaria seasonally may drive iron deficiency. This  paper examines monthly seasonal infection patterns of malaria, abnormal vaginal  flora, chorioamnionitis, antibiotic and antimalarial prescriptions, in relation to  changes in iron biomarkers and nutritional indices in adolescents living in a rural  area of Burkina Faso, in order to assess the requirement for seasonal infection  control and nutrition interventions. METHODS: Data collected between April 2011 and  January 2014 were available for an observational seasonal analysis, comprising  scheduled visits for 1949 non-pregnant adolescents (≤19 years), (315 of whom  subsequently became pregnant), enrolled in a randomised trial of periconceptional  iron supplementation. Data from trial arms were combined. Body Iron Stores (BIS)  were calculated using an internal regression for ferritin to allow for inflammation.  At recruitment 11% had low BIS (\< 0 mg/kg). Continuous outcomes were fitted to a  mixed-effects linear model with month, age and pregnancy status as fixed effect  covariates and woman as a random effect. Dichotomous infection outcomes were fitted  with analogous logistic regression models. RESULTS: Seasonal variation in malaria  parasitaemia prevalence ranged between 18 and 70% in non-pregnant adolescents  (P \< 0.001), peaking at 81% in those who became pregnant. Seasonal variation  occurred in antibiotic prescription rates (0.7-1.8 prescriptions/100 weekly visits,  P \< 0.001) and chorioamnionitis prevalence (range 15-68%, P = 0.026). Mucosal  vaginal lactoferrin concentration was lower at the end of the wet season (range  2-22 μg/ml, P \< 0.016), when chorioamnionitis was least frequent. BIS fluctuated  annually by up to 53.2% per year around the mean BIS (5.1 mg/kg(2), range  4.1-6.8 mg/kg), with low BIS (\< 0 mg/kg) of 8.7% in the dry and 9.8% in the wet  seasons (P = 0.36). Median serum transferrin receptor increased during the wet  season (P \< 0.001). Higher hepcidin concentration in the wet season corresponded  with rising malaria prevalence and use of prescriptions, but with no change in BIS.  Mean Body Mass Index and Mid-Upper-Arm-Circumference values peaked mid-dry season  (both P \< 0.001). CONCLUSIONS: Our analysis supports preventive treatment of malaria  among adolescents 15-19 years to decrease their disease burden, especially  asymptomatic malaria. As BIS were adequate in most adolescents despite seasonal  malaria, a requirement for programmatic iron supplementation was not substantiated.},

note = {© 2021. The Author(s).

PMID: 34579679 

PMCID: PMC8477466},

keywords = {Abnormal vaginal flora, Adolescents, Bacterial vaginosis, Body Mass Index, Burkina Faso/epidemiology, Child, Female, Humans, Iron, iron biomarkers, Malaria, Malaria/drug therapy/epidemiology, MUAC, Pregnancy, Seasons, Vagina},

pubstate = {published},

tppubtype = {article}

}