1. 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

2. 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.

3. 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

4. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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