614 Impact of Vitamin A and zinc supplementations on malaria morbidity in Ghana Seth Owusu-Agyei1, Sam Newton1, Emmanuel Mahama1, Lawrence Gyabaa-Febir1, Martha Ali1, Kwame Adjei1, Samuel Kofi Tchum1, Latifa Alhassan1, Thabisile Moleah2, Sherry Tanumihardjo3. Kintampo Health Research Centre, P. O. Box 200 Kintampo Ghana International Atomic Energy Agency, P O Box 100, A-1400, Vienna, Austria University of Wisconsin, Madison USA

Background Malaria is a leading cause of morbidity and mortality among young children and is estimated to cause at least 1 million deaths each year especially among pregnant women and young children under the age of five Vitamin A (VA) supplementation is known to reduce morbidity and mortality in young children. Zinc (Zn) is also required for growth and immunity.

Objectives To determine the effect of VA alone versus VA and Zn supplements on the incidence of clinical malaria and other anthropometric indices To assess the effects of VA alone versus VA and Zn supplements on the incidence of anaemia, diarrhoea and pneumonia

Methods The study was community-based and 200 children between the ages of 6–24 mo were randomised to receive either VA (100,000 IU for infants less than 12 mo & 200,000 IU for children greater than 12 mo and 10 mg daily Zn in the intervention group or VA and Zn placebo for 6 mo in the control group At baseline, socio-demographic information was collected Morbidity data was collected during the study on days 7, 14 and 28 after hospital referral

Methods Cont’d) A baseline and endline blood samples were collected for determination of vitamin A status (VAS)using the modified relative dose response (MRDR) test and Zn analysis The MRDR test involved administering 5.3 μmol 3,4-didehydroretinyl acetate dissolved in corn oil to the child orally after which blood was taken 4–6 hours later using HPLC MRDR values ≥0.060 indicated vitamin A deficiency (VAD) Filter paper for PCR tests for future anti malarial drug resistance analysis using genotyping

Methods (cont’d) VITAMIN A & ZINC GROUP VITAMIN A GROUP 200 RECRUITED CHILDREN 100 BASELINE (M0) ANTHRO HB ,VA, ZN &MPS DONE 8 Children lost to follow up 10 children lost to follow up 92 ENDLINE (M6) HB, VA, ZN &MPS DONE 182 90 7 lost to follow up 8 lost to follow up 85 FINAL (M7) ANTHRO ONLY 167 82

Results . Infant VAS, Zn, haematologic and anaemia indexes at baseline and endline of study Indices Intervention (n = 100) Control (n = 100) P-values Baseline Endline Heamoglobin (g/dl) 10.7 (10.4, 11.0) 10.9 (10.4, 11.0) 10.8 (10.5, 11.2) 10.8 (10.5, 11.0) 0.84 0.93 Aneamia (n%) 28/100 (28.0) 21/88 (23.9 ) 31/100 (31 ) 27/92 (29.4) 0.64 0.69 Low VAS 59/64 (92.2) 45/57 (78.9) 42/47 (89.4) 37/43 (86.1) 0.61 0.36 Adequate VAS 1/64 (1.6) 1/57 (1.8) 0/47 (1.6) 1/43 (2.3) 0.39 Received VA in 6 mo - 96/100 (96.0) 95/100 (95.0) 0.50 Plasma Zn (µ/dl) 81 (72,90) 63 (52, 73) 69 (57, 81) 58 (49, 66) 0.10 0.48

Results The number of children who were diagnosed with uncomplicated malaria in the intervention group were 27% significantly lower compared to the children in the control group (p=0.03). There were, however, no effects on severe malaria, pneumonia, anaemia and diarrhea

Conclusions and Recommendations It was safe to administer VA and Zn to infants as there were no reports of adverse events associated with administering Zn and VA supplements This study revealed the critical role played by micronutrients, such as VA and Zn, in the reduction of clinical attacks of malaria in young children, imposing a huge economic and social burden and any methods that can be used to reduce this burden should be explored.

Acknowledgement Director and staff of Kintampo Health Research Centre , Ghana International Atomic Energy Agency, P O Box 100, A-1400, Vienna, Austria University of Wisconsin, Madison USA Chiefs, elders, opinion leaders and community members from Kintampo North Municipal and South District