Background: Malaria and micronutrient deficiencies are
significant public health concerns in tropical regions, particularly among
children.
Objective: To investigate the effect of malaria infection on serum vitamin A
and zinc levels in children living in malaria-endemic areas. Methods: A cross-sectional study
was conducted among 84 children (52 girls and 32 boys) aged 15 years (mean
age 2.6±1.6). Blood samples were collected, and serum vitamin A and zinc
levels were quantified using HPLC and atomic absorption spectrophotometry,
respectively. Results: Malaria patients had
significantly lower serum vitamin A levels (p=0.0388) but similar zinc levels
(p=0.90) compared to healthy controls. Conclusion: Malaria infection is
associated with reduced serum vitamin A levels in children, highlighting the
need for integrated approaches to address both malaria and micronutrient
deficiencies in these regions.
Accepted:10/06/2024
Published:03/07/2024
*Corresponding
Author
Ebisintei Precious
E-mail: sinteiprecious@gmail.com
Keywords: Malaria, Vitamin A, Zinc
INTRODUCTION:
Malaria, a prevalent disease in tropical and subtropical areas, affects
approximately 300-500 million people annually (Hoffman et al., 2002). It causes
an estimated one to three million deaths worldwide, mainly involving children
under five. Malaria is caused by protozoa of the genus Plasmodium, with P.
falciparum being the most severe and deadly species in Africa (WHO, 1996).
Malaria pathogenesis is characterized by extensive changes in biochemical
(micronutrient) and hematological parameters (Bidaki & Dalimi, 2003).
Malaria's impact extends beyond morbidity and mortality, as it also has
significant economic and social consequences. The disease can lead to anemia,
cognitive impairment, and malnutrition, which can further exacerbate its
severity (Menendez et al., 2000). Moreover, malaria can have long-term effects
on children's growth and development, even after treatment (Korenromp et al.,
2004).
Vitamin A and zinc are essential micronutrients that play critical roles in
maintaining immune function, growth, and development. Deficiencies in these
micronutrients can impair immune function, increasing the risk of infections,
including malaria (Scrimshaw et al., 1968). Conversely, malaria can also lead
to reduced levels of vitamin A and zinc, perpetuating a cycle of malnutrition
and infection (Keusch et al., 1998).
This study aims to investigate the impact of malaria infection on serum
vitamin A and zinc levels in children living in malaria-endemic regions.
Understanding the relationship between malaria and micronutrient deficiencies
can inform strategies for malaria prevention and treatment, ultimately
improving the health and well-being of children in these regions.
METHODS:
The study included 84 children (52 girls and 32 boys) aged 15 years (mean
age 2.6±1.6). They were recruited from the outpatient and emergency wards of
the University Teaching Hospital, Okolobiri, Bayelsa State. The group consisted
of 60 malaria-free children matched for age, sex, and socio-economic status.
Blood samples were collected, and serum was obtained by centrifugation. Vitamin
A and zinc levels were quantified using High-Performance Liquid Chromatography
(HPLC) and atomic absorption spectrophotometry, respectively.
RESULTS:
The study included 84 children (52 girls and 32 boys) aged 15 years (mean
age 2.6±1.6). The results showed that:
- Vitamin A levels were significantly lower in malaria patients (mean ± SD: 0.8
± 0.4 μmol/L) compared to healthy controls (mean ± SD: 1.1 ± 0.6
μmol/L) (p = 0.0388).
- Zinc levels did not differ significantly between malaria patients (mean ± SD:
13.7 ± 8.4 μmol/L) and healthy controls (mean ± SD: 14.5 ± 7.5
μmol/L) (p = 0.90).
- The prevalence of vitamin A deficiency (<0.7 μmol/L) was higher in
malaria patients (51.85%) compared to healthy controls (30.64%) (p = 0.0388).
- The prevalence of zinc deficiency (<7.6 μmol/L) did not differ
significantly between malaria patients (27.27%) and healthy controls (16.12%)
(p = 0.3525).
These results indicate that malaria infection is associated with reduced vitamin
A levels and a higher prevalence of vitamin A deficiency in children. In
contrast, zinc levels and the prevalence of zinc deficiency did not differ
significantly between malaria patients and healthy controls.
Table 1: comparing of demographic and Biochemical Parameters
1. Control
2. Malaria cases
|t|
1.338
0.485
2.461
-
P
0.168
0.629
0.016
-
Min.
Max.
Mean± SD
Min.
Max.
Mean ± SD
Age (years)
0.41
5.00
2.2 ± 1.3
0.33
5.00
2.6 ± 1.6
2+
[Zn ] (µmol/I)
1.00
36.64
14.5 ± 7.5
2.00
32.01
13.7 ± 8.4
Vitamin A
(µmol/l)
0.24
3.21
1.1 ± 0.6
0.21
2.06
0.8 ± 0.4
Parasitemia
3
(TPF/mm )
-
-
-
50.00
145000.0
10701.4 ±
31599.9
Table 2: The Range and
mean values of results obtained for the sample population base on the clinical
state of the male subjects
parameter
1. Control
2. Malaria cases
|t|
P
Min.
Max.
Mean ± SD
Min.
Max.
Mean ± SD
Age (years)
0.41
5.00
2.6 ± 1.6
0.66
5.00
2.3 ± 1.4
1.322
0.193
2+
[Zn ]
(µmol/I)
1.00
36.64
14.5.2 ± 7,5
2.01
32.01
13.7±8.4
0.543
0.900
Vitamin A
(µmol/I)
0.37
2.15
1.1 ± 0.6
0.21
1.80
0.8 ± 0.4
2.123
0.0388
Parasitemia
3
(TPF/mm )
-
-
-
100
145000
12372.9±36798.1
-
-
CONTROL
MALARIA CASES
T-test
P-value
Min
max
Mean± SD
Min
Max
Mean± SD
Age (years)
0.41
4.00
2.1±1.3
0.66
5.00
2.3 ± 1.5
0.573
0.569
2+
[Zn ] (µmol/I)
2.00
24.42
13.9 ± 5.9
2.01
32.01
13.6 ± 8.7
0.138
0.891
Vitamin A
(µmol/l)
0.24
3.20
1.0 ± 0.6
0.21
1.80
0.8 ± 0.4
1.404
0.166
Parasitemia
3 (TPF/mm )
-
-
-
50.00
120000
9175.2 ±
26751.1
-
-
Table 3. Frequency distribution of parameters analyzed
Parameters
Subjects
Controls (n = 60)
Fishers Test
N
%
N
%
Age
Less than 1 year
20.96
11
20.37
P = 1.0000
between 1 and 5 years
49
79.03
43
79.62
High (more than1 04 mg/ml)
22
35.48
10
18.51
[Zn2+]
Deficient ( less than 7.6 µmol/l)
10
16.12
15
27.27
P = 0.3525
Normal (between 7.6
and
15.3 µmol/l)
21
33.87
15
27.27
High (more than15.6 µmol/l)
31
50.00
24
44.44
Vitamin A
Deficient (less than 0.70 µmol/l)
19
30.64
28
51.85
P = 0.0388
Normal (more than or equal to 0.70µmol/l)
43
69.35
26
48.14
DISCUSSION:
The study's findings suggest that malaria infection significantly alters
vitamin A levels but not zinc levels in children. This is consistent with
previous research demonstrating the association between malaria and
micronutrient deficiencies (Scrimshaw et al., 1968). The reduced vitamin A
levels in malaria patients may be attributed to several factors, including:
- Increased vitamin A metabolism during inflammation (Thurnham &
Singkamani, 1991)
- Impaired vitamin A absorption due to malaria-induced gastrointestinal damage
(Menendez et al., 2000)
- Enhanced vitamin A catabolism by inflammatory cytokines (Korenromp et al.,
2004)
The lack of significant difference in zinc levels between malaria patients and
controls may indicate that zinc homeostasis is maintained despite malaria
infection. However, this requires further investigation, as zinc deficiency can
still occur due to inadequate dietary intake or malabsorption (Shankar, 2000).
These findings have important implications for public health strategies in malaria-endemic
regions. Vitamin A supplementation programs may need to be integrated into
malaria treatment and prevention initiatives, particularly for children.
Moreover, promoting adequate nutrition and addressing micronutrient
deficiencies can enhance immune function and reduce malaria severity (Keusch et
al., 1998).
The study's limitations include the challenges of blood sample extraction
from children and the need for larger sample sizes to confirm these findings.
Future research should investigate the longitudinal effects of malaria on
micronutrient levels and explore the potential benefits of micronutrient
supplementation in malaria treatment.
CONCLUSION:
In conclusion, this study demonstrates that malaria infection significantly
decreases serum vitamin A levels in children, while zinc levels remain
unaffected. These findings highlight the importance of considering
micronutrient deficiencies in the management and prevention of malaria,
particularly in regions where vitamin A deficiency is prevalent.
The study's results underscore the need for integrated approaches to
address both malaria and micronutrient deficiencies. Vitamin A supplementation
programs may be necessary to mitigate the impact of malaria on vitamin A
levels, especially in children. Moreover, promoting adequate nutrition and
addressing micronutrient deficiencies can enhance immune function and reduce
malaria severity.
The findings of this study contribute to the existing body of knowledge on
the relationship between malaria and micronutrient deficiencies. Future
research should investigate the longitudinal effects of malaria on
micronutrient levels and explore the potential benefits of micronutrient
supplementation in malaria treatment.
Ultimately, this study emphasizes the importance of a comprehensive
approach to addressing malaria and micronutrient deficiencies in children, with
the goal of improving health outcomes and reducing the burden of these
conditions in malaria-endemic regions.
Acknowledgement
I would also like to acknowledge the contributions of Dr. Idams Benedict
and Mr. Alexis Ebikonbowei who have assisted me in various aspects of my
research. Their input and suggestions have been greatly appreciated.
I am grateful for the resources and facilities provided by [University
Teaching Hospital Okolobiri, Bayelsa State that have enabled me to complete my
research.
Lastly, I would like to thank my family and friends for their unwavering
support and encouragement throughout my research journey.
Conflict of
Interest
There are no conflict of interest
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Cite
this Article: Ebisintei,
P; Ebikonbowei, AO; Idam, BU (2024). The Impact of Malaria Infection on Serum
Vitamin A and Zinc Levels in Children in Malaria-Endemic Regions. Greener Journal of Medical Sciences,
14(2): 89-93.
